{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:16:53Z","timestamp":1780399013215,"version":"3.54.1"},"reference-count":155,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Biologic and targeted synthetic therapies have substantially improved the management of autoimmune diseases (ADs), achieving unprecedented disease control. However, by modulating key immune pathways, these agents increase susceptibility to a wide spectrum of infections. This narrative review synthesizes current evidence on infectious risks associated with biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in AD, characterizing infection profiles across different drug classes, identifying patient- and treatment-related risk factors, and providing evidence-based recommendations for screening, prevention, and management. A comprehensive literature search was conducted through March 2026, across PubMed, Embase, and the Cochrane Library, using predefined search terms combining biologic and targeted synthetic drug classes with infection-related outcomes. Evidence from major international registries (BSRBR-RA, DANBIO, RABBIT) and society guidelines (ACR, EULAR, IDSA) was prioritized. Among bDMARDs, TNF-\u03b1 inhibitors (TNF-\u03b1 i) and rituximab were associated with the highest rates of serious infections, whereas IL-17 and IL-23 inhibitors demonstrated comparatively lower infectious risk profiles. Steroids, older age, and prior serious infections emerged as the most consistent patient-related risk modifiers. Unlike prior reviews focused on single diseases or drug classes, this work provides an integrated, cross-disciplinary risk stratification framework. bDMARDs and tsDMARDs remain among the most innovative treatments available for effective management of ADs, with favorable benefit\u2013risk profiles when accompanied by systematic prevention strategies. Universal pre-treatment screening for tuberculosis and viral hepatitis, risk-stratified parasitic screening, evidence-based vaccination, and selective antimicrobial prophylaxis can mitigate infectious complications.<\/jats:p>","DOI":"10.3390\/microorganisms14061250","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:14:57Z","timestamp":1780395297000},"page":"1250","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Infectious Risks Associated with Biologic Therapies in Autoimmune, Rheumatologic and Dermatologic Diseases: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5938-0850","authenticated-orcid":false,"given":"Stefania","family":"Capuccio","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy"},{"name":"Department of Medicine and Surgery, \u201cKore\u201d University of Enna, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan R.","family":"Rello","sequence":"additional","affiliation":[{"name":"Microbiology Department, Pharmacy Faculty, University of Barcelona, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5179-0327","authenticated-orcid":false,"given":"Antonios","family":"Katsounas","sequence":"additional","affiliation":[{"name":"Ruhr University Bochum, Knappschaft Kliniken University Hospital Bochum, Department of Medicine, 44780 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0676-6210","authenticated-orcid":false,"given":"Jordi","family":"Rello","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Critical Care, Pain and Emergency Medicine, N\u00eemes University Hospital, University of Montpellier, 30900 N\u00eemes, France"},{"name":"Medicine Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain"},{"name":"Clinical Research Pneumonia and Sepsis (CRIPS) Research Group-Vall d\u2019Hebron Institute Research (VHIR), 08035 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jare.2018.09.003","article-title":"Risk of Serious Infection among Patients Receiving Biologics for Chronic Inflammatory Diseases: Usefulness of Administrative Data","volume":"15","author":"Quartuccio","year":"2019","journal-title":"J. Adv. