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Infectious Complications of Biologics

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Treatment of Inflammatory Bowel Disease with Biologics

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Abstract

Infection is the most frequently encountered consequence of biologic therapy and a major concern for both patients and healthcare providers. Biologic agents suppress immune function to mitigate aberrant and unregulated inflammatory activity but can also predispose to serious, sometimes fatal, consequences including newly acquired infections, opportunistic infections, or reactivation of latent disease. The risk of such infections reflects a variety of external factors including biologic type and the use of concomitant immunosuppressant medication(s) as well as host-specific variables such as age, inflammatory bowel disease (IBD) severity, underlying nutritional status, medical comorbidity, and history of bowel surgery. Other considerations include history of malignancy, presence of cytopenia, geographic location, previous infectious exposure(s), and vaccination status, among others. Appropriate screening with identification and stratification of at-risk patients, the use of primary or secondary chemoprophylaxis, and close clinical and laboratory surveillance with early recognition and timely goal-directed therapy for both common and opportunistic infections may optimize patient outcomes and decrease associated morbidity and mortality.

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Abbreviations

CDI:

Clostridium difficile infection

CI:

Confidence interval

CMV:

Cytomegalovirus

DNA:

Deoxyribonucleic acid

EBV:

Epstein-Barr virus

FDA:

Food and Drug Administration

HBc:

Hepatitis B core

HBsAb:

Hepatitis B surface antibody

HBsAg:

Hepatitis B surface antigen

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

HR:

Hazard ratio

HSV:

Herpes simplex virus

IBD:

Inflammatory bowel disease

JC:

John Cunningham

OR:

Odds ratio

PCP:

Pneumocystis pneumonia

PML:

Progressive multifocal leukoencephalopathy

PYF:

Patient-years of follow-up

SIR:

 Standardized incidence ratio

TNF:

 Tumor necrosis factor

TOUCH:

 Tysabri Outreach: Unified Commitment to Health

TREAT:

 [Crohn’s] Therapy, Resource, Evaluation, and Assessment Tool

USA:

 United States

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  1. Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Renée M. Marchioni Beery & Joshua R. Korzenik

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  1. Beth Israel Deaconess Medical Center Center for Inflammatory Bowel Disease, Harvard Medical School, Boston, Massachusetts, USA

    Adam S. Cheifetz

  2. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Joseph D. Feuerstein

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Marchioni Beery, R.M., Korzenik, J.R. (2018). Infectious Complications of Biologics. In: Cheifetz, A., Feuerstein, J. (eds) Treatment of Inflammatory Bowel Disease with Biologics . Springer, Cham. https://doi.org/10.1007/978-3-319-60276-9_12

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