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Published on: January 31, 2020
Immune reconstitution inflammatory syndrome associated with biologic therapy
Malika Gupta1, Kashif Jafri, Rebecca Sharim
1Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Biologic drugs can cause opportunistic infections. Stopping these drugs may lead to immune reconstitution inflammatory syndrome (IRIS), a serious condition where the immune system overreacts during recovery from infection.
Area of Science:
- Immunology
- Pharmacology
- Infectious Diseases
Background:
- Biologic therapies have transformed treatment for autoimmune diseases, cancer, and immune disorders.
- A significant drawback of biologics is increased susceptibility to opportunistic infections.
- Immune reconstitution inflammatory syndrome (IRIS) is an emerging risk associated with biologic withdrawal after infection.
Purpose of the Study:
- To highlight the potential risk of IRIS following opportunistic infections in patients using biologic drugs.
- To raise awareness among clinicians about this specific complication of biologic therapy.
Main Methods:
- This review synthesizes current literature on IRIS in the context of biologic use.
- It examines the pathophysiology of IRIS following immune suppression and subsequent immune recovery.
- The review draws parallels between IRIS in HIV patients and potential IRIS in biologic users.
Main Results:
- Opportunistic infections are a known complication of immunosuppression from biologics.
- Withdrawal of biologics can precipitate IRIS as the immune system recovers.
- IRIS presents a significant clinical challenge, mimicking or exacerbating the initial infection.
Conclusions:
- Clinicians must be vigilant for IRIS in patients on biologics who develop opportunistic infections.
- Understanding the mechanism of IRIS is crucial for managing patients on biologic therapies.
- This review emphasizes the need for careful monitoring and management strategies to mitigate IRIS risk.
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