title: Risk of infections of biological therapies with accent on inflammatory bowel disease.
abstract: BACKGROUND
  Biological therapies using anti-tumor necrosis factor (TNF)-α agents have an important impact in the treatment of inflammatory bowel disease, rheumatoid arthritis, psoriasis, and other inflammatory conditions. However, a significant number of patients lose their response to these medications over time. Clinical trials have demonstrated that antibodies against anti-TNF agents may impact treatment response and increase the risk of infusion reactions. Of concern is also the possibility of developing adverse events induced by anti-TNF agents. The purpose of the present systematic review is to describe the current knowledge on the risk of infections associated with anti-TNF agents antagonists, as well as integrin antagonists. We also intend to describe case reports of these adverse events in inflammatory bowel disease patients.
  
  
  METHODS
  Currently approved anti-TNF biologicals in IBD include the monoclonal antibodies infliximab, adalimumab, certolizumab pegol and golimumab. Integrin antagonists include natalizumab, etrolizumab and vedolizumab.
  
  
  RESULTS
  The most frequently-reported adverse events of these biologicals were infections, and these are described in detail in this study.
  
  
  CONCLUSIONS
  Most adverse events are due to the failure of host immunological control, which involves de novo infection, or reactivation of latent bacterial or viral infection, often with a different expression of disease.
  
  
  CONCLUSIONS
  Risk assessment in individuals undergoing treatment with biologicals represents a step towards achieving treatment personalization to identify those patients that will safely benefit from this therapeutic approach. Patients and physicians must be alert for anti-TNF agents and anti-integrin medication as potential causes of drug-induced infections and monitor the therapies. Personalizing therapeutic vigilance promises to optimize benefits while minimizing infections.
authors.affiliation: Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, and In Vitro Drug Safety and Biotechnology.
authors.forename: Radu M
authors.initials: RM
authors.lastname: Nanau
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Cohen
authors.forename: Manuela G
authors.initials: MG
authors.lastname: Neuman
mesh_terms: D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000503:physiopathology; D016023:Integrins / Q000037:antagonists & inhibitors; D018570:Risk Assessment; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D007155:Immunologic Factors; D016023:Integrins; D014409:Tumor Necrosis Factor-alpha