Risk of infection associated with biological agents used for autoimmune inflammatory diseases
The risk of infection associated with immunosuppressive therapies is related to their mechanism of action but establishing a causal relationship is challenging. Tuberculosis screening has been associated with a 7-fold reduction in the risk of activation of latent tuberculosis. For the moment, it is advisable to apply the recommendations for anti-TNF-a therapies to the other biological therapies. Although herpes zoster is one of the most frequent adverse events associated with anti-TNF-a therapies, evidence of a causal relationship is limited, as patients with autoimmune inflammatory diseases are at a higher risk of zoster infection. HBV and HCV screening is recommended. Immunization is recommended in HBsAg-negative patients prior to initiation of a biological therapy, whereas HBsAg-positive patients must receive prophylaxis.
Live attenuated vaccines are contraindicated during the use of biological treatment, and influenza and pneumococcus immunization are recommended for all patients receiving biological therapies. HIV screening, pregnancy testing and assessment of other conditions such as heart failure, cytopenias, interstitial lung disease, demyelinating disease, or tumor disease are recommended prior to the start of the therapy.