Biologic-Induced Immunodeficiency? Is It An Issue?

Biological therapies have transformed the paradigm of treatment of several inflammatory rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, vasculitis or systemic lupus, among others. Since the first TNF antagonists, numerous molecules targeting other immune pathways (IL-1, IL-6, IL-17, IL-12/IL-23, B Lymphocytes and co-stimulation) have become broadly available and the use of biologics is increasing worldwide. Nevertheless, blocking and neutralizing major pro-inflammatory pathways, depleting B-cells and interfering with T-cell function lowers the threshold for infections. In fact, patients on biologics are at higher risk of infectious complications, including serious infections and rare opportunistic infections. This risk is not the same for all biologics, nor for all patients, and it represents a real issue that clinicians should be aware of, recognize promptly and anticipate whenever appropriated. This lecture aims to provide an overview of current knowledge on the infectious risk associated with the use of biologics, in particular of viral infections. Importantly, preventive strategies will be addressed. Disclosure of Interest None declared