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Stopping, continuing, or restarting immunomodulators and biologics when an infection or malignancy develops
Jason M Swoger1, Miguel Regueiro
1Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Inflammatory Bowel Diseases
|March 22, 2014
Summary
Thiopurines and biologics are increasingly used for inflammatory bowel disease. This review offers guidance on managing infections and cancers by advising when to stop or restart these immunosuppressants.
Area of Science:
- Gastroenterology and Hepatology
- Immunosuppressive Therapy
- Inflammatory Bowel Disease Management
Background:
- Thiopurines and biologics are frequently used for Crohn's disease and ulcerative colitis.
- While generally well-tolerated, these immunosuppressants carry risks of serious infections and cancers.
- Clinical guidance is lacking on managing treatment complications.
Purpose of the Study:
- To review infectious and malignant complications associated with thiopurine and biologic therapy.
- To provide evidence-based recommendations for continuing, stopping, and restarting these medications.
- To aid physicians in managing treatment-related adverse events in IBD patients.
Main Methods:
- Literature review of infectious and malignant complications.
- Analysis of data to inform management strategies.
- Development of recommendations for clinical practice.
Main Results:
- Identified key infectious and malignant risks associated with thiopurines and biologics.
- Outlined criteria for medication cessation and reintroduction.
- Emphasized the need for individualized patient care.
Conclusions:
- Physicians need clear guidance on managing complications from thiopurines and biologics.
- Recommendations support informed decision-making for IBD treatment.
- This review aims to supplement, not replace, clinical judgment.
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