Infectious Complications of Biological and Small Molecule Targeted Immunomodulatory Therapies

Joshua S. Davis, David Ferreira, Emma Paige, Craig Gedye, Michael Boyle

Research output: Contribution to journalReview articlepeer-review


Summary: The past 2 decades have seen a revolution in our approach to therapeutic immunosuppression. We have moved from relying on broadly active traditional medications, such as prednisolone or methotrexate, toward more specific agents that often target a single receptor, cytokine, or cell type, using monoclonal antibodies, fusion proteins, or targeted small molecules. This change has transformed the treatment of many conditions, including rheumatoid arthritis, cancers, asthma, and inflammatory bowel disease, but along with the benefits have come risks. Contrary to the hope that these more specific agents would have minimal and predictable infectious sequelae, infectious complications have emerged as a major stumbling block for many of these agents. Furthermore, the growing number and complexity of available biologic agents makes it difficult for clinicians to maintain current knowledge, and most review articles focus on a particular target disease or class of agent. In this article, we review the current state of knowledge about infectious complications of biologic and small molecule immunomodulatory agents, aiming to create a single resource relevant to a broad range of clinicians and researchers. For each of 19 classes of agent, we discuss the mechanism of action, the risk and types of infectious complications, and recommendations for prevention of infection.

Original languageEnglish
Article numbere00035-19
Pages (from-to)1-117
Number of pages117
JournalClinical Microbiology Reviews
Issue number3
Publication statusPublished - 17 Jun 2020


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