Screening, prophylaxis and counselling before the start of biological therapies: A practical approach focused on IBD patients.
The standard of care in the management of immune-mediated inflammatory conditions relies on immunomodulators, glucocorticoids, and biologicals (including anti-tumour necrosis factor -α and other monoclonal antibodies). These agents have an overall favourable benefit/risk ratio; however, they modulate the immune response as part of their mechanisms of action, and therefore they may increase the risk of developing infections, particularly in older patients or in patients with concomitant corticosteroids. Some of these infections may be preventable by immunization, chemoprophylaxis or counselling.


AIM
screening for and monitoring infections throughout these therapies is so mandatory to ensure patients' safety. Still, standardized guidelines focused on these procedures have yet to be established. This review aims to fill such a gap. The authors searched for articles published in English from 2009 until 2017 using PUBMED, with the terms "immunomodulators", "biological drugs", "anti-TNF α", "inflammatory bowel diseases", "immunomediated inflammatory diseases", "risk of infection", "infection prevention", "screening", "immunization", "tuberculosis", "latent tuberculosis", "listeriosis", "endemic mycosis", "Pneumocystis jiroveci pneumonia", "granulomatous infection", "varicella", "herpes virus", "hepatitis B", "hepatitis A", "hepatitis C" and identified the journal articles. Based on the literature and in their own experience the authors established recommendations and a practical guide for infections' screening, monitoring and prevention before and during immunomodulatory and biological therapies.
['Abreu|Cândida|C|', 'Sarmento|António|A|', 'Magro|Fernando|F|']
D001688:Biological Products D018890:Chemoprevention D003141:Communicable Diseases D003376:Counseling D005938:Glucocorticoids D006801:Humans D007166:Immunosuppressive Agents D015212:Inflammatory Bowel Diseases D008403:Mass Screening D017410:Practice Guidelines as Topic D012307:Risk Factors D014409:Tumor Necrosis Factor-alpha D014611:Vaccination
Screening Inflammatory bowel diseases Biologics (IBD) Immunosuppression Microbiology