Safety issues and concerns of new immunomodulators in rheumatology

Carlo F Selmi, Angela Ceribelli, Stanley M. Naguwa, Luca Cantarini, Yehuda Shoenfeld

    Research output: Contribution to journalArticlepeer-review

    30 Scopus citations


    Introduction: The development of biologic therapies has been an enormous leap in the management of patients with rheumatoid and psoriatic arthritis. Since the first anti-TNF-α therapies, numerous molecules have been identified as targets of immunomodulatory therapies, such as IL-1 (anakinra, canakinumab), IL-6 (tocilizumab), CD20+ B cells (rituximab), CTLA4 (abatacept) and two additional anti-TNF-α therapies (certolizumab pegol, golimumab).Areas covered: In the present review, we will describe the safety issues related to the immunosuppressive action of these biologic drugs that are mainly represented by infection and malignancy. The risk of infection should be identified before initiating a biologic treatment and markers checked over time, in particular for tuberculosis and hepatitis B and C viruses. Other infections (bacterial, viral, parasitic; opportunistic; surgery-related) and safety issues may require temporary interruption of the treatment until complete resolution. No significantly increased risk of malignancy, both hematological and solid, has been associated with the use of biologic agents. In all cases, it is difficult to dissect the risks related to biologics from those related to baseline treatments.Expert opinion: Detailed medical history and laboratory screening should be performed before starting biologic therapies. Clinicians should be aware of the different safety profiles associated with different molecules and they should follow up data coming out of the existing registries for biologics in regard to new or old side effects.

    Original languageEnglish (US)
    Pages (from-to)389-399
    Number of pages11
    JournalExpert Opinion on Drug Safety
    Issue number3
    StatePublished - Mar 1 2015


    • Adverse event
    • Biologic registry
    • Cancer
    • Infection
    • TNF-α inhibitor

    ASJC Scopus subject areas

    • Pharmacology (medical)


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