New immunosuppressive agents and risk for invasive fungal infections

Increased numbers of invasive fungal infections (IFI) were reported in patients treated with newer immunosuppressive drugs such as tumor necrosis factor (TNF)-alpha antagonists, the anti-CD52 antibody alemtuzumab, or the interleukin-2 receptor antibody basiliximab. These drugs are administered to patients who have autoimmune inflammatory diseases and lymphoid malignancies, or are recipients of solid organ or allogeneic hematopoietic stem cell transplants. IFI risk is higher in patients receiving TNF-alpha blockers or alemtuzumab late in the course of disease and in those with a history of IFI. Incidence and mortality rates of IFI are confounded by frequent, multiple comedications, heterogeneous definitions for IFI, and a presumed reporting bias. For filamentous molds and endemic fungal infections, different regional prevalence rates must be considered. Generally, invasive infections are more frequent among these groups and thus are important considerations in the management of patients receiving these immunosuppressive drugs.