Safety of anti-tumor necrosis factor therapy in inflammatory bowel disease

World J Gastroenterol. 2009 May 7;15(17):2067-73. doi: 10.3748/wjg.15.2067.


Inflammatory bowel disease (IBD), in particular Crohn's disease refractory to conventional therapy, fistulizing Crohn's disease and chronic active ulcerative colitis, generally respond well to anti-tumor necrosis factor (TNF) therapy. However, serious side effects do occur, necessitating careful monitoring of therapy. Potential side effects of anti-TNF therapy include opportunistic infections, which show a higher incidence when concomitant immunosuppression is used. Furthermore, antibody formation against anti-TNF is associated with decreased efficacy and an increased frequency of infusion reactions. The hypothesis of a slightly increased risk of lymphomas in IBD patients treated with anti TNF-therapy is debatable, since most studies lack the specific design to properly address this issue. Alarmingly, the occurrence of hepatosplenic T-cell lymphomas coincides with combined immunosuppressive therapy. Despite the potential serious side effects, anti-TNF therapy is an effective and relatively safe treatment option for refractory IBD. Future research is needed to answer important questions, such as the long-term risk of malignancies, safety during pregnancy, when to discontinue and when to switch anti-TNF therapy, as well as to determine the balance between therapeutic and toxic effects.

Publication types

  • Editorial
  • Review

MeSH terms

  • Anti-Inflammatory Agents* / adverse effects
  • Anti-Inflammatory Agents* / therapeutic use
  • Antibodies / adverse effects
  • Antibodies / immunology
  • Antibodies / therapeutic use*
  • Antibodies, Monoclonal* / adverse effects
  • Antibodies, Monoclonal* / therapeutic use
  • Autoimmunity / immunology
  • Female
  • Gastrointestinal Agents* / adverse effects
  • Gastrointestinal Agents* / therapeutic use
  • Humans
  • Immunotherapy* / adverse effects
  • Immunotherapy* / statistics & numerical data
  • Inflammatory Bowel Diseases* / drug therapy
  • Inflammatory Bowel Diseases* / immunology
  • Infliximab
  • Pregnancy
  • Tumor Necrosis Factor-alpha / immunology*


  • Anti-Inflammatory Agents
  • Antibodies
  • Antibodies, Monoclonal
  • Gastrointestinal Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab