Biologic Agents and Secondary Immune Deficiency

Biologics are protein-based pharmaceuticals derived from living organisms or their products, and are widely used in treatment of autoimmune and autoinflammatory diseases. The use of biologics has become the standard of care for many pediatric rheumatologic conditions because of their efficacy in disease remission. TNF-alpha inhibitors are the oldest and best studied with regard to immune suppression and possible infectious consequences. Pediatricians need to be aware of immune suppression caused by biologics and the spectrum of infections that should be screened for before use (especially TB) and during use. Specific guidelines for screening, measures to reduce risk, and precautions to be given to patients on biologics do not yet exist for children, and are needed.