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Pudipeddi A, Kariyawasam V, Haifer C, Baraty B, Paramsothy S, Leong RWL. Safety of drugs used for the treatment of Crohn’s disease. Expert Opin Drug Saf 2019; 18:357-367. [PMID: 31026401 DOI: 10.1080/14740338.2019.1612874] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Medications in treating Crohn's disease (CD) have evolved over the last two decades, particularly with the use of biologic agents. There are, however, concerns about the safety and adverse events associated with these medications. The authors review the safety profile of immunosuppressive medications used in Crohn's disease in adult patients. AREAS COVERED The authors performed a literature search until October 2018 to examine safety data on thiopurines, methotrexate, anti-TNFα agents, vedolizumab and ustekinumab. The authors focused on 'trial' and 'real-world' data for the biologic agents. Safety in pregnancy and the elderly are also presented. EXPERT OPINION Available data in CD suggest that immunosuppressive medications are relatively safe, although there are concerns about an elevated risk of serious infections, skin cancer and lymphoma particularly with thiopurines and anti-TNFα agents. Data on vedolizumab and ustekinumab suggest these newer biologic agents are well tolerated; however, longer term data in CD are required to identify risks with extended use. Apart from methotrexate, there appear to be no adverse congenital outcomes with exposure of drugs during pregnancy.
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Affiliation(s)
- Aviv Pudipeddi
- Department of Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Viraj Kariyawasam
- Department of Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Craig Haifer
- Department of Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Brandon Baraty
- Department of Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sudarshan Paramsothy
- Department of Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Rupert WL Leong
- Department of Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
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Richardson SE, Brian D, Grandage V, Hough R, Kottaridis P, Mansour MR, Payne EM, Khwaja A. Intensive Chemotherapy Is Associated With Poor Overall Survival in Autoimmune Disease-associated Myeloid Malignancies. Hemasphere 2019; 3:e164. [PMID: 31723803 PMCID: PMC6745931 DOI: 10.1097/hs9.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Simon E. Richardson
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Duncan Brian
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Victoria Grandage
- Teenage and Young Adult Unit, Department of Hematology, University College London Hospital, London, UK
| | - Rachael Hough
- Teenage and Young Adult Unit, Department of Hematology, University College London Hospital, London, UK
| | | | - Marc R. Mansour
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Elspeth M. Payne
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Asim Khwaja
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
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Li B, Zhu Z, Long S, Li F, Zhu X, Liao W. Acute Myeloid Leukemia with Myelodysplasia-Related Changes in a Patient with Crohn’s Disease Treated with Immunosuppressive Therapy. Case Rep Oncol 2018; 11:573-576. [PMID: 30186142 PMCID: PMC6120370 DOI: 10.1159/000491573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 11/19/2022] Open
Abstract
We report a case of acute myeloid leukemia with myelodysplasia-related changes in a patient with Crohn's disease. The patient was diagnosed with Crohn's disease at the age of 47 years and was treated with the tumor necrosis factor α inhibitors adalimumab and infliximab, and a short course of azathioprine. Four years later, the patient developed acute myeloid leukemia with myelodysplasia that involved mainly erythropoiesis. Crohn's disease is associated with an increased risk of cancers including hematological malignancies. Cancer surveillance including hematology assessment is warranted to monitor the patients on immunosuppressive therapy.
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Affiliation(s)
- Bowen Li
- The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Zhenhua Zhu
- The First Affiliated Hospital, Nanchang University, Nanchang, China
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Shunhua Long
- The First Affiliated Hospital, Nanchang University, Nanchang, China
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Fei Li
- The First Affiliated Hospital, Nanchang University, Nanchang, China
- Department of Hematology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xuan Zhu
- The First Affiliated Hospital, Nanchang University, Nanchang, China
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Wangdi Liao
- The First Affiliated Hospital, Nanchang University, Nanchang, China
- Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, China
- *Dr. Wangdi Liao, Department of Gastroenterology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi 330006 (China), E-Mail
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