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Review

Prevention Strategies to Minimize the Infection Risk Associated with Biologic and Targeted Immunomodulators

, , ORCID Icon &
Pages 513-532 | Published online: 18 Feb 2020

References

  • Morrow TH, Felcone LH. Defining the difference: what makes biologics unique. Biotechnol Healthc. 2004;1(4):24–29.
  • Ferguson FM, Gray NS. Kinase inhibitors: the road ahead. Nat Rev Drug Discov. 2018;17(5):353–377. doi:10.1038/nrd.2018.2129545548
  • Bresnihan B, Cunnane G. Infection complications associated with the use of biologic immunomodulators. Rheum Dis Clin North Am. 2003;29(1):185–202. doi:10.1016/S0889-857X(02)00101-112635507
  • Meroni PL, Zavaglia D, Girmenia C. Vaccinations in adults with rheumatoid arthritis in an era of new disease-modifying anti-rheumatic drugs. Clin Exp Rheumatol. 2018;36(2):317–328.29303710
  • Henrickson SE, Ruffner MA, Kwan M. Unintended immunological consequences of biologic therapy. Curr Allergy Asthma Rep. 2016;16(6):46. doi:10.1007/s11882-016-0624-727324478
  • Kaplan B, Bonagura VR. Secondary hypogammaglobulinemia: an increasingly recognized complication of treatment with immunomodulators and after solid organ transplantation. Immunol Allergy Clin North Am. 2019;39(1):31–47. doi:10.1016/j.iac.2018.08.00530466771
  • Eisenberg R. Immune Compromise Associated with Biologics. Stiehm’s Immune Deficiencies Academic Press; 2014:889–906.
  • Winthrop KL, Mariette X, Silva JT, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infection diseases perspective (Soluble immune effector molecules [II]: agents targeting interleukins, immunoglobulins and complement factors). Clin Microbiol Infect. 2018;24:S21–S40. doi:10.1016/j.cmi.2018.02.00229447987
  • Reinwald M, Silva JT, Mueller NJ, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infection diseases perspective (Intracellular signaling pathways: tyrosine kinase and mTOR inhibitors). Clin Microbiol Infect. 2018;24:S53–70. doi:10.1016/j.cmi.2018.02.00929454849
  • Mikulska M, Lanini S, Gudiol C, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infection diseases perspective (Agents targeting lymphoid cells surface antigens [I]: CD19, CD20 and CD52). Clin Microbiol Infect. 2018;24:S71–S82.29447988
  • Redelman-Sidi G, Michielin O, Cervera C, et al. ESCMID study group for infections in compromised hosts (ESGICH) consensus document on the safety of targeted and biological therapies: an infection diseases perspective (Immune checkpoint inhibitors, cell adhesion inhibitors, sphingosine-1-phosphate receptor modulators and proteasome inhibitors). Clin Microbiol Infect. 2018;24:S95–S107. doi:10.1016/j.cmi.2018.01.03029427804
  • Drgona L, Gudiol C, Lanini S, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infection diseases perspective (Agents targeting lymphoid or myeloid cells surface antigens [II]: CD22, CD30, CD33, CD38, CD40, SLAMF-7 and CCR4). Clin Microbiol Infect. 2018;24:S83–S94. doi:10.1016/j.cmi.2018.03.02229572070
  • Baddley JW, Cantini F, Goletti D, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Soluble immune effector molecules [I]: anti-tumor necrosis factor-α agents). Clin Microbiol Infect. 2018;24:S10–S20. doi:10.1016/j.cmi.2017.12.02529459143
  • Baden LR, Swaminathan S, Angarone M, et al. Prevention and treatment of cancer-related infections, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14(7):882–913. doi:10.6004/jnccn.2016.009327407129
  • Kotton CN, Kumar D, Caliendo AM, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102(6):900–931. doi:10.1097/TP.000000000000219129596116
  • Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2013;58(3):e44–e100.24311479
  • Martin SI, Fishman JA, AST Infection Diseases Community of Practice. Pneumocystis pneumonia in solid organ transplantation. Am J Transplant. 2013;13(s4):272–279. doi:10.1111/ajt.2013.13.issue-s423465020
  • Van Assen S, Elkayam O, Agmon-Levin N, et al. Vaccination in adult patients with auto-immune inflammatory rheumatic diseases: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases. Autoimmun Rev. 2011;10(6):341–352. doi:10.1016/j.autrev.2010.12.00321182987
  • Salinas GF, De Rycke L, Barendregt B, et al. Anti-TNF treatment blocks the induction of T cell-dependent humoral responses. Ann Rheum Dis. 2013;72(6):1037–1043. doi:10.1136/annrheumdis-2011-20127022968102
  • Farraye FA, Melmed GY, Lichtenstein GR, et al. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017;112(2):241. doi:10.1038/ajg.2016.53728071656
  • Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68(1):1–26. doi:10.1002/art.39480
  • Wijetilleka S, Jayne DR, Mukhtyar C, et al. Recommendations for the management of secondary hypogammaglobulinaemia due to B cell targeted immunomodulators in autoimmune rheumatic diseases. Rheumatology. 2018;58(5):889–896. doi:10.1093/rheumatology/key394
  • Mikulska M, Cesaro S, de Lavallade H, et al. Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19(6). doi:10.1016/S1473-3099(18)30601-7
  • Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57(5):1–30.
