The Crohn’s Disease-Ulcerative Colitis Clinical AppraisalPart II

Overall, the most recent evidence indicates that concomitant IMM use does not increase the risk of infections in anti-TNF-treated patients with IBD (Table 1).² Taken together, it appears that most, if not all, of the increased lymphoma risk associated with anti-TNF and immunosuppressant combination therapy may be attributable to the immunosuppressant agent, thiopurine (Table 1).^1,2 In addition, combination therapy may further increase the risk of skin cancer attributed to anti-TNF monotherapy, but this will require further investigation (Table 1).¹⁹

Table 1.

Risk of infections and malignancies associated with combination therapy with an anti-TNF agent and an IMM relative to anti-TNF monotherapy in IBD.^{1, 2, 19}
	Serious infection risk	Lymphoma risk	Skin cancer risk
Anti-TNF monotherapy	Yes	No	Yes for melanoma and probably for NMSC
Combination therapy with thiopurines versus anti-TNF monotherapy	Same	Increased	Increased for NMSC

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