Vol.65 No.4 July 2017
Influences of biologics on infection and chemotherapy
Research Division for Development of Anti-Infective Agents, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, Japan
Abstract
Recently, an increasing number of biologics have proved effective as treatment for immunological inflammatory diseases such as rheumatoid arthritis. However, the occurrence of various infectious diseases as concomitant complications, such as tuberculosis, pneumonia, and pneumocystis pneumonia, has increased. "Biologic" means biological preparations, as opposed to commonly-used chemically synthesized products (compounds). They are manufactured by biotechnological methods using materials derived from organisms, such as humans. Biologics, that inhibit TNF-α (tumor necrosis factor α), constitutes the basis of human immunity against tuberculosis, may increase the occurrence of tuberculosis in Japan, where many people have a history of tuberculosis infection. However, as demonstrated by a post-marketing all-patient survey, prophylactic administration of antitubercular drugs may suppress the onset of tuberculosis in infected patients detected by screening for latent tuberculosis prior to the administration of a TNF-α inhibitor. However, this prophylaxis is not 100% effective and some patients may develop tuberculosis, which may be rapidly aggravated and lead to death. Since the severity of the disease and death are likely to be caused by a mechanism of immune reconstitution, second or continuous administration of biologics should be considered. In Japan, non-tuberculous mycobacteriosis patients are rapidly increasing recently, and, biologics have been thought to be contraindicated for non-tuberculous mycobacteriosis patients, because of the lack of therapeutic agents. However, from the results of detailed examination of clinical cases, it has been recognized that biologics can be administered for non-tuberculous mycobacteriosis under certain conditions. On the other hand, the risk factors for the occurrence of bacterial and pneumocystis pneumonia-for which influenza and pneumococcal vaccines and prophylactic administration of an ST agent are effective-have been revealed. Also, early start of treatment for the complications, including influenza is critical.
Key word
biological agents, TNF-α (tumor necrosis factor-α), tuberculosis, prophylaxis
Received
January 10, 2017
Accepted
March 15, 2017
Jpn. J. Chemother. 65 (4): 568-576, 2017