  • Kroger AT, Duchin J, Vázquez M. General best practice guidelines for immunization. best practices guidance of the advisory committee on immunization practices (ACIP). Available from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. Accessed 129, 2020.
  • Maertens J, Cesaro S, Maschmeyer G, et al. ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother. 2016;71(9):2397–2404. doi:10.1093/jac/dkw15727550992
  • Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148(1):215–219. doi:10.1053/j.gastro.2014.10.03925447850
  • Rieger CT, Liss B, Mellinghoff S, et al. Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors. Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol. 2018;29(6):1354–1365. doi:10.1093/annonc/mdy11729688266
  • Subramanian AK, Theodoropoulos NM. Mycobacterium tuberculosis infections in solid organ transplantation: Guidelines from the infectious diseases community of practice of the American Society of Transplantation. Clin Transplant. 2019 9;33(9):e13513. doi:10.1111/ctr.1351330817030
  • Loomba R, Liang TJ. Hepatitis B reactivation associated with immune suppressive and biological modifier therapies: current concepts, management strategies, and future directions. Gastroenterology. 2017;152(6):1297–1309. doi:10.1053/j.gastro.2017.02.00928219691
  • Ciardi MR, Iannetta M, Zingaropoli MA, et al. Reactivation of hepatitis B virus with immune-escape mutations after ocrelizumab treatment for multiple sclerosis. Open Forum Infect Dis. 2018;6(1):ofy356.30697576
  • Li HR, Huang JJ, Guo HQ, et al. Comparison of entecavir and lamivudine in preventing hepatitis B reactivation in lymphoma patients during chemotherapy. J Viral Hepat. 2011;18(12):877–883. doi:10.1111/j.1365-2893.2010.01386.x21054683
  • Picardi M, Della Pepa R, Giordano C, et al. Tenofovir vs lamivudine for the prevention of hepatitis B virus reactivation in advanced-stage DLBCL. Blood. 2019;133(5):498. doi:10.1182/blood-2018-10-87889230530802
  • Chen YM, Huang WN, Wu YD, et al. Reactivation of hepatitis B virus infection in patients with rheumatoid arthritis receiving tofacitinib: a real-world study. Ann Rheum Dis. 2018;77(5):780–782. doi:10.1136/annrheumdis-2017-21132228663308
  • Göksu SS, Bilal Ş, Coşkun HŞ. Hepatitis B reactivation related to everolimus. World J Hepatol. 2013;5(1):43. doi:10.4254/wjh.v5.i1.4323383366
  • Mizuno S, Yamagishi Y, Ebinuma H, et al. Progressive liver failure induced by everolimus for renal cell carcinoma in a 58-year-old male hepatitis B virus carrier. Clin J Gastroenterol. 2013;6(2):188–192. doi:10.1007/s12328-013-0371-423606919
  • Swan CD, Reid AB. Three cases of presumed pneumocystis pneumonia in patients receiving bortezomib therapy for multiple myeloma. IDCases. 2014;1(3):32–35. doi:10.1016/j.idcr.2014.04.00226955521
  • Wondergem MJ, Grünberg K, Wittgen BP, et al. Interstitial pneumonitis caused by Pneumocystis jirovecii pneumonia (PCP) during bortezomib treatment. Histopathology. 2009;54(5):631–633. doi:10.1111/j.1365-2559.2009.03263.x19302537
  • Tabanor JA, Lakshminarayanan S. Do patients on biologic drugs for rheumatic disease need PCP prophylaxis? Cleve Clin J Med. 2019;86(7):449–453. doi:10.3949/ccjm.86a.1808431291178
  • Mori S, Yoshitama T, Hidaka T, et al. Comparative risk of hospitalized infection between biological agents in rheumatoid arthritis patients: a multicenter retrospective cohort study in Japan. PLoS One. 2017;12(6):e0179179. doi:10.1371/journal.pone.017917928594905
