Biological agents and respiratory infections: Causative mechanisms and practice management.
Biological agents are increasingly being used to treat patients with immune-mediated inflammatory disease. In Japan, currently approved biological agents for patients with rheumatoid arthritis (RA) include tumor necrosis factor inhibitors, interleukin-6 receptor-blocking monoclonal antibody, and T-cell costimulation inhibitor. Rheumatologists have recognized that safety issues are critical aspects of treatment decisions in RA. Therefore, a wealth of safety data has been gathered from a number of sources, including randomized clinical trials and postmarketing data from large national registries. These data revealed that the most serious adverse events from these drugs are respiratory infections, especially pneumonia, tuberculosis, nontuberculous mycobacteriosis, and Pneumocystis jirovecii pneumonia, and that the most common risk factors associated with these respiratory infections are older age, concomitant corticosteroid use, and underlying respiratory comorbidities. Because of this background, in 2014, the Japanese Respiratory Society published their consensus statement of biological agents and respiratory disorders. This review summarizes this statement and adds recent evidence, especially concerning respiratory infections in RA patients, biological agents and respiratory infections, and practice management of respiratory infections in patients treated with biological agents. To decrease the incidence of infections and reduce mortality, we should know the epidemiology, risk factors, management, and methods of prevention of respiratory infections in patients receiving biological agents.
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama 360-0105, Japan. Electronic address: takayanagi.noboru@pref.saitama.lg.jp.
Noboru
N
Takayanagi
D000367:Age Factors; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001685:Biological Factors / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D011358:Product Surveillance, Postmarketing; D016032:Randomized Controlled Trials as Topic; D012140:Respiratory Tract Diseases; D012141:Respiratory Tract Infections / Q000209:etiology* / Q000517:prevention & control*; D012307:Risk Factors
D001685:Biological Factors; D005938:Glucocorticoids
Biological agents; Mycobacterial infection; Pneumocystis jirovecii pneumonia; Pneumonia; Rheumatoid arthritis