Anti-TNF therapy in inflammatory bowel diseases: a huge review

Anti-tumour necrosis factor-alpha (TNF-a) agents have changed the way of treating inflammatory bowel diseases (IBD) refractory to conventional medications (corticosteroids, immu-nomodulators). Infliximab, adalimumab, and certolizumab are more effective than placebo for induction and maintenance of remission in luminal Crohn's disease. Infliximab and adalimumab are also effective for maintenance of fistula closure in Crohn's disease. Only infliximab is Food and Drug Administration (FDA)-approved for ulcerative colitis. Only adalimumab has demonstrated its efficacy in a randomized controlled trial to induce remission after infliximab failure in Crohn's disease. Anti-TNF therapy leads to mucosal healing, reduces hospitalizations and surgeries, and improves patients' quality of life. Safety data indicate that serious infections occur in 2-4% of patients treated with anti-TNF therapy, with no statistical difference when compared to controls. The risk of rare events such as malignancies and lymphoma, in IBD patients treated with anti-TNF agents, will require a longer duration of follow-up. Currently, the risk-benefit ratio of anti-TNF therapy supports its use in IBD. Several questions remain to be answered: can an indiscriminate use of anti-TNF agents modify the natural course of the disease, should mucosal healing be used in clinical practice, and should anti-TNF therapy be used alone or in combination with immunomodulators in the long-term?