Viral infections in the biologic therapy era

ABSTRACT

Introduction: The development of biologic therapies for treating patients with rheumatic, hematologic, or oncological diseases has increased in the last few years, spreading their use in clinical practice.

Areas covered: Clinical experience has evidenced substantial risks for some viral infections and/or reactivations such as viral hepatitis, herpetic infections, and other viruses, as a consequence of specific immune pathway blockages. Biological therapies produce a variable risk of reactivation of viral infections, which is particularly uncertain in the case of the most recently introduced agents. Here we make an extensive review of the viral infections associated with the use of biological drugs and provide a series of recommendations for its prevention and management.

Expert commentary: To prevent these infections/reactivations, the practitioner must be aware of the infection-risk profile, performing accurate screening during and after the use of any biologic agent. In some instances, expert recommendations are made for some therapies, while in other scenarios recommendations have not yet been defined making experimental and clinical research an essential approach to elucidate multiple issues yet not resolved in this field.

KEYWORDS:

• Viruses
• infection
• biological therapy
• immunosuppression
• risk

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research was supported by “Plan Nacional de I+D+I” and Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias [FIS] 12/02269 and Proyecto Integrado de Excelencia [PIE] 13/00045), Subdirección General de Redes y Centros de Investigación Cooperativa, the Spanish Ministry of Economy and Competitiveness, and the Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), and was co-financed by the European Development Regional Fund (EDRF) ‘A way to achieve Europe’. M.F.R. holds a ‘Juan Rodés’ (JR14/00036) clinical research contract with the Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness.