Infectious complications of biological therapy

Although the remarkable efficacy of biological therapy has resulted in significant success in rheumatic disease management, susceptibility to infections remains a concern. Here we review the latest publications on infectious complications of biological therapy in rheumatic diseases.

The recent data on anti-tumor necrosis factor agents show encouraging results in relation to infections. The majority of the infections are minor, and opportunistic infections including tuberculosis are rare. The incidence of infections decreases with time on biologic therapy. Vaccination is effective while on biological agents, although live vaccines should be avoided. Biologic therapy in the setting of HIV, HCV and HBV continues to be studied, but data are accumulating in support of a favorable safety profile. There are degrees of differential susceptibility to infection across the rheumatic diseases, which should be taken into account in weighing the infectious risks of biologics in the respective diseases.

Biological medications have a favorable safety profile but continued vigilance is appropriate. Most infectious reported episodes are minor and the risk of infection appears to decrease with duration of treatment.