Abstract
The clinical need for better treatments as well as the significant progress in understanding the pathophysiology of inflammation on one hand, and the progressive development of biotechnology on the other, were the driving force for the emergence of new treatments for autoimmune disorders at the beginning of the 21st century, heralding the ‘age of biologic response modifying agents’ or biologics. This new class of drugs, although in use for just over a decade, has revolutionized the treatment of many inflammatory disorders, such as rheumatic, connective tissue disorders, autoimmune and autoinflammatory diseases. They have already made an immense impact on the quality of life of patients experiencing many years of combined immunosuppressive and anti-inflammatory treatments for chronic and often debilitating diseases. As these drugs were developed with the aim of altering specific components in the immune system function and, in particular, the inflammatory response, it is not surprising that infectious complications, including the severe and unusual, are among the serious side effects alongside other features of dysregulated immune system function, such as autoimmunity, lymphoproliferation and malignancy. The aim of this article is to highlight and anticipate further the infectious risks of the most commonly used biologics in children.
Acknowledgements
This manuscript is based on M Abinun‘s presentation (Invited lecture) to the European Society for Pediatric Infectious Diseases (ESPID), 28th Annual Meeting Opening Session, Nice, France on 5th May 2010.
Financial & competing interests disclosure
The author has 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.
No writing assistance was utilized in the production of this manuscript.
Notes
†Very rarely used, mainly as part of the immunosuppressive conditioning regimen in autologous hematopoietic stem cell transplantation.
†All patients should have: thorough history prior to initiating therapy; close monitoring for signs and symptoms of active TB (especially if traveled to countries with a high prevalence of TB or if in close contact with a person with active TB).
‡For patients with rheumatoid arthritis, Crohn‘s disease, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, plaque psoriasis (NB: patients with Crohn‘s disease, rheumatoid arthritis or plaque psoriasis, particularly those with highly active disease and/or chronic exposure to immunosuppressants, may be at a higher risk [up to several-fold] than the general population for the development of lymphoma, even in the absence of TNF-blocking therapy).
SEER: Surveillance Epidemiology and End Results.
Data taken from Citation[7].