Anti-TNF Treatment in Crohn’s Disease Complicated by Intra-abdominal Abscess

Abstract

Excess production of TNF-α leads to chronic inflammation and tissue damage in immune-mediated inflammatory diseases (IMID) such as Crohn’s Disease (CD), rheumatoid arthritis, and psoriasis. The introduction of anti-TNF agents revolutionised therapy for patients with IMIDs, and two anti-TNFs are currently approved for use in CD in Europe: infliximab and adalimumab. The chronic transmural inflammation associated with CD commonly leads to intestinal complications such as intra-abdominal abscesses, which present a challenge to a multidisciplinary medical team. While surgical management may ultimately be required in some patients, it is associated with a risk of morbidity and loss of function, particularly in a patient who requires immunosuppression to address their underlying CD. This mini review summarises the current evidence surrounding the use of anti-TNFs in CD complicated by intra-abdominal abscess, including current treatment guidelines, the use of anti-TNFs in combination with conservative (non-surgical) management, and the impact of anti-TNFs on post-operative complications and abscess recurrence.