  • Lee R, Nayernama A, Jones SC, et al. Ibrutinib‐associated Pneumocystis jirovecii pneumonia. Am J Hematol. 2017;92(11):E646–E648. doi:10.1002/ajh.2489028815693
  • Noreña I, Fernández-Ruiz M, Aguado JM. Viral infections in the biologic therapy era. Expert. Rev Anti Infect Ther. 2018;16(10):781–791. doi:10.1080/14787210.2018.1521270
  • Carson KR, Focosi D, Major EO, et al. Monoclonal antibody-associated progressive multifocal leucoencephalopathy in patients treated with rituximab, natalizumab, and efalizumab: a Review from the Research on Adverse Drug Events and Reports (RADAR) Project. Lancet Oncol. 2009;10(8):816–824. doi:10.1016/S1470-2045(09)70161-519647202
  • Blankenbach K, Schwab N, Hofner B, et al. Natalizumab-associated progressive multifocal leukoencephalopathy in Germany. Neurology. 2019;92(19):e2232–e2233. doi:10.1212/WNL.000000000000745130952796
  • Siegler JE, Galetta S. Editors’ note: progressive multifocal leukoencephalopathy after fingolimod treatment. Neurology. 2019;92(3):150. doi:10.1212/WNL.000000000000677230643031
  • Lalive PH, Roth S, Du Pasquier R. Reader response: progressive multifocal leukoencephalopathy after fingolimod treatment. Neurology. 2019;92(3):151. doi:10.1212/WNL.0000000000006773
  • Bigaut K, De Seze J, Collongues N. Ocrelizumab for the treatment of multiple sclerosis. Expert Rev Neurother. 2019;19(2):97–108. doi:10.1080/14737175.2019.156128430570368
  • Williamson EM, Berger JR. Diagnosis and treatment of progressive multifocal leukoencephalopathy associated with multiple sclerosis therapies. Neurotherapeutics. 2017;14(4):961–973. doi:10.1007/s13311-017-0570-728913726
  • Ai JW, Zhang S, Ruan QL, et al. The risk of tuberculosis in patients with rheumatoid arthritis treated with tumor necrosis factor-α antagonist: a meta analysis of both randomized controlled trials and registry/cohort studies. J Rheumatol. 2015;42(12):2229–2237. doi:10.3899/jrheum.15005726472414
  • Bongartz T, Sutton AJ, Sweeting MJ, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA. 2006;295(19):2275–2285. doi:10.1001/jama.295.19.227516705109
  • Souto A, Maneiro JR, Salgado E, et al. Risk of tuberculosis in patients with chronic immune-mediated inflammatory diseases treated with biologics and tofacitinib: a systematic review and meta-analysis of randomized controlled trials and long-term extension studies. Rheumatology. 2014;53(10):1872–1885. doi:10.1093/rheumatology/keu17224821849
  • Brassard P, Kezouh A, Suissa S. Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis. 2006;43(6):717–722.16912945
  • Lussana F, Cattaneo M, Rambaldi A, et al. Ruxolitinib‐associated infections: a systematic review and meta‐analysis. Am J Hematol. 2018;93(3):339–347. doi:10.1002/ajh.2497629150886
  • Cantini F, Nannini C, Niccoli L, et al. Risk of tuberculosis reactivation in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis receiving non-anti-TNF-targeted biologics. Mediators Inflamm. 2017;2017:8909834. doi:10.1155/2017/890983428659665
  • Helfrich M, Ison MG. Opportunistic infections complicating solid organ transplantation with alemtuzumab induction. Transpl Infect Dis. 2015;17(5):627–636. doi:10.1111/tid.2015.17.issue-526228653
  • Au WY, Leung AY, Eric WC, et al. High incidence of tuberculosis after alemtuzumab treatment in Hong Kong Chinese patients. Leuk Res. 2008;32(4):547–551. doi:10.1016/j.leukres.2007.06.01017714782
