Choice of Biologic Therapy for Patients with Rheumatoid Arthritis: The Infection Perspective

Biologicals revolutionized the treatment of Rheumatoid Arthritis (RA). The targeted suppression of key inflammatory pathways involved in joint inflammation and destruction allows better disease control, which, however, comes at the price of an elevated infection risk due to relative immunosuppression. The disease-related infection risk and the infection risk associated with the use of TNF-α inhibitors (infliximab, adalimumab, etanercept, golimumab and certolizumab pegol), rituximab, abatacept and tocilizumab are discussed. Risk factors clinicians need to take into account when selecting the most appropriate biologic therapy for RA patients, as well as precautions and screening concerning a number of specific infections, such as tuberculosis, intracellular bacterial infections, reactivation of chronic viral infections and HIV are reviewed. Keywords: Rheumatoid arthritis, infection, biologicals, targeted therapies, TNF inhibitors, adalimumab, etanercept, golimumab, ertolizumab pegol, rituximab, abatacept, tocilizumab, tuberculosis,, B-cell specific, CD 20 antigen, corticosteroid, comorbidities, disease-modifying antirheumatic drugs (DMARDs), prednisolone, Progressive multifocal leukoencephalopathy, interferon-release assays, tuberculin skin test, tuberculosis-specific interferon-gamma release