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.3855\/jidc.8222","article-title":"Infections with Biological Therapy: Strategies for Risk Minimization in Tropical and Developing Countries","volume":"10","author":"Calixto","year":"2016","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Placha, D., and Jampilek, J. (2021). Chronic Inflammatory Diseases, Anti-Inflammatory Agents and Their Delivery Nanosystems. Pharmaceutics, 13.","DOI":"10.3390\/pharmaceutics13010064"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.ad.2023.06.012","article-title":"Long-Term Safety Profile and Off-Label Use of JAK Inhibitors in Dermatological Disorders","volume":"114","year":"2023","journal-title":"Actas Dermosifiliogr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(23)01525-8","article-title":"Rheumatoid Arthritis","volume":"402","author":"Bathon","year":"2023","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/annrheumdis-2013-204317","article-title":"Proposal for a New Nomenclature of Disease-Modifying Antirheumatic Drugs","volume":"73","author":"Smolen","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Abdessamad, H. (2026). A Clinician\u2019s Update on Infection Risk in Patients Receiving Biologic and Targeted Synthetic DMARDs for Autoimmune Disease. Rheumato, 6.","DOI":"10.3390\/rheumato6010004"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Rosman, Z., Shoenfeld, Y., and Zandman-Goddard, G. (2013). Biologic Therapy for Autoimmune Diseases: An Update. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-88"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S0140-6736(24)02519-4","article-title":"Atopic Dermatitis","volume":"405","author":"Brunner","year":"2025","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/s41584-021-00726-8","article-title":"Janus Kinase-Targeting Therapies in Rheumatology: A Mechanisms-Based Approach","volume":"18","author":"Tanaka","year":"2022","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1016\/S0140-6736(16)30173-8","article-title":"Rheumatoid Arthritis","volume":"388","author":"Smolen","year":"2016","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2611461","DOI":"10.1080\/07853890.2025.2611461","article-title":"The Molecular Mechanism of the Adverse Effects of the Biological and Small Molecular Drugs in the Therapy of Inflammatory Skin Diseases\u2014Psoriasis and Atopic Dermatitis","volume":"58","author":"Lemiesz","year":"2026","journal-title":"Ann. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jaut.2011.08.002","article-title":"Immune-Mediated Adverse Effects of Biologicals Used in the Treatment of Rheumatic Diseases","volume":"37","author":"Borchers","year":"2011","journal-title":"J. Autoimmun."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s10238-025-01558-6","article-title":"Biosimilars versus Biological Therapy in Inflammatory Bowel Disease: Challenges and Targeting Strategies Using Drug Delivery Systems","volume":"25","author":"Aljabri","year":"2025","journal-title":"Clin. Exp. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/s12016-019-08739-8","article-title":"Immunologic Adverse Effects of Biologics for the Treatment of Atopy","volume":"59","author":"Aranez","year":"2020","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1016\/j.cmi.2017.12.025","article-title":"ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the Safety of Targeted and Biological Therapies: An Infectious Diseases Perspective (Soluble Immune Effector Molecules [I]: Anti-Tumor Necrosis Factor-\u03b1 Agents)","volume":"24","author":"Baddley","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Lv, X., Liu, Y., Li, Y., Zhang, Q., Chen, S., Liu, X., Shi, G., and Li, Y. (2026). Comparative Risk of Tuberculosis Infection with Different TNF-\u03b1 Inhibitors in Immune-Mediated Inflammatory Diseases: A Systematic Review and Network Meta-Analysis. Front. Immunol., 17.","DOI":"10.3389\/fimmu.2026.1726299"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Campbell, C., Andersson, M.I., Ansari, M.A., Moswela, O., Misbah, S.A., Klenerman, P., and Matthews, P.C. (2021). Risk of Reactivation of Hepatitis B Virus (HBV) and Tuberculosis (TB) and Complications of Hepatitis C Virus (HCV) Following Tocilizumab Therapy: A Systematic Review to Inform Risk Assessment in the COVID-19 Era. Front. Med., 8.","DOI":"10.3389\/fmed.2021.706482"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Bellan, M., Scotti, L., Ferrante, D., Calzaducca, E., Manfredi, G.F., Sainaghi, P.P., and Barone-Adesi, F. (2022). Risk of Severe Infection among Rheumatoid Arthritis Patients on Biological DMARDs: A Population-Based Cohort Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11112955"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wu, S., Xu, Y., Yang, L., Guo, L., and Jiang, X. (2023). Short-Term Risk and Long-Term Incidence Rate of Infection and Malignancy with IL-17 and IL-23 Inhibitors in Adult Patients with Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-Analysis. