Second Austrian Consensus On The Safe Use Of Anti-Tnf Alpha-Antibodies In Patients With Inflammatory Bowel Diseases

Anti-TNF alpha-antibodies have revolutionized the therapy of inflammatory bowel diseases and other immune-mediated inflammatory diseases. Due to the increasing application of these substances, the Working Group of Inflammatory Bowel Diseases of the Austrian Association of Gastroenterology and Hepatology intended to update their consensus report on the safe use of Infliximab (published in 2010) and to enlarge its scope to cover all anti-TNF alpha-antibodies. The present consensus report summarizes the current evidence on the safe use of anti-TNF alpha-antibodies and covers the following topics: general risk of infection, bacterial infections (i.e., Clostridium difficile, Tuberculosis, food hygiene), Pneumocystis jiroveci, viral infections (i.e., Hepatitis B, Hepatitis C, HIV, CMV, VZV), vaccination in general and recommendation for vaccines, gastrointestinal aspects (i.e., perianal fistula, abdominal fistula, intestinal strictures, stenosis and bowel obstruction), dermatologic aspects (skin malignancies, eczema-like drug-related skin eruption), infusion reactions and immunogenicity, demyelinating diseases, hepatotoxicity, haematotoxicity, congestive heart failure, risk and history of malignancies, and pregnancy and breast feeding. For practical reasons, the relevant aspects are summarized in a checklist which is divided into two parts: issues to be addressed before therapy and issues to be addressed during therapy.