Anti-TNF Therapy May Increase Risk for IBD

Although uncommon, new-onset inflammatory bowel disease (IBD) may be an adverse side effect of the anti-tumor necrosis factor-α (anti-TNF-α) therapy etanercept (ETN), according to a recent literature review.

Anti-TNF-α therapy is the most prescribed biologic therapy in rheumatology and gastroenterology. However, several serious side effects have been reported with use. Adverse effects reported include new-onset IBD, mostly in children with juvenile idiopathic arthritis (JIA).
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The literature review included data from 137 articles, including 11 articles and 4 cited publications, found via PubMed MESH. In their analysis, the researchers noted 53 cases of IBD reported after anti-TNF-α therapy, most of which were case series collected retrospectively from national databases or studies.

Results of the review indicated that almost all patients, including 2 patients with rheumatoid arthritis, introduced to ETN had developed IBD subsequently. The median age of IBD onset was 17.3 years, and the average time from ETN initiation to IBD onset was 27 months. Most of the patients who had discontinued ETN reported improving or subsiding gastrointestinal symptoms.

“Although this manifestation is not common, it should be taken into consideration as an adverse effect of ETN,” the researchers concluded. “Rheumatologists, and in particular rheumatologists treating adult patients, should be aware of this possible complication. Further investigation about the pathogenic process underlying this phenomenon is warranted.”

—Christina Vogt

Reference:

Bieber A, Fawaz A, Novofastovski I, Mader R. Antitumor necrosis factor-α therapy associated with inflammatory bowel disease: three cases and a systematic literature review. J Rheumatol. 2017;44(7):1088-1095. doi:10.3899/jrheum.160952.