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1294416"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jaad.2025.11.033","article-title":"Joint Position Statement from the National Psoriasis Foundation Medical Board and the International Psoriasis Council on Routine Testing for Latent Tuberculosis Infection Prior to and during Treatment of Psoriasis Patients with Interleukin 17 or Interleukin 23 Inhibitors","volume":"94","author":"Blauvelt","year":"2026","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1111\/jdv.19328","article-title":"Evaluating the Risk of Infections under Interleukin 23 and Interleukin 17 Inhibitors Relative to Tumour Necrosis Factor Inhibitors\u2014A Population-Based Study","volume":"37","author":"Kridin","year":"2023","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Perrone, S., Tomasello, R., Raso, S., Annibali, O., Tafuri, M., Mattana, M., Soriano, T., Fanciullo, D., Assanto, G.M., and Pedone, G.L. (2026). Incidence of Infections in Patients Treated with Rituximab for Autoimmune Disorders of Hematological Interest or Non-Hodgkin Lymphoma. Ann. Hematol.","DOI":"10.1007\/s00277-026-07047-4"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"43048","DOI":"10.1038\/s41598-025-26999-7","article-title":"A Real-World Safety Analysis of Infection-Related Adverse Events Associated with Belimumab, Rituximab, and TNF Inhibitors Using the FAERS Database","volume":"15","author":"Sisi","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1053\/j.gastro.2020.01.001","article-title":"Safety of Janus Kinase Inhibitors in Patients with Inflammatory Bowel Diseases or Other Immune-Mediated Diseases: A Systematic Review and Meta-Analysis","volume":"158","author":"Olivera","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/j.ard.2026.02.024","article-title":"Safety of Synthetic and Biological DMARDs: A Systematic Literature Review Informing the 2025 Update of the EULAR Recommendations for the Management of Rheumatoid Arthritis","volume":"85","author":"Laskou","year":"2026","journal-title":"Ann. Rheum. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1002\/path.2287","article-title":"TNF-mediated Inflammatory Disease","volume":"214","author":"Bradley","year":"2008","journal-title":"J. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1146\/annurev.immunol.19.1.163","article-title":"Anti-TNF\u03b1 Therapy of Rheumatoid Arthritis: What Have We Learned?","volume":"19","author":"Feldmann","year":"2001","journal-title":"Annu. Rev. Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4620","DOI":"10.4049\/jimmunol.168.9.4620","article-title":"TNF Regulates Chemokine Induction Essential for Cell Recruitment, Granuloma Formation, and Clearance of Mycobacterial Infection","volume":"168","author":"Roach","year":"2002","journal-title":"J. Immunol."},{"key":"ref_30","unstructured":"Gerriets, V., Goyal, A., and Khaddour, K. (2025). Tumor Necrosis Factor Inhibitors. StatPearls, StatPearls Publishing."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/intimm\/dxq030","article-title":"IL-6: From Its Discovery to Clinical Applications","volume":"22","author":"Kishimoto","year":"2010","journal-title":"Int. Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"109130","DOI":"10.1016\/j.intimp.2022.109130","article-title":"Interleukin-6 Cytokine: An Overview of the Immune Regulation, Immune Dysregulation, and Therapeutic Approach","volume":"111","author":"Aliyu","year":"2022","journal-title":"Int. Immunopharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Narazaki, M., and Kishimoto, T. (2018). The Two-Faced Cytokine IL-6 in Host Defense and Diseases. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19113528"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.smim.2014.01.009","article-title":"A New Era for the Treatment of Inflammatory Autoimmune Diseases by Interleukin-6 Blockade Strategy","volume":"26","author":"Tanaka","year":"2014","journal-title":"Semin. