Guideline for the Treatment and Prevention of Infections Associated with Immunosuppressive Therapy for Autoimmune Diseases

• Main Authors: Sofia R. Valdoleiros, Isabel Furtado, Carolina Silva, Inês Correia Gonçalves, André Santos Silva, Olga Vasconcelos, Ana Aboim Horta, A. Ludgero Vasconcelos, Sandra Xará, Maria João Gonçalves, Miguel Araújo Abreu, Rui Sarmento-Castro
• Format: Article
• Language: English
• Published: Ordem dos Médicos 2021-06-01
• Series: Acta Médica Portuguesa
• Subjects: doenças autoimunes/terapêutica farmacológica; doenças preveníveis por vacina; imunossupressores; infeções/prevenção & controlo; infeções/terapêutica farmacológica
• Online Access: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/15625
• ISSN: 0870-399X; 1646-0758

We propose a guideline about the risk, prevention and treatment of infection in the patient under immunomodulatory or immunosuppressive therapy in the context of autoimmune or autoinflammatory disease. It is divided into three sections: drugs and associated risk of infection; immunizations; risk, prevention, and treatment of specific infections. The treatment of autoimmune diseases involves the use of immunosuppressive or immunomodulatory therapies, with an increasing number of new drugs being used. It is associated with an increased risk of infection, which may be present globally or only for specific agents, varying widely depending on the pharmacological class and even within the same class. The prevention strategy and clinical management need to be individually tailored and there are several key factors: characterization of the disease that prompts the immunosuppression, understanding of the mechanism of action of the immunosuppressive drug, knowledge of previous infections, recognition of risk factors, laboratory test results, vaccine administration, monitoring of clinical signs and symptoms and patient education.