Biologics Versus JAK Inhibitors. Part II: Risk of Infections. A Narrative Review.

IF 3.5 3区医学 Q1 DERMATOLOGY Dermatology and Therapy Pub Date : 2024-08-01 Epub Date: 2024-07-16 DOI:10.1007/s13555-024-01203-2

Miguel Mansilla-Polo, Daniel Morgado-Carrasco

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Abstract

Introduction: The risk of infections associated with biological drugs (BD) and Janus kinase inhibitors (JAKi) has been extensively explored in the literature. However, there is a dearth of studies that evaluate both pharmacological groups together and, furthermore, compare them. Here, we review the risk of infections associated with BD and JAKi used in dermatology.

Methods: A narrative review was performed. All relevant articles evaluating the risk of infection and opportunistic infections with BD and JAKi between January 2010 and February 2024 were selected.

Results: Overall, the incidence of infections, serious infections, and opportunistic infections associated with BD and JAKi is low, but higher than in the general population. JAKi approved for dermatological disorders (abrocitinib, baricitinib, deucravacitinib, upadacitinib, ritlecitinib, and topical ruxolitinib) have been shown to be safe, and present a low rate of infections. We found an elevated risk, especially with anti-tumor necrosis factor (anti-TNF) agents, rituximab, and JAKi (particularly tofacitinib at high doses). Specific associations with infections include tuberculosis and tuberculosis reactivation with anti-TNF agents and tocilizumab; candidiasis with anti-interleukin (IL) 17 agents; hepatitis B virus reactivation with rituximab, anti-TNF, and JAKi; and herpes simplex and herpes zoster infections with JAKi (especially tofacitinib and upadacitinib at high doses). The incidence of infections with ustekinumab and anti-IL-23 was very low. Anti-IL-1, nemolizumab, tralokinumab, and omalizumab were not associated with an increased risk of infections. Dupilumab could decrease the incidence of cutaneous infections.

Conclusions: Anti-TNF agents, rituximab, and JAKi (particularly tofacitinib) can increase the risk of infections. Close monitoring of patients undergoing these therapies is recommended. Prospective studies with long-term follow-up are needed to comparatively evaluate the risks of infection deriving from treatment with BD and JAKi.

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生物制剂与 JAK 抑制剂。第二部分：感染风险。叙述性综述。

导言：文献已广泛探讨了生物药物（BD）和酪氨酸激酶抑制剂（JAKi）的感染风险。然而，同时评估这两类药物并对其进行比较的研究却非常缺乏。在此，我们回顾了与皮肤科使用的BD和JAKi相关的感染风险：方法：我们进行了叙述性综述。方法：我们进行了叙述性综述，选取了 2010 年 1 月至 2024 年 2 月间所有评估 BD 和 JAKi 感染风险和机会性感染的相关文章：总体而言，与BD和JAKi相关的感染、严重感染和机会性感染的发生率较低，但高于普通人群。已获批用于皮肤病的 JAKi（阿昔替尼、巴利替尼、deucravacitinib、upadacitinib、ritlecitinib 和局部用药 ruxolitinib）已被证明是安全的，感染率较低。我们发现感染风险较高，尤其是抗肿瘤坏死因子（anti-TNF）药物、利妥昔单抗和JAKi（尤其是高剂量的托法替尼）。与感染有关的特殊情况包括：使用抗肿瘤坏死因子药物和托西珠单抗会导致结核病和结核病再活化；使用抗白细胞介素（IL）17药物会导致念珠菌病；使用利妥昔单抗、抗肿瘤坏死因子和JAKi会导致乙型肝炎病毒再活化；使用JAKi（尤其是高剂量的托法替尼和乌达替尼）会导致单纯疱疹和带状疱疹感染。乌司替尼和抗IL-23的感染发生率非常低。抗IL-1、奈莫单抗、曲妥珠单抗和奥马珠单抗与感染风险增加无关。杜匹鲁单抗可降低皮肤感染的发生率：结论：抗肿瘤坏死因子药物、利妥昔单抗和JAKi（尤其是托法替尼）会增加感染风险。建议对接受这些疗法的患者进行密切监测。需要进行长期随访的前瞻性研究，以比较评估BD和JAKi治疗的感染风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Dermatology and Therapy Medicine-Dermatology

CiteScore

6.00

自引率

8.80%

发文量

187

审稿时长

6 weeks

期刊介绍： Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.