Infections in the era of immunobiologicals<sup/>

Romiti, Ricardo; Hirayama, André Luís da Silva; Porro, Adriana Maria; Gonçalves, Heitor de Sá; Miot, Luciane Donida Bartoli; Durães, Sandra Maria Barbosa; Marques, Silvio Alencar

doi:10.1016/j.abd.2023.08.004

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Continuing Medical Education • An. Bras. Dermatol. 99 (2) • Mar-Apr 2024 • https://doi.org/10.1016/j.abd.2023.08.004 linkcopy

Infections in the era of immunobiologicals^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Immunobiologicals represent an innovative therapeutic option in dermatology. They are indicated in severe and refractory cases of different diseases when there is contraindication, intolerance, or failure of conventional systemic therapy and in cases with significant impairment of patient quality of life. The main immunobiologicals used in dermatology basically include inhibitors of tumor necrosis factor-alpha (anti-TNF), inhibitors of interleukin-12 and -23 (anti-IL12/23), inhibitors of interleukin-17 and its receptor (anti-IL17), inhibitors of interleukin-23 (anti-IL23), rituximab (anti-CD20 antibody), dupilumab (anti-IL4/IL13) and intravenous immunoglobulin. Their immunomodulatory action may be associated with an increase in the risk of infections in the short and long term, and each case must be assessed individually, according to the risk inherent to the drug, the patient general condition, and the need for precautions. This article will discuss the main risks of infection associated with the use of immunobiologicals, addressing the risk in immunocompetent and immunosuppressed patients, vaccination, fungal infections, tuberculosis, leprosy, and viral hepatitis, and how to manage the patient in the most diverse scenarios.

Keywords
Biological products; Hepatitis, viral, human; Leprosy; Mycosis fungoides; Tuberculosis; Vaccination; Psoriasis

Inactivated agents	Attenuated agents
Pentavalent (diphtheria, tetanus, pertussis, Haemophilus influenzae and polio)	MMR (measles, mumps and rubella)
Hexavalent (pentavalent and Hepatitis B)	Tetra viral (MMR + varicella)
Pneumococcal	Varicella
Inactivated polio vaccine (IPV)	Yellow Fever
Trivalent or quadrivalent influenza	Oral Polio Vaccine
Adult Td (tetanus and diphtheria)	BCG (if mother is taking anti-TNF wait six months for baby vaccination)
HPV	Rotavirus
Haemophilus influenza B	Herpes Zoster (Zostavax®)
Hepatitis B	Dengue (Qdenga®)
Hepatitis A
COVID-19 (including recombinant mRNA)
Pneumococcal conjugate vaccine 13
Pneumo-23 Vaccine
Meningitis ACWY (MenACWY) vaccine
Meningitis B vaccine
Herpes Zoster (Shingrix®)

Exam	PRE	Every 2 to 5 months
Complete Blood Count	X	X
Liver Enzymes	X	X
Renal function	X	X
Urinalysis	X	X
Pregnancy test	X	X
PPD or IGRA and chest X-ray	X	When indicated
Hepatitis and HIV serologies	X	When indicated

vertical_align_top file_download show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

Acessibilidade / Reportar erro

[1] Adapted source: Lok ASF, Bounis PAL. 2023.⁷⁵

[TFN1] ^a
Possible scenarios: 1) Patient recovering from acute hepatitis B; 2) Patient may have a previous infection and the test might not be sensitive enough to detect very low levels of anti-HBs; 3) False positive for anti-HBc; 4) Possible undetectable level of HBsAg, and patient is chronically infected - possible occult hepatitis B (anti-HBs can be positive in these cases too).

Profile 1	Anti-HBs	Negative	Susceptible
	Anti-HBc	Negative
	AgHBs	Negative
Profile 2	Anti-HBs	Positive	Previous exposure
	Anti-HBc	Positive
	AgHBs	Negative
Profile 3	Anti-HBs	Positive	Immunized by the vaccine
	Anti-HBc	Negative
	AgHBs	Negative
Profile 4	Anti-HBs	Negative	Acute infection
	Anti-HBc	Positive
	Anti-HBc IgM	Positive
	AgHBs	Positive
Profile 5	Anti-HBs	Negative	Chronic infection
	Anti-HBc	Positive
	Anti-HBc IgM	Negative
	AgHBs	Positive
Profile 6	Anti-HBs	Negative	4 possible scenarios^a a Possible scenarios: 1) Patient recovering from acute hepatitis B; 2) Patient may have a previous infection and the test might not be sensitive enough to detect very low levels of anti-HBs; 3) False positive for anti-HBc; 4) Possible undetectable level of HBsAg, and patient is chronically infected - possible occult hepatitis B (anti-HBs can be positive in these cases too).
	Anti HBc	Positive
	AgHBs	Negative

Infections in the era of immunobiologicals*

Abstract

Infections in the era of immunobiologicals^*