  • Jeon SY, Yhim HY, Lee NR, et al. Everolimus-induced activation of latent Mycobacterium tuberculosis infection in a patient with metastatic renal cell carcinoma. Korean J Intern Med. 2017;32(2):365–368. doi:10.3904/kjim.2015.12126837008
  • Coriat R, Mir O, Ropert S, et al. Reactivation of tuberculosis during temsirolimus therapy. Invest New Drugs. 2011;29(6):1494–1496. doi:10.1007/s10637-010-9487-220623161
  • Guirao-Arrabal E, Santos F, Redel‐Montero J, et al. Risk of tuberculosis after lung transplantation: the value of pretransplant chest computed tomography and the impact of m TOR inhibitors and azathioprine use. Transpl Infect Dis. 2016;18(4):512–519. doi:10.1111/tid.1255527224905
  • Nucci M, Anaissie E. Infections in patients with multiple myeloma in the era of high-dose therapy and novel agents. Clin Infect Dis. 2009;49(8):1211–1225. doi:10.1086/59919119769539
  • Winthrop KL, Yamanaka H, Valdez H, et al. Herpes zoster and tofacitinib therapy in patients with rheumatoid arthritis. Arthritis Rheumatol. 2014;66(10):2675–2684. doi:10.1002/art.v66.1024943354
  • Yun H, Xie F, Delzell E, et al. Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy. Arthritis Care Res (Hoboken). 2015;67(5):731–736. doi:10.1002/acr.2247025201241
  • Arvin AM, Wolinsky JS, Kappos L, et al. Varicella-zoster virus infections in patients treated with fingolimod: risk assessment and consensus recommendations for management. JAMA Neurol. 2015;72(1):31–39. doi:10.1001/jamaneurol.2014.306525419615
  • Buonomo AR, Zappulo E, Viceconte G, et al. Risk of opportunistic infections in patients treated with alemtuzumab for multiple sclerosis. Expert Opin Drug Saf. 2018;17(7):709–717. doi:10.1080/14740338.2018.148333029848085
  • Prestes DP, Arbona E, Nevett-Fernandez A, et al. Dasatinib use and risk of cytomegalovirus reactivation after allogeneic hematopoietic-cell transplantation. Clin Infect Dis. 2017;65(3):510–513. doi:10.1093/cid/cix32528419210
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: remicade. European Medicines Agency EMA/CHMP/47828/2019. Available from: https://www.ema.europa.eu/en/documents/product-information/remicade-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: kineret. Available from: https://www.ema.europa.eu/en/documents/product-information/kineret-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: ilaris ‎EMEA/H/C/001109. Available from: https://www.ema.europa.eu/en/documents/product-information/ilaris-epar-product-information_en.pdf. Accessed 129, 2020.
  • Alten R, Bingham CO, Cohen SB, et al. Antibody response to pneumococcal and influenza vaccination in patients with rheumatoid arthritis receiving abatacept. BMC Musculoskelet Disord. 2016;17(1):231. doi:10.1186/s12891-016-1082-z27229685
  • Chatham W, Chadha A, Fettiplace J, et al. A randomized, open-label study to investigate the effect of belimumab on pneumococcal vaccination in patients with active, autoantibody-positive systemic lupus erythematosus. Lupus. 2017;26(14):1483–1490. doi:10.1177/096120331770349528467293
  • Kaufman M, Pardo G, Rossman H, Sweetser MT, Forrestal F, Duda P. Natalizumab treatment shows no clinically meaningful effects on immunization responses in patients with relapsing-remitting multiple sclerosis. J Neurol Sci. 2014;341(1–2):22–27. doi:10.1016/j.jns.2014.03.03524731783
