Adverse reactions to biological modifiers

PURPOSE OF REVIEW: Newer biologic immunomodulators such as interferons, tumor necrosis factor alpha (TNFalpha) inhibitors, and monoclonal antibodies have been introduced into the management of various inflammatory conditions. This review addresses adverse responses to these agents. RECENT FINDINGS: Both interferon-alpha and interferon-beta have been associated with autoimmune phenomena. The ability of TNFalpha antagonists to cause significant adverse reactions appears to be substantial. These are either related to interference with TNFalpha activity or as consequence of the agents, either immunoglobulin or fusion protein, being recognized as foreign proteins, becoming themselves targets of an immune response. SUMMARY: Although advancing the management of inflammatory conditions, biologic modifiers are attended by significant concerns. Identification of at risk groups and careful selection of appropriate patients will minimize occurrence of adverse events.