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 [II]: Agents targeting interleukins, immunoglobulins and complement factors)

Kevin Winthrop, X. Mariette, J. T. Silva, E. Benamu, L. H. Calabrese, A. Dumusc, J. S. Smolen, J. M. Aguado, M. Fernández-Ruiz

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Background: The present review is part of the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies. Aims: To review, from an Infectious Diseases perspective, the safety profile of agents targeting interleukins, immunoglobulins and complement factors and to suggest preventive recommendations. Sources: Computer-based MEDLINE searches with MeSH terms pertaining to each agent or therapeutic family. Content: Patients receiving interleukin-1 (IL-1) -targeted (anakinra, canakinumab or rilonacept) or IL-5-targeted (mepolizumab) agents have a moderate risk of infection and no specific prevention strategies are recommended. The use of IL-6/IL-6 receptor-targeted agents (tocilizumab and siltuximab) is associated with a risk increase similar to that observed with anti-tumour necrosis factor-α agents. IL-12/23-targeted agents (ustekinumab) do not seem to pose a meaningful risk of infection, although screening for latent tuberculosis infection may be considered and antiviral prophylaxis should be given to hepatitis B surface antigen-positive patients. Therapy with IL-17-targeted agents (secukinumab, brodalumab and ixekizumab) may result in the development of mild-to-moderate mucocutaneous candidiasis. Pre-treatment screening for Strongyloides stercoralis and other geohelminths should be considered in patients who come from areas where these are endemic who are receiving IgE-targeted agents (omalizumab). C5-targeted agents (eculizumab) are associated with a markedly increased risk of infection due to encapsulated bacteria, particularly Neisseria spp. Meningococcal vaccination and chemoprophylaxis must be administered 2-4 weeks before initiating eculizumab. Patients with high-risk behaviours and their partners should also be screened for gonococcal infection. Implications: Preventive strategies are particularly encouraged to minimize the occurrence of neisserial infection associated with eculizumab.

Original languageEnglish (US)
JournalClinical Microbiology and Infection
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Anakinra
  • Brodalumab
  • Canakinumab
  • Eculizumab
  • Infection
  • Ixekizumab
  • Prevention
  • Rilonacept
  • Secukinumab
  • Tocilizumab

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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