title: [Safe use of biological therapies for the treatment of rheumatoid arthritis and spondyloarthritides].
abstract: The treatment of autoimmune rheumatic diseases has gradually improved over the last half century, which has been expanded with the contribution of biological therapies or immunobiopharmaceuticals. However, we must be alert to the possibilities of undesirable effects from the use of this class of medications. The Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia/SBR) produced a document based on a comprehensive literature review on the safety aspects of this class of drugs, specifically with regard to the treatment of rheumatoid arthritis (RA) and spondyloarthritides. The themes selected by the participating experts, on which considerations have been established as the safe use of biological drugs, were: occurrence of infections (bacterial, viral, tuberculosis), infusion reactions, hematological, neurological, gastrointestinal and cardiovascular reactions, neoplastic events (solid tumors and hematologic neoplasms), immunogenicity, other occurrences and vaccine response. For didactic reasons, we opted by elaborating a summary of safety assessment in accordance with the previous themes, by drug class/mechanism of action (tumor necrosis factor antagonists, T-cell co-stimulation blockers, B-cell depletors and interleukin-6 receptor blockers). Separately, general considerations on safety in the use of biologicals in pregnancy and lactation were proposed. This review seeks to provide a broad and balanced update of that clinical and experimental experience pooled over the last two decades of use of immunobiological drugs for RA and spondyloarthritides treatment.
authors.affiliation: Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil. Electronic address: liciamhmota@gmail.com.
authors.forename: Licia Maria Henrique da
authors.initials: LM
authors.lastname: Mota
authors.affiliation: Instituto BIOCOR, Belo Horizonte, MG, Brasil.
authors.forename: Bóris Afonso
authors.initials: BA
authors.lastname: Cruz
authors.affiliation: Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
authors.forename: Claiton Viegas
authors.initials: CV
authors.lastname: Brenol
authors.affiliation: Escola Paulista de Medicina, Universidade Federal do Estado de São Paulo, São Paulo, SP, Brasil.
authors.forename: Daniel Feldman
authors.initials: DF
authors.lastname: Pollak
authors.affiliation: Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Geraldo da Rocha Castelar
authors.initials: Gda R
authors.lastname: Pinheiro
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Ieda Maria Magalhães
authors.initials: IM
authors.lastname: Laurindo
authors.affiliation: Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Ivânio Alves
authors.initials: IA
authors.lastname: Pereira
authors.affiliation: Centro Médico Aliança, Salvador, BA, Brasil.
authors.forename: Jozélio Freire de
authors.initials: JF
authors.lastname: Carvalho
authors.affiliation: Faculdade de Ciências Médicas, Hospital de Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
authors.forename: Manoel Barros
authors.initials: MB
authors.lastname: Bertolo
authors.affiliation: Ambulatório de Espondiloartrites e Osteoporose, Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal do Estado de São Paulo, São Paulo, SP, Brasil.
authors.forename: Marcelo de Medeiros
authors.initials: Mde M
authors.lastname: Pinheiro
authors.affiliation: Reumatologista, Fortaleza, CE, Brasil.
authors.forename: Max Victor Carioca
authors.initials: MV
authors.lastname: Freitas
authors.affiliation: Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brasil.
authors.forename: Nilzio Antônio da
authors.initials: NA
authors.lastname: Silva
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Louzada-Júnior
authors.affiliation: Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Percival Degrava
authors.initials: PD
authors.lastname: Sampaio-Barros
authors.affiliation: Seção de Diagnóstico e Terapêutica, Serviço de Reumatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil.
authors.forename: Rina Dalva Neubarth
authors.initials: RD
authors.lastname: Giorgi
authors.affiliation: Hospital Universitário de Brasília, Hospital de Base do Distrito Federal, Brasília, DF, Brasil.
authors.forename: Rodrigo Aires Corrêa
authors.initials: RA
authors.lastname: Lima
authors.affiliation: Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luis Eduardo Coelho
authors.initials: LE
authors.lastname: Andrade
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D001691:Biological Therapy; D006801:Humans; D000069283:Rituximab / Q000627:therapeutic use; D025241:Spondylarthritis / Q000628:therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000069283:Rituximab; D000069594:Abatacept; C502936:tocilizumab
keywords: Artrite reumatoide; Biologicals; Biológicos; Espondiloartrites; Immunobiologicals; Imunobiológicos; Rheumatoid arthritis; Security; Segurança; Spondyloarthritis