Vol.68 No.3 May 2020
Management of respiratory infections under biologic therapy
Department of Respiratory Medicine, Tokyo Yamate Medical Center, Japan Community Health Care Organization, 3-22-1 Hyakunin, Shinjuku-ku, Tokyo, Japan
Abstract
With the advent of biologic therapy for rheumatoid arthritis (RA) and other immune-mediated inflammatory diseases (IMIDs), the treatment of these diseases has substantially changed in the past decades. Nowadays more than 20 biologic agents have been approved in Japan, including tumor necrosis factor inhibitors, anti-interleukin-6 receptor antibody, and T-cell costimulatory signaling inhibitor for rheumatic diseases and inflammatory bowel diseases (IBD), succeeded by anti-interleukin 12/23 agent and anti-interleukin 17 agents for psoriasis and psoriatic arthritis, and so on. Importantly, these cytokines and molecules which these drugs target play important roles in innate and adaptive immunity, raising the concern that host protective immunity against pathogenic organisms may be weakened. Post-marketing surveillance and real-world studies of these drugs have revealed that the risk of infections, especially respiratory infections which are often serious and require hospitalization really increased with these treatments, such as bacterial infections, tuberculosis, non-tuberculous mycobacterial disease, and mycotic infections including Pneumocystis pneumonia. Substantial efforts have been made and many studies have been performed resulting in the accumulation of data for the management of these complications, one of the examples of which is the recently-seen decrease in tuberculosis. Nevertheless, problems remain unsolved for other complications such as bacterial pneumonia or Pneumocystis pneumonia. Aside from RA, in IBD and psoriasis, the safety profile of these treatments has not been elucidated sufficiently. In the United States serious concern has been raised about the safety of biologics in elderly IBD patients. Further studies are required for the implementation of safe management of these drugs which may secure the better clinical courses of patients with various IMIDs.
Key word
biologic agent, respiratory infection, rheumatoid arthritis, inflammatory bowel disease, psoriasis
Received
November 11, 2019
Accepted
January 14, 2020
Jpn. J. Chemother. 68 (3): 321-329, 2020
