Biologics Toxicity

Question 1

Infectious associated with anti-IL1 therapy (anakinra, canakinumab, rilonacept)

Answer 1

anti– IL-1 therapy has been relatively safe. The most prevalent infec- tious events are common bacterial and viral infections, and there is little or no increased risk of opportunistic infections with the use of anakinra.2

Question 2

Belatacept infectious risks

Answer 2

Adverse reactions reported include nasopharyngitis, cytomegalovirus, mycobacteria, fungi, progressive multifocal leukoencephalopathy (PML), and polyo- mavirus nephropathy.

Question 3

Alemtuzumab infectious risk

Answer 3

alemtuzumab can cause significant cellular immunodeficiency. Severe and lethal infections, including tuberculosis reactivation, systemic viral infections, and invasive systemic fungal infections, have been reported. Infections occur in 30% to 97% of patients

Question 4

TNF-alpha inhibitors (infliximab, etanercept, adalimumab, certolizumab, golimumab) infectious risk

Answer 4

unanticipated finding. In addition to mycobacterial infec- tions, other infections are associated with anti–TNF-a therapy, including Pneumocystis jirovecii, Listeria species, Legionella species, coccidioidomycosis, Candida species, Histoplasma spe- cies, Aspergillus species, and reactivation of hepatitis B.

Question 5

Eclizumab infectious risk

Answer 5

Eculizumab is an mAb that binds with high affinity to complement protein C5, inhibiting its cleavage to C5a and C5b and preventing generation of the terminal complement complex C5b-9.95,9

Although patients were given meningococcal vaccine before the antibody therapy, during clin- ical trials, 2 patients had Neisseria species–related meningitis, thus reproducing the natural deficiencies of terminal complement components.45