  • Brodmerkel C, Wadman E, Langley RG, et al. Immune response to pneumococcus and tetanus toxoid in patients with moderate-to-severe psoriasis following long-term ustekinumab use. J Drugs Dermatol. 2013;12(10):1122–1129.24085047
  • Chioato A, Noseda E, Stevens M, et al. Treatment with the interleukin-17A-blocking antibody secukinumab does not interfere with the efficacy of influenza and meningococcal vaccinations in healthy subjects: results of an open-label, parallel-group, randomized single-center study. Clin Vaccine Immunol. 2012;19(10):1597–1602. doi:10.1128/CVI.00386-1222875601
  • Mori S, Ueki Y, Hirakata N, et al. Impact of tocilizumab therapy on antibody response to influenza vaccine in patients with rheumatoid arthritis. Ann Rheum Dis. 2012;71(12):2006–2010. doi:10.1136/annrheumdis-2012-20195022887851
  • Celotto K, Nair J, Lee K. The effect of bortezomib treatment on antibody titers against common viral and vaccine antigens. Clin Lymph Myelom Leuk. 2015;15:e179. doi:10.1016/j.clml.2015.07.402
  • Berger T, Elovaara I, Fredrikson S, et al. Alemtuzumab use in clinical practice: recommendations from European multiple sclerosis experts. CNS Drugs. 2017;31(1):33–50. doi:10.1007/s40263-016-0394-827882532
  • Issa NC, Baden LR. Current issues in vaccines for adult patients with hematologic malignancies. J Natl Compr Canc Netw. 2012;10(11):1447–1454. doi:10.6004/jnccn.2012.014723138170
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: raptiva ‎EMEA/H/C/000542. Available from: https://www.ema.europa.eu/en/documents/product-information/raptiva-epar-product-information_en.pdf. Accessed 129, 2020.
  • De Lavallade H, Khoder A, Hart M, et al. Tyrosine kinase inhibitors impair B-cell immune responses in CML through off-target inhibition of kinases important for cell signaling. Blood. 2013;122(2):227–238. doi:10.1182/blood-2012-11-46503923719297
  • Winthrop KL, Silverfield J, Racewicz A, et al. The effect of tofacitinib on pneumococcal and influenza vaccine responses in rheumatoid arthritis. Ann Rheum Dis. 2016;75(4):687–695. doi:10.1136/annrheumdis-2014-20719125795907
  • Douglas AP, Trubiano JA, Barr I, Leung V, Slavin MA, Tam CS. Ibrutinib may impair serological responses to influenza vaccination. Haematologica. 2017;102(10):e397. doi:10.3324/haematol.2017.16428528659336
  • Struijk GH, Minnee RC, Koch SD, et al. Maintenance immunosuppressive therapy with everolimus preserves humoral immune responses. Kidney Int. 2010;78(9):934–940. doi:10.1038/ki.2010.26920703211
  • Barmettler S, Ong MS, Farmer JR, et al. Association of immunoglobulin levels, infection risk, and mortality with rituximab and hypogammaglobulinemia. JAMA Netw Open. 2018;1(7):e184169. doi:10.1001/jamanetworkopen.2018.416930646343
  • Danovitch GM, editor. Handbook of Kidney Transplantation. Lippincott Williams & Wilkins; 2017 6, 13.
  • Terrault NA, Lok AS, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–1599. doi:10.1002/hep.2980029405329
  • Winthrop KL. Tumor necrosis factor-alpha inhibitors: bacterial, viral, and fungal infections. Bow Blumberg EA, Bond Sh, editors. UpToDate Inc.2019 Available from: https://www.uptodate.com/contents/tumor-necrosis-factor-alpha-inhibitors-bacterial-viral-and-fungal-infections. Accessed 129, 2020.
  • Morrison VA. Prevention of infections in patients with chronic lymphocytic leukemia. Bow E, Throner AR, editors. UpToDate Inc. 2019 Available from: https://www.uptodate.com/contents/prevention-of-infections-in-patients-with-chronic-lymphocytic-leukemia. Accessed 129, 2020.
