4.7 Review

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)

Journal

CLINICAL MICROBIOLOGY AND INFECTION
Volume 24, Issue -, Pages S21-S40

Publisher

ELSEVIER SCI LTD
DOI: 10.1016/j.cmi.2018.02.002

Keywords

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

Funding

  1. Plan Nacional de I+D+I 2013-2016
  2. Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Spanish Ministry of Economy and Competitiveness, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0002, REIPI RD16/0016/0008]
  3. European Development Regional Fund (EDRF) A way to achieve Europe
  4. Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness [JR14/00036]

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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-alpha 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. Pretreatment 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. (c) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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