Abstract
In recent decades, biological therapy has enabled disease activity control and improved quality of life in patients with autoimmune diseases. These therapies that are involved in immune response modifications and change multiple immunological pathways induce an incremental risk for certain infectious diseases. Though there have been recent advances in risk assessment for biological therapy, there is a lack of data and recommendations for assessing risks in populations with high prevalence of infectious diseases, such as those located in tropical areas and developing countries. We performed a review on infections with biological therapy as well strategies for risk minimization in areas with a high prevalence of tropical diseases.
Highlights
Autoimmune diseases (AD) are chronic diseases with common pathophysiology
According to the Latin American Group for the Study of Rheumatoid Arthritis (GLADAR) registry, approximately 1.1% of rheumatoid arthritis (RA) patients from Latin America with short duration of the disease are treated with biological therapy [6]
There is a greater frequency of arthritis and enthesitis among SpA patients from Latin America (LA) compared with patients from Europe, and approximately 14% of LA patients were on a biological therapy regimen [11]
Summary
Autoimmune diseases (AD) are chronic diseases with common pathophysiology. The most remarkable characteristic is loss of immunological tolerance to selfantigens, which induce immune-related damage affecting tissues, organs, or even body systems simultaneously. The main immunosuppressive agents are the corticosteroids and the drug modifying against rheumatic diseases (DMARDs), such as methotrexate (MTX), azathioprine, and sulfasalazine, among others These drugs (mainly corticosteroids) are associated with many adverse events and lack of efficacy in the long term [4]. Another study from North America combined four large databases in the SABER (safety assessment of biologic therapy) and analyzed the rate of serious infections in patients with AD (including IBD, RA, psoriasis, SpA, and AS) exposed to anti-TNF. The use of biological therapy has been associated with an increased risk for different infectious diseases, including tuberculosis (TB) [4,15,16]. Recent studies gathered in a meta-analysis found that standard-dose biological drug usage, with or without DMARDs, was associated with increased risk of serious infections [18,19,20,21,22]. A detailed analysis found that infliximab, certolizumab pegol, and anakinra were associated with high rates of adverse events (AEs) and withdrawals due to AE compared with placebo [19]
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