  • Puzanov I, Diab A, Abdallah K, et al. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J Immunother Cancer. 2017;5(1):95. doi:10.1186/s40425-017-0300-z29162153
  • Fishman JA, Gans H; AST Infectious Diseases Community of Practice. Pneumocystis jiroveci in solid organ transplantation: guidelines from the american society of transplantation infectious diseases community of practice. Clin Transplant. 2019;33:e13587.31077616
  • Casulo C, Maragulia J, Zelenetz AD. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. Clin Lymph Myelom Leuk. 2013;13(2):106–111. doi:10.1016/j.clml.2012.11.011
  • Yilmaz E, Mahani MG, Bilen MA, et al. Clinical characteristics of rituximab-induced late onset neutropenia. Am J Hematol. 2010;85(10):810–812. doi:10.1002/ajh.2181820730791
  • Salmon JH, Cacoub P, Combe B, et al. Late-onset neutropenia after treatment with rituximab for rheumatoid arthritis and other autoimmune diseases: data from the autoimmunity and rituximab registry. RMD Open. 2015;1(1):e000034. doi:10.1136/rmdopen-2014-00003426509060
  • Cohen BA. Late-onset neutropenia following ocrelizumab therapy for multiple sclerosis. Neurology. 2019;92(9):435–436. doi:10.1212/WNL.000000000000692430635476
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: xeljanz EMEA/H/C/004214. Available from: https://www.ema.europa.eu/en/documents/product-information/xeljanz-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: Jakavi - EMEA/H/C/002464. Available from: https://www.ema.europa.eu/en/documents/product-information/jakavi-epar-product-information_en.pdf. Accessed 2 10, 2020.
  • Click B, Regueiro M. Managing Risks with Biologics. Curr Gastroenterol Rep. 2019;21(1):1. doi:10.1007/s11894-019-0669-630635807
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: gilenya EMEA/H/C/002202. Available from: https://www.ema.europa.eu/en/documents/product-information/gilenya-epar-product-information_en.pdf. Accessed 129, 2020.
  • Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(1):39–52. doi:10.1136/annrheumdis-2019-21588231413005
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: humira EMEA/H/C/000481. Available from: https://www.ema.europa.eu/en/documents/product-information/humira-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: enbrel. EMEA/H/C/000262l. Available from: https://www.ema.europa.eu/en/documents/product-information/enbrel-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: Simponi. European Medicines Agency. EMEA/H/C/000992. Available from: https://www.ema.europa.eu/en/documents/product-information/simponi-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: cimzia. EMEA/H/C/001037. Available from: https://www.ema.europa.eu/en/documents/product-information/cimzia-epar-product-information_en.pdf. Accessed 129, 2020.
  • Papp KA, Haraoui B, Kumar D, et al. Vaccination guidelines for patients with immune-mediated disorders on immunosuppressive therapies. J Cutan Med Surg. 2019;23(1):50–74. doi:10.1177/120347541881133530463418
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: regeneron EMEA/H/C/001047. Available from: https://www.ema.europa.eu/en/documents/product-information/rilonacept-regeneron-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP) International non- proprietary name: blincyto EMEA/H/C/003731 https://www.ema.europa.eu/en/documents/product-information/blincyto-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: ocrevus EMA/790835/2017. Available from: https://www.ema.europa.eu/en/documents/product-information/ocrevus-epar-product-information_en.pdf. Accessed 129, 2020.
  • Stokmaier D, Winthrop K, Chognot C, et al. Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis (S36. 002).
  • Beaulieu DB, Ananthakrishnan AN, Martin C, et al. Use of biologic therapy by pregnant women with inflammatory bowel disease does not affect infant response to vaccines. Clin Gastroenterol Hepatol. 2018;16(1):99–105. doi:10.1016/j.cgh.2017.08.04128870657
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: arzerra ‎EMEA/H/C/001131. Available from: https://www.ema.europa.eu/en/documents/product-information/arzerra-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: Gazyvaro - EMEA/H/C/002799. Available from:https://www.ema.europa.eu/en/documents/product-information/gazyvaro-epar-product-information_en.pdf. Accessed 2 5, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: mabcampath‎ EMEA/H/C/000353. Available from: https://www.ema.europa.eu/en/documents/product-information/mabcampath-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: orenica EMEA/H/C/000701. Available from: https://www.ema.europa.eu/en/documents/product-information/orencia-epar-product-information_en.pdf. Accessed 129, 2020.
  • Committee for Medicinal Products for Human Use (CHMP). International non- proprietary name: stelara EMEA/H/C/000958. Available from: https://www.ema.europa.eu/en/documents/product-information/stelara-epar-product-information_en.pdf. Accessed 129, 2020.
  • Danziger Isakov L, Kumar D; AST ID Community of Practice. Vaccination of solid organ transplant candidates and recipients: guidelines from the American society of transplantation infectious diseases community of practice. Clin Transplant. 2019;33:e13563.31002409