Beyond tumor necrosis factor inhibition: the expanding pipeline of biologic therapies for inflammatory diseases and their associated infectious sequelae

Clin Infect Dis. 2014 Jun;58(11):1587-98. doi: 10.1093/cid/ciu104. Epub 2014 Feb 27.


Patients with rheumatoid arthritis and other immune-mediated inflammatory diseases are at higher risk for infectious morbidity and mortality, partially due to the therapies used to treat these conditions. Both prednisone and targeted biologic therapies such as tumor necrosis factor antagonists have been implicated to various degrees, although in some cases firm data are lacking with regard to certain types of infections. To date, there is a paucity of information regarding the infectious risks associated with the newer biologic agents. As new biologic agents become available for use, their potential infectious risks will challenge infectious disease clinicians who must work to prevent, diagnose, and treat infections in this setting. This article reviews our current understanding of infectious risk in the setting of targeted therapies and provides an update of the immune system targets and potential infectious sequelae of both current and emerging biologic therapies.

Keywords: anti-TNF agents; autoimmune disease; biologic therapies; infection; opportunistic infections.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use*
  • Biological Products / adverse effects
  • Biological Products / therapeutic use*
  • Biological Therapy / adverse effects
  • Biological Therapy / methods*
  • Communicable Diseases / chemically induced
  • Communicable Diseases / epidemiology*
  • Humans
  • Inflammation / drug therapy*


  • Anti-Inflammatory Agents
  • Biological Products