Preparing patients with inflammatory bowel diseases for biological therapies in clinical practice

• Autor(a) principal: Fonseca Chebli, Júlio Maria
• Data de Publicação: 2019
• Outros Autores: da Silva, Raphael José, Gomes Guércio, Bruno, Rocha Couto, Vitor, Sousa Pereira, Maviel, Fernandes Oliveira, Isaac Nilton, Castro de Rezende, Gabriela, Laranjeira Lima, Elaine Jéssica
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: HU Revista (Online)
• Texto Completo: https://periodicos.ufjf.br/index.php/hurevista/article/view/28789
• topic: Inflammatory Bowel Diseases; Immunosuppressive Agents; Biological Therapy; Screening; Immunization; Doenças Inflamatórias Intestinais; Imunossupressores; Terapia Biológica; Rastreio; Imunização

Introduction: 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. Objective: To review a better strategy to show a detailed view of the essential steps in preparing IBD patients for biological therapy. Material and Methods: A systematic literature review was performed in February 2018 using the search terms: "Crohn's disease", "inflammatory bowel disease", "immunization", "immunosuppressants" and "clinical therapy" in English and Portuguese. Only original and review articles were included. Discussion and Conclusion: 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. All these measures are essential to safely establish the expected therapy from the use of biologics.