Serious infections in patients with inflammatory bowel disease receiving anti-tumor-necrosis-factor-alpha therapy: an Australian and New Zealand experience

J Gastroenterol Hepatol. 2010 Nov;25(11):1732-8. doi: 10.1111/j.1440-1746.2010.06407.x.


Background and aim: Anti-tumor-necrosis-factor-alpha (anti-TNF-α) medications are effective in inflammatory bowel disease (IBD), but have an increased risk of tuberculosis (TB) and serious infections. The aim of this study was to examine the Australian/New Zealand experience of serious infections and TB in IBD patients receiving anti-TNF-α therapy from 1999-2009.

Methods: Serious infections, defined as 'requiring hospital admission' and TB cases in patients receiving, or within 3 months following, anti-TNF-α therapy were analyzed across Australia and New Zealand. Patient demographics, IBD medications, duration of anti-TNF-α therapy, and infection details were collected.

Results: A total of 5562 IBD patients were managed across the centers. Of these, 489 (16.8%) Crohn's disease and 137 (5.2%) ulcerative colitis patients received anti-TNF-α therapy. There were three cases of latent TB that received prophylaxis prior to anti-TNF-α therapy. No cases of active TB were reported. Fourteen (2.2%) serious infections occurred. Seven occurred in patients receiving anti-TNF-α therapy for less than 6 months, including two cases of primary Varicella zoster (VZV), two cases of Pneumocystis jiroveci pneumonia, two cases of Staphylococcus aureus bacteremia, and one severe flu-like illness. Six patients were taking additional immunosuppressive medications. The other seven infections occurred after 6 months (mean 32.6 ± 24.3 months) and included one case of primary VZV, one flu-like illness, and five bacterial infections. All infections resolved with treatment.

Conclusion: TB is a very rare complication of anti-TNF-α therapy in Australia and New Zealand. Serious infections are uncommon but early opportunistic infections with Pneumocystis jiroveci pneumonia suggest a need for vigilance in patients on multiple immunosuppressive medications. VZV vaccination prior to immunosuppressive therapy should be considered in VZV-naïve patients.

MeSH terms

  • Adalimumab
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Anti-Inflammatory Agents / adverse effects*
  • Anti-Inflammatory Agents / immunology
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / immunology
  • Antibodies, Monoclonal, Humanized
  • Australia / epidemiology
  • Bacterial Infections / epidemiology
  • Bacterial Infections / microbiology
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Colitis, Ulcerative / drug therapy*
  • Crohn Disease / drug therapy*
  • Female
  • Herpes Zoster / epidemiology
  • Humans
  • Immunocompromised Host
  • Infant
  • Infliximab
  • Male
  • Middle Aged
  • New Zealand / epidemiology
  • Opportunistic Infections / epidemiology*
  • Tuberculosis / epidemiology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Young Adult


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