Overall and comparative safety of biologic and immunosuppressive therapy in inflammatory bowel diseases

Holmer A1, Singh S1,2. Expert Rev Clin Immunol. 2019 Jul 19. doi: 10.1080/1744666X.2019.1646127. [Epub ahead of print]


Author information

a Division of Gastroenterology , University of California San Diego , La Jolla , California , USA.

b Division of Biomedical Informatics , University of California San Diego , La Jolla , California , USA.


Introduction: Efficacy and safety are key aspects when choosing therapies for patients with inflammatory bowel diseases (IBD). While several randomized trials and indirect comparisons have informed the comparative efficacy of medications, there has been limited synthesis of safety of different agents. Areas covered: We focus on the overall and comparative risk of serious and opportunistic infections and malignancy of biologic and immunosuppressive therapy in IBD, based on randomized trials, open-label extension and registry studies and real-world comparative observational studies. Expert opinion: Comparative safety of pharmacotherapy for IBD should be viewed in conjunction with efficacy and in the context of treatment strategies/approach, rather than in the context of specific agents used. TNFα antagonists may be more immunosuppressive than non-TNF-targeted biologic agents, and increase the risk of systemic infections. Most consistent risk factors for serious infections include use of combination therapy with immunosuppressive agents and/or corticosteroids, moderate to severe disease activity, and older age. TNFα antagonists may also be associated with an increased risk of lymphoma, especially when combined with thiopurines. Real-world comparative safety studies, especially with newer biologic agents, are warranted to inform decision making.

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