Infections in Children on Biologics

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Key points

  • Biologics represent a wide range of products that often target immune system pathways resulting in unintended consequences, including infectious events.

  • Tumor necrosis factor-α inhibitors in pediatric patients may have a differential infection risk based on the agent and underlying condition being treated.

  • Emerging data on infections specific to biologic administration in pediatrics will be essential to determine the risks of these agents in the future.

Tumor Necrosis Factor-α Inhibitors

Tumor necrosis factor (TNF)-α, a cell-signaling protein produced acutely by macrophages and monocytes, activates the vascular endothelium and increases vascular permeability. TNF-α inhibitors block the signaling to reduce acute inflammation in patients with RA, juvenile idiopathic arthritis (JIA), various types of psoriasis, and IBD, such as Crohn disease (CD) and ulcerative colitis (UC). Infliximab (CD), adalimumab (CD, JIA), and etanercept (JIA, plaque psoriasis) currently have approved

Summary

Biologic agents target specific pathways to treat immune-mediated diseases, and the use of biologics has expanded exponentially. Pediatric use continues to develop with new indications and emergence of new targets. Epidemiologic data reporting infection-related complications of biologics in pediatric patients are limited, but current data suggest that differences in types of pathogens exist relative to the pathways targeted by the agents. Further reporting of infectious events associated with

Acknowledgments

The author acknowledges Grant Paulsen, MD for his careful review of this article.

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