Abstract
Biological therapy has redesigned the treatment of certain systemic inflammatory disorders, and it is currently employed in clinical practice by specialties such as rheumatology, dermatology, gastroenterology, neurology and oncology. A decade’s worth of data has classified biological therapy as safe and effective for the treatment of a large number of diseases. However, its associated risk of secondary infections remains a major issue, particularly when discussing long-term immunosuppressive treatment. Secondary viral infections can require delaying or discontinuing biological therapy, thus leading to a relapse or reactivation of the underlying disorder, and this can happen in patients with already limited therapeutic options. Thorough screening and timely diagnosis of viral reactivations are necessary in order to maximize the benefits and reduce the risks associated with biological therapy. Viruses frequently associated with such reactivations include hepatitis B and C viruses, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus. This review focuses on the risk of reactivation associated with biological therapy in patients with autoimmune diseases and underlying herpes virus, human papilloma virus and polyomavirus infections.
Highlights
Biological therapy has become the cornerstone for the treatment of many autoimmune conditions and malignancies
This review focuses on the risk of reactivation associated with biological therapy in patients with autoimmune diseases and underlying herpes virus, human papilloma virus and polyomavirus infections
Even though most cases of progressive multifocal leukoencephalitis (PML) have been described in patients with severe immunosuppression, such as AIDS stage HIV infection, neoplasia or postorgan transplant [92], the association between this condition and biological therapy has become widely known after several PML cases were reported in patients who received natalizumab, a monoclonal antibody directed against α4 integrin, that is used in the treatment of multiple sclerosis [99] and Crohn’s disease [100]
Summary
Biological therapy has become the cornerstone for the treatment of many autoimmune conditions and malignancies. This review focuses on the risk of reactivation associated with biological therapy in patients with autoimmune diseases and underlying herpes virus, human papilloma virus and polyomavirus infections.
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