Preventation and Management of Infectious Diseases in Children Using Biological Response Modifiers

Yıl 2025, Cilt: 11 Sayı: 2, 89 - 96, 27.05.2025

Sevgi Aslan Tuncay , Sevliya Öcal Demir

https://doi.org/10.30934/kusbed.1388668

Öz

In this manuscript, it is aimed to summarize the infectious diseases in children treated with biological response modifying agents, and to determine the protective measures and the conditions to be considered in follow-up.
Biological response modifying agents are medical molecules utilized in managing autoimmune and autoinflammatory diseases, exerting suppressive effects on the immune system through cytokines. The major targeted cytokines include tumor necrosis factor α; interleukin 6, 12, and 23; interleukin 1α and 1β receptors. Biological response modifying agents create a suppressive effect on these targets, making underlying disease remission more accessible. Patients using biological agents have an increased risk of opportunistic infections, particularly tuberculosis and viral infections. Although the risk varies by drug class, patients are generally at risk for mycobacterial (Mycobacterium tuberculosis and non-tuberculosis mycobacteria), viral (Herpes simplex virus, chickenpox virus, Epstein-Barr virus, Hepatitis B virus), and fungal (histoplasmozis, coccidioidomycosis) and other opportunistic infections. These infections can cause significant morbidity and mortality in immunosuppressive patients. Therefore, it is crucial for healthcare providers to closely monitor patients receiving biological agents for any signs or symptoms of infection. Additionally, appropriate prophylactic measures, such as vaccination against certain infectious agents or use of antimicrobial prophylaxis, may be considered to reduce the risk of opportunistic infections in these patients.
Overall, the management of patients using biological agents requires a careful balance between controlling the underlying disease and minimizing the risk of infections.

Anahtar Kelimeler

cytokine , immunosuppression , tuberculosis , immunization

Kaynakça

• Davies HD; Committee on Infectious Diseases. Infectious complications with the use of biologic response modifiers in infants and children. Pediatrics. 2016;138(2):e20161209. doi:10.1542/peds.2016-1209.
• Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762-784. doi:10.1002/art.23721.
• Alexeeva EI, Valieva SI, Bzarova TM, et al. Efficacy and safety of repeat courses of rituximab treatment in patients with severe refractory juvenile idiopathic arthritis. Clin Rheumatol. 2011;30(9):1163-1172. doi: 10.1007/s10067-011-1720-7.
• Askling J, Fored CM, Brandt L, et al. Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum. 2005;52(7):1986-1992. doi:10.1002/art.21137.
• Salgado E, Gómez-Reino JJ. The risk of tuberculosis in patients treated with TNF antagonists. Expert Rev Clin Immunol. 2011;7(3):329-340. doi:10.1586/eci.11.6
• Ayaz NA, Demirkaya E, Bilginer Y, et al. Preventing tuberculosis in children receiving anti-TNF treatment. Clin Rheumatol. 2010;29(4):389-392. doi:10.1007/s10067-009-1334-5.
• Tüberküloz Saha Rehberi. Sağlık Bakanlığı, Ankara-2019. Available at: https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz-db/Dokumanlar/Rehberler/Tuberkuloz_Tani_ve_Tedavi_Rehberi.pdf. Accessed September 25, 2023.
• Starke JR; Committee on Infectious Diseases. Interferon-γ release assays for diagnosis of tuberculosis infection and disease in children. Pediatrics. 2014;134(6):e1763-e1773. doi:10.1542/peds.2014-2983.
• Debord C, De Lauzanne A, Gourgouillon N, et al. Interferon-gamma release assay performance for diagnosing tuberculosis disease in 0- to 5-year-old children. Pediatr Infect Dis J. 2011;30(11):995-997. doi: 10.1097/INF.0b013e3182272227.
• Moyo S, Isaacs F, Gelderbloem S, et al. Tuberculin skin test and QuantiFERON® assay in young children investigated for tuberculosis in South Africa. Int J Tuberc Lung Dis. 2011;15(9):1176-1181. doi: 10.5588/ijtld.10.0770.
• American Academy of Pediatrics. Summaries of Infectious Diseases. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:786-814.
• Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children.Clin Infect Dis. 2017;64(2):e1-e33. doi: 10.1093/cid/ciw778.
• Holroyd CR, Seth R, Bukhari M, et al. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis-Executive summary. Rheumatology (Oxford). 2019;58(2):220-226. doi:10.1093/rheumatology/key207.
• Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2021;73(7):1108-1123. doi:10.1002/art.41752.
• Winthrop KL, Chang E, Yamashita S, Iademarco MF, LoBue PA. Nontuberculous mycobacteria infections and anti-tumor necrosis factor-alpha therapy. Emerg Infect Dis. 2009;15(10):1556-1560. doi: 10.3201/eid1510.090310.
• American Academy of Pediatrics. Summaries of Infectious Diseases. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:831-843.
• Carroll MB. The impact of biologic response modifiers on hepatitis B virus infection. Expert Opin Biol Ther. 2011;11(4):533-544. doi: 10.1517/14712598.2011.554810.
• Motaparthi K, Stanisic V, Van Voorhees AS, Lebwohl MG, Hsu S. From the Medical Board of the National Psoriasis Foundation: recommendations for screening for hepatitis B infection prior to initiating anti-tumor necrosis factor-alpha inhibitors or other immunosuppressive agents in patients with psoriasis. J Am Acad Dermatol. 2014;70(1):178-186. doi: 10.1016/j.jaad.2013.08.049.
• Loomba R, Liang TJ. Hepatitis B reactivation associated with immune suppressive and biological modifier therapies: current concepts, management strategies, and future directions. Gastroenterology. 2017;152(6):1297-1309. doi:10.1053/j.gastro.2017.02.009.
• Gundacker ND, Baddley JW. Fungal infections in the era of biologic therapies. Curr Clin Micro Rpt. 2015;2:76-83. doi:10.1007/s40588-015-0018-y.
• American Academy of Pediatrics. Summaries of Infectious Diseases. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:527-532.
• Risk Grubu Aşılamaları, Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu, 2016. Available at: https://istanbul.saglik.gov.tr/Eklenti/83243/0/risk-grubu-asilamalari-ekdoc.doc. Accessed October 1, 2023.
• American Academy of Pediatrics. Summaries of Infectious Diseases. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2024 Report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024:819-820
• American Academy of Pediatrics. Summaries of Infectious Diseases. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2024 Report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024:114.
• Crew PE, Abara WE, McCulley L, et al. Disseminated gonococcal infections in patients receiving eculizumab: a case series. Clin Infect Dis. 2019;69(4):596-600. doi: 10.1093/cid/ciy958.
• Rondeau E, Cataland SR, Al-Dakkak I, Miller B, Webb NJ,Landau D. Eculizumab safety: five-year experience from theglobal atypical hemolytic uremic syndrome registry. Kidney IntRep. 2019;4(11):1568-1576. doi: 10.1016/j.ekir.2019.07.016.
• American Academy of Pediatrics. Summaries of Infectious Diseases. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:527-532.