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1038\/nrrheum.2017.83","article-title":"The Role of IL-6 in Host Defence Against Infections: Immunobiology and Clinical Implications","volume":"13","author":"Winthrop","year":"2017","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1002\/art.41477","article-title":"Improvement of Signs and Symptoms of Nonradiographic Axial Spondyloarthritis in Patients Treated with Secukinumab: Primary Results of a Randomized, Placebo-Controlled Phase III Study","volume":"73","author":"Deodhar","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1126\/science.1200439","article-title":"Chronic Mucocutaneous Candidiasis in Humans with Inborn Errors of Interleukin-17 Immunity","volume":"332","author":"Puel","year":"2011","journal-title":"Science"},{"key":"ref_38","unstructured":"(1985). Approved Drug Products with Therapeutic Equivalence Evaluations|Orange Book."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"adv00698","DOI":"10.2340\/actadv.v102.563","article-title":"Long-Term Safety of Secukinumab Over Five Years in Patients with Moderate-to-Severe Plaque Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis: Update on Integrated Pooled Clinical Trial and Post-Marketing Surveillance Data","volume":"102","author":"Gottlieb","year":"2022","journal-title":"Acta Derm. Venereol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"103987","DOI":"10.1016\/j.autrev.2026.103987","article-title":"Risk of Infection for Different B-Cell Targeting Agents in Treating Systemic Lupus Erythematosus: A Systematic Review and Network Meta-Analysis","volume":"25","author":"Yu","year":"2026","journal-title":"Autoimmun. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s11926-015-0539-7","article-title":"B Cell Therapies, Approved and Emerging: A Review of Infectious Risk and Prevention During Use","volume":"17","author":"Vital","year":"2015","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1136\/annrheumdis-2018-213032","article-title":"Phase III Trial Results with Blisibimod, a Selective Inhibitor of B-Cell Activating Factor, in Subjects with Systemic Lupus Erythematosus (SLE): Results from a Randomised, Double-Blind, Placebo-Controlled Trial","volume":"77","author":"Merrill","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e23536","DOI":"10.1096\/fj.202302259RR","article-title":"Repurposing of Rituximab Biosimilars to Treat B Cell Mediated Autoimmune Diseases","volume":"38","author":"Mostkowska","year":"2024","journal-title":"FASEB J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1056\/NEJMoa2410965","article-title":"Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis","volume":"392","author":"Furie","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1093\/toxsci\/kfj148","article-title":"Chronic Administration of Belimumab, a BLyS Antagonist, Decreases Tissue and Peripheral Blood B-Lymphocyte Populations in Cynomolgus Monkeys: Pharmacokinetic, Pharmacodynamic, and Toxicologic Effects","volume":"91","author":"Halpern","year":"2006","journal-title":"Toxicol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Li, L., Shen, S., Shao, S., Dang, E., Wang, G., Fang, H., and Qiao, H. (2025). The Role of B Cell-Activating Factor System in Autoimmune Diseases: Mechanisms, Disease Implications, and Therapeutic Advances. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1538555"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e355","DOI":"10.1016\/S2665-9913(24)00338-2","article-title":"Evolution and Trajectory of B-Cell Targeted Therapies in Rheumatic Diseases","volume":"7","author":"Carter","year":"2025","journal-title":"Lancet Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/ar3920","article-title":"B-Cell Activating Factor Targeted Therapy and Lupus","volume":"14","author":"Boneparth","year":"2012","journal-title":"Arthritis Res. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"102736","DOI":"10.1016\/j.autrev.2020.102736","article-title":"B Cell Activating Factor (BAFF): Structure, Functions, Autoimmunity and Clinical Implications in Systemic Lupus Erythematosus (SLE)","volume":"20","author":"Basta","year":"2021","journal-title":"Autoimmun. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1093\/rheumatology\/key339","article-title":"Clinical Significance of Janus Kinase Inhibitor Selectivity","volume":"58","author":"Choy","year":"2019","journal-title":"Rheumatology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1080\/00325481.2020.1855921","article-title":"JAK-STAT Pathway Inhibition and Their Implications in COVID-19 Therapy","volume":"133","author":"Satarker","year":"2021","journal-title":"Postgrad. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1002\/JLB.5RI0218-084R","