Risk of infections associated with biological treatment in inflammatory bowel disease

Tumor necrosis factor-alpha (TNF-alpha) inhibitors are biological agents introduced in the late 1990s for the treatment of different immune-mediated diseases as inflammatory bowel disease, rheumatoid arthritis and psoriasis. The most commonly used TNF-alpha antagonists are infliximab, adalimumab, and certolizumab pegol, and though highly effective in lowering inflammation, the efficacy must be weighed against the potential for adverse events. The treatment-induced immunosuppression is suspected to increase the risk of infections, including the risk of reactivation of latent tuberculosis, as the TNF-alpha cytokine plays an important role in the immune function. In this topic highlight a short overview of the infection risk associated with TNF-alpha inhibiter therapy is outlined with a focus on the overall risk of serious infections, mycobacterial infection and latent viral infections. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.