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Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

Cohn, H. Matthew MD*; Dave, Maneesh MD, MPH*,†; Loftus, Edward V. Jr MD

doi: 10.1097/MIB.0000000000001199
Clinical Review Articles

Abstract: Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine, and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the inflammatory bowel disease population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms.

Article first published online 13 July 2017.

*Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio;

Division of Gastroenterology and Liver Disease, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; and

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Address correspondence to: Edward V. Loftus, Jr, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 (e-mail:

M. Dave is supported by Department of Defense PR141774 and Crohn's and Colitis Foundation of America Career Development Award. H. M. Cohn was supported by the National Institutes of Health Ruth L. Kirschstein National Research Service Award 5 T32 DK 83251 to 5 and the Lansing C. Hoskins Education Research Fund Award.

E. V. Loftus has consulted for AbbVie, UCB, Janssen, Takeda, Bristol-Myers Squibb, Amgen, Eli Lilly, Mesoblast, Salix, Pfizer, Seres Therapeutics, and CVS Caremark. E. V. Loftus has received research support from AbbVie, UCB, Janssen, Takeda, Amgen, Genentech, Gilead, Receptos, Celgene, Seres Therapeutics, Robarts Clinic Trials, MedImmune, and Pfizer. The remaining authors have no conflict of interest to disclose.

Received March 08, 2017

Accepted May 31, 2017

© Crohn's & Colitis Foundation
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