Infection risk of targeted synthetic drugs used in immune-mediated inflammatory diseases

OBJECTIVE To review the available evidence concerning the infectious risks related to the targeted synthetic drugs used in immune-mediated inflammatory diseases and the measures for preventing infections in this type of disease. MATERIAL AND METHODS Targeted synthetic drugs with an indication in immune-mediated inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, inflammatory bowel disease, psoriasis and atopic dermatitis, were selected. The summary of product information for these drugs were consulted and a search carried out in Pubmed, reviewing the most relevant articles and clinical guidelines. RESULTS AND CONCLUSIONS Patients with immune-mediated inflammatory diseases present a higher risk of developing infections compared with the general population, partly due to immunosuppressive therapy. The infection risk associated with these treatments depends on the mechanism of action. There is no evidence for an increased risk of serious infections associated with apremilast use. Therefore, prior to initiating therapy with apremilast, no type of test other than clinical monitoring of the disease needs to be performed. Treatment with JAK inhibitors has been associated with an increase in infection risk, including reactivation of tuberculosis, herpes zoster and hepatitis B, among other infections. The vaccination status must be evaluated, a screening for infection with hepatitis B or latent tuberculosis performed, and an active systemic or local infection ruled out before starting treatment with JAK inhibitors. The inactivated vaccines recommended for patients being treated with JAK inhibitors are pneumococcus, influenza, hepatitis A, hepatitis B, herpes zoster and SARS-CoV-2. Attenuated live vaccines are contraindicated in these patients. Insufficient data are available to demonstrate that apremilast or JAK inhibitors increase the risk of COVID-19 infection and its complications. It is important that both healthcare professionals and patients are aware of the infection-prevention measures and recognise the signs and symptoms of infection before and during treatment with these drugs. KEY WORDS Targeted synthetic drugs, immune-mediated diseases, infection risk, herpes zoster, tuberculosis, vaccination