Preparing Patients With Inflammatory Bowel Diseases For Biological Therapies In Clinical Practice

Julio Maria Chebli, Pedro Duarte Gaburri, Lívia de Almeida Costa, Liliana Andrade Chebli, Tarsila Campanha da Rocha Ribeiro, Nayara Peres Aguiar, Carla Malaguti, Maria Cristina Vasconcellos Furtado

Abstract


Biological therapy has revolutionized the treatment of inflammatory bowel disease (IBD). Although greatly effective, theses biologics put the patients at increased risk for developing infusions and paradoxical reactions, infections and some types of cancer as lymphomas, the latter one especially when on combination of biologics and thiopurines. Suitable patient selection, counseling and education are all important items for successful use of the biologics. A comprehensive history to exclude contraindications to this kind of drugs and an emphatic monitoring on guidelines are meaningful steps before starting therapy. Biologics should only be considered if a current evaluation has assured that the patient has active disease. Likewise, it is relevant to exclude disease activity mimickers. To date, biological agents have demonstrated a favorable safety profile in IBD patients. Nonetheless, it is paramount that in clinical practice, commencement of biological therapy be attentively discussed with the patients, widely explaining the potential benefits and risks of such treatment. Before starting biologics use, the patients need to be screened for latent tuberculosis, hepatitis B and C viruses, and HIV infection. Additionally, clinicians must stay vigilant about the risk of infectious tropical diseases reactivation during biological therapy in patients migrating or travelling from tropical endemic areas. Ideally, vaccination status should be checked and updated upon diagnosis of IBD previously immunosuppressant therapy. Current guidelines recommend to IBD adult patients the same routine immunization schedule as for healthy people, strictly avoiding live vaccines during immunosuppressive therapy. Our aim is to review the best strategy to provide an updated overview of important steps involved in the preparation of with IBD patients for biological therapy.

Keywords


Inflammatory bowel diseases; Biologics; Immunosuppression; Screening; Immunizations

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