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Risks and Side Effects of Medical Therapy

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Abstract

The risks of treatment for inflammatory bowel disease (IBD) are of concern for both patients and providers. Overall, IBD treatments are safe, but there are a range of important potential side effects that need to be discussed with patients. This chapter will review the risks associated with aminosalicylates, corticosteroids, immunomodulators, biologics, and the newer small molecules. In addition to discussing these possible adverse events, guidance is offered on the best methods for communicating these risks to patients.

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References

  • Arnason BGW, Jacobs G, Hanlon M, Clay BH, Noronha ABC, Auty A, Davis B, Nath A, Bouchard JP, Belanger C, Gosselin F (1999) TNF neutralization in MS: results of a randomized, placebo-controlled multicenter study. The Lenercept Multiple Sclerosis Study Group and The University of British Columbia MS/MRI Analysis Group. Neurology 53:457–465

    Article  CAS  Google Scholar 

  • Baecklund E, Askling J, Rosenquist R et al (2004) Rheumatoid arthritis and malignant lymphomas. Curr Opin Rheumatol 16:254–261

    Article  Google Scholar 

  • Beaugerie L, Brousse N, Bouvier AM et al (2009) Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 374:1617–1625

    Article  CAS  Google Scholar 

  • Buchbinder R, Barber M, Heuzenroeder L et al (2008) Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate. Arthritis Rheum 59:794–799

    Article  CAS  Google Scholar 

  • Chung ES, Packer M, Lo KH et al (2003) Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation 107:3133–3140

    Article  CAS  Google Scholar 

  • Colombel JF, Sandborn WJ, Reinisch W et al (2010) Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med 362:1383–1395

    Article  CAS  Google Scholar 

  • Colombel JF, Sands BE, Rutgeerts P et al (2017) The safety of vedolizumab for ulcerative colitis and Crohn’s disease. Gut 66:839–851

    Article  CAS  Google Scholar 

  • Curkovic I, Egbring M, Kullak-Ublick GA (2013) Risks of inflammatory bowel disease treatment with glucocorticosteroids and aminosalicylates. Dig Dis 31:368–373

    Article  Google Scholar 

  • Danese S, Siegel CA, Peyrin-Biroulet L (2014) Review article: integrating budesonide-MMX into treatment algorithms for mild-to-moderate ulcerative colitis. Aliment Pharmacol Ther 39:1095–1103

    Article  CAS  Google Scholar 

  • Dayharsh GA, Loftus EV Jr, Sandborn WJ et al (2002) Epstein-Barr virus-positive lymphoma in patients with inflammatory bowel disease treated with azathioprine or 6-mercaptopurine. Gastroenterology 122:72–77

    Article  CAS  Google Scholar 

  • de Jong DJ, Tielen J, Habraken CM et al (2005) 5-Aminosalicylates and effects on renal function in patients with Crohn’s disease. Inflamm Bowel Dis 11:972–976

    Article  Google Scholar 

  • Dulai PS, Singh S, Jiang X et al (2016) The real-world effectiveness and safety of vedolizumab for moderate-severe Crohn’s disease: results from the US VICTORY consortium. Am J Gastroenterol 111:1147–1155

    Article  CAS  Google Scholar 

  • Ejima-Yamada K, Oshiro Y, Okamura S et al (2017) Epstein-Barr virus infection and gene promoter hypermethylation in rheumatoid arthritis patients with methotrexate-associated B cell lymphoproliferative disorders. Virchows Arch 470:205–215

    Article  CAS  Google Scholar 

  • Farrell RJ, Ang Y, Kileen P et al (2000) Increased incidence of non-Hodgkin’s lymphoma in inflammatory bowel disease patients on immunosuppressive therapy but overall risk is low. Gut 47:514–519

    Article  CAS  Google Scholar 

  • Feagan BG, McDonald JW, Panaccione R et al (2013) Methotrexate in combination with infliximab is no more effective than infliximab alone in patients with Crohn’s disease. Gastroenterology 146(3):681–688

    Article  Google Scholar 

  • Feagan BG, Sandborn WJ, Gasink C et al (2016) Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med 375:1946–1960

    Article  CAS  Google Scholar 

  • Kotlyar DS, Osterman MT, Diamond RH et al (2011) A systematic review of factors that contribute to hepatosplenic T-cell lymphoma in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 9:36–41 e1

    Article  CAS  Google Scholar 

  • Lim WC, Wang Y, MacDonald JK et al (2016) Aminosalicylates for induction of remission or response in Crohn’s disease. Cochrane Database Syst Rev 7:CD008870

    PubMed  Google Scholar 

  • Loftus EV Jr, Kane SV, Bjorkman D (2004) Systematic review: short-term adverse effects of 5-aminosalicylic acid agents in the treatment of ulcerative colitis. Aliment Pharmacol Ther 19:179–189

    Article  CAS  Google Scholar 

  • Long MD, Martin CF, Pipkin CA et al (2012) Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology 143:390–399 e1

    Article  Google Scholar 

  • Magro F, Peyrin-Biroulet L, Sokol H et al (2014) Extra-intestinal malignancies in inflammatory bowel disease: results of the 3rd ECCO Pathogenesis Scientific Workshop (III). J Crohns Colitis 8:31–44

    Article  Google Scholar 

  • Mason M, Siegel CA (2013) Do inflammatory bowel disease therapies cause cancer? Inflamm Bowel Dis 19:1306–1321

    Article  Google Scholar 

  • Meng Y, Dongmei L, Yanbin P et al (2014) Systematic review and meta-analysis of ustekinumab for moderate to severe psoriasis. Clin Exp Dermatol 39:696–707

    Article  CAS  Google Scholar 

  • Osterman MT, Sandborn WJ, Colombel JF et al (2014) Increased risk of malignancy with adalimumab combination therapy, compared with monotherapy, for Crohn’s disease. Gastroenterology 146:941–949

    Article  CAS  Google Scholar 

  • Peyrin-Biroulet L, Khosrotehrani K, Carrat F et al (2011) Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease. Gastroenterology 141:1621–28 e1-5

    Article  CAS  Google Scholar 

  • Present DH (2000) How to do without steroids in inflammatory bowel disease. Inflamm Bowel Dis 6:48–57; discussion 58

    Article  CAS  Google Scholar 

  • Ransford RA, Langman MJ (2002) Sulphasalazine and mesalazine: serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines. Gut 51:536–539

    Article  CAS  Google Scholar 

  • Rutgeerts PJ (2001) Review article: the limitations of corticosteroid therapy in Crohn’s disease. Aliment Pharmacol Ther 15:1515–1525

    Article  CAS  Google Scholar 

  • Rutgeerts P, Lofberg R, Malchow H et al (1994) A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med 331:842–845

    Article  CAS  Google Scholar 

  • Sandborn WJ, Su C, Sands BE et al (2017) Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med 376:1723–1736

    Article  CAS  Google Scholar 

  • Sands BE (2017) Leukocyte anti-trafficking strategies: current status and future directions. Dig Dis 35:13–20

    Article  Google Scholar 

  • Siegel CA (2010) Lost in translation: helping patients understand the risks of inflammatory bowel disease therapy. Inflamm Bowel Dis 16:2168–2172

    Article  Google Scholar 

  • Siegel CA, Sands BE (2005) Review article: practical management of inflammatory bowel disease patients taking immunomodulators. Aliment Pharmacol Ther 22:1–16

    Article  CAS  Google Scholar 

  • Siegel CA, Levy LC, Mackenzie TA et al (2008) Patient perceptions of the risks and benefits of infliximab for the treatment of inflammatory bowel disease. Inflamm Bowel Dis 14:1–6

    Article  Google Scholar 

  • Siegel CA, Marden SM, Persing SM et al (2009) Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn’s disease: a meta-analysis. Clin Gastroenterol Hepatol 7:874–881

    Article  CAS  Google Scholar 

  • Toruner M, Loftus EV Jr, Harmsen WS et al (2008) Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology 134:929–936

    Article  Google Scholar 

  • Van Assche G, Van Ranst M, Sciot R et al (2005) Progressive multifocal leukoencephalopathy after natalizumab therapy for Crohn’s disease. N Engl J Med 353:362–368

    Article  Google Scholar 

  • Vos AC, Bakkal N, Minnee RC et al (2011) Risk of malignant lymphoma in patients with inflammatory bowel diseases: a Dutch nationwide study. Inflamm Bowel Dis 17:1837–1845

    Article  CAS  Google Scholar 

  • Wolfe F, Michaud K (2007) The effect of methotrexate and anti-tumor necrosis factor therapy on the risk of lymphoma in rheumatoid arthritis in 19,562 patients during 89,710 person-years of observation. Arthritis Rheum 56:1433–1439

    Article  CAS  Google Scholar 

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Correspondence to Corey A. Siegel .

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Peterson, T.E., Siegel, C.A. (2019). Risks and Side Effects of Medical Therapy. In: Sturm, A., White, L. (eds) Inflammatory Bowel Disease Nursing Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-75022-4_15

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  • DOI: https://doi.org/10.1007/978-3-319-75022-4_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-75021-7

  • Online ISBN: 978-3-319-75022-4

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