Q: 39 years old male with history of severe Crohn's disease was admitted to ICU with shock due to ongoing colonic bleeding. The GI service decided to use an anti-TNF agent. Name a few of the underlying conditions that need to be ruled out?
Answer:
- Any active, uncontrolled infection
- Latent (untreated) tuberculosis (TB)
- Demyelinating disease (e.g., multiple sclerosis, optic neuritis)
- New York Heart Association class III/IV heart failure
- Active lymphoma
- Risk of Hepatitis B and C reactivation
Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) should be checked.
To rule out latent TB, interferon-gamma release assay is preferred.
#pharmacology
References:
1. Chebli JM, Gaburri PD, Chebli LA, da Rocha Ribeiro TC, Pinto AL, Ambrogini Júnior O, Damião AO. A guide to prepare patients with inflammatory bowel diseases for anti-TNF-α therapy. Med Sci Monit. 2014 Mar 26;20:487-98. doi: 10.12659/MSM.890331. PMID: 24667275; PMCID: PMC3972052.
2. Nordgaard-Lassen I, Dahlerup JF, Belard E, Gerstoft J, Kjeldsen J, Kragballe K, Ravn P, Sørensen IJ, Theede K, Tjellesen L; Danish Society for Gastroenterology. Guidelines for screening, prophylaxis and critical information prior to initiating anti-TNF-alpha treatment. Dan Med J. 2012 Jul;59(7):C4480. PMID: 22759856.
3. Gerriets V, Goyal A, Khaddour K. Tumor Necrosis Factor Inhibitors. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482425/
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