title: Managing the risks of immunosuppression.
abstract: OBJECTIVE
  New immunomodulating approaches to neuroinflammatory diseases present new challenges in clinical risk management. We review recent data on immunosuppression in diverse settings to guide the assessment and prevention of adverse effects from these therapies with the aim of improving the benefit to risk equation.
  
  
  RESULTS
  Although individual immunomodulatory agents affect the immune system in different ways, there are common themes in patient risk. Impairment of immunity is primarily responsible for an increased risk of a characteristic spectrum of infection-related cancers in immunocompromised patients. Additional themes include the reactivation of existing infections such as herpes viruses, mycobacterial and JC virus infections, vaccine preventable disease, cardiovascular and metabolic risk and immune dysregulation resulting in autoimmune and immune reconstitution inflammatory syndromes. An online immunosuppression screening tool may help reduce omissions in individual patient-specific risk assessment.
  
  
  CONCLUSIONS
  Systematic patient-tailored risk management protocols will be required to ensure reduction in preventable adverse outcomes with new immunomodifying approaches to neuroinflammatory disease and thereby optimize the benefits to patients from these treatments.
authors.affiliation: Department of Immunology, Concord Hospital, Concord, Sydney, New South Wales, Australia. sean.riminton@email.cs.nsw.gov.au
authors.forename: D Sean
authors.initials: DS
authors.lastname: Riminton
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hartung
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Reddel
mesh_terms: D002318:Cardiovascular Diseases / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use*; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007239:Infections / Q000276:immunology; D009369:Neoplasms / Q000276:immunology; D012308:Risk Management
chemical_list: D007155:Immunologic Factors