Extract

The anti-tumor necrosis factor antibodies (anti-TNF) have had a major impact on the treatment of inflammatory bowel disease (IBD) since their introduction in the late 1990s. Infliximab (IFX),1,2 adalimumab (ADA),3,4 and certolizumab pegol (CZP)5,6 are approved for the treatment of moderate-to-severe Crohn's disease (CD) in the United States, whereas IFX,7 ADA,8 and golimumab (GLM)9,10 are all licensed for the treatment of ulcerative colitis. IFX is administered as an intravenous infusion; ADA, GLM, and CZP are self-injected subcutaneously by the patient. Initial experience with IFX in the treatment of CD highlighted the importance of regular scheduled maintenance therapy over episodic dosing, which was associated with antibody formation and secondary loss of response.11,12

Although effective in treating IBD, all the TNF agents are associated with potential adverse events. Some of the most frequent side effects associated with TNF agents are felt to be immune-mediated and include infusion reactions (IRs), autoimmune reactions, and certain dermatologic reactions. This review discusses the antigenicity of the various anti-TNF but focuses on the diagnosis and management of the most common immune-mediated reactions associated with TNF therapy in patients with IBD, such as IRs, drug-induced lupus erythematosus (DILE), and psoriaform reactions.

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