Adverse events in IBD: to stop or continue immune suppressant and biologic treatment

Expert Rev Gastroenterol Hepatol. 2014 Mar;8(3):223-40. doi: 10.1586/17474124.2014.881715. Epub 2014 Feb 4.


Crohn's disease and ulcerative colitis affect an increasing number of patients. A variety of medical options exist for the treatment of these diseases including immune suppressants and biologic therapies. Unfortunately, these agents are associated with adverse events ranging from mild nuisance symptoms to potentially life-threatening complications including infections and malignancies. This review discusses adverse events associated with azathioprine, mercaptopurine, and methotrexate as well as anti-TNF-α and anti-integrin antibodies. In addition, adverse events associated with combination therapy are discussed as are clinical scenarios in which it may be reasonable to discontinue or de-escalate drug therapy. It is the responsibility of the treating gastroenterologist to effectively communicate the benefits and risks of therapy with patients; this review offers strategies that may assist providers in communicating risk with patients in addition to offering our perspective on whether modification or cessation of therapy can be considered.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Antibodies, Anti-Idiotypic / adverse effects
  • Antibodies, Anti-Idiotypic / therapeutic use
  • Azathioprine / adverse effects
  • Azathioprine / therapeutic use
  • Biological Products / adverse effects*
  • Biological Products / therapeutic use*
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use*
  • Inflammatory Bowel Diseases / drug therapy*
  • Integrins / antagonists & inhibitors
  • Mercaptopurine / adverse effects
  • Mercaptopurine / therapeutic use
  • Methotrexate / adverse effects
  • Methotrexate / therapeutic use
  • Risk Assessment
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Withholding Treatment


  • Antibodies, Anti-Idiotypic
  • Biological Products
  • Immunosuppressive Agents
  • Integrins
  • Tumor Necrosis Factor-alpha
  • Mercaptopurine
  • Azathioprine
  • Methotrexate