Risks associated with biologic therapy in IBD

Dr John Marshall is a professor and director in the Division of Gastroenterology at McMaster University and editor in chief of the Journal of the Canadian Association of Gastroenterology.

What are the risks associated with biologic therapy in patients with inflammatory bowel disease (IBD)? Can they be avoided?

John Marshall, MD, MSc: In general, I would say that the safety of biologics has been surprisingly good. If you had asked me that question 20 years ago, I would have had much more concern about long-term safety. In general, there is not a lot of specific monitoring that is required in patients on biologics, although we do the usual things to monitor the underlying disease activity.

First, complications of the biologics themselves are, I think, relatively infrequent. Depending on class, there is, of course, an increase in the risk of infection, so I think that [we should perform] just a general health check-up when we see these patients to monitor those sorts of things. We do advise patients to report to us or to their primary health provider any symptoms that could be suggestive of infection. There is not much proactive monitoring required to look for those things.

I think the only small concerning signal with biologics is that it seems from a couple of studies that there may be a very small increase in the risk of melanoma with anti–tumor necrosis factor (TNF) therapy. I do not know if that requires different monitoring but I think being aware of that and having an index of suspicion for that would be important.

There is a warning on anti-TNF therapy with respect to lymphoma, but the data are really difficult to interpret. I do not think they have really shown an independent risk of anti-TNF therapy with respect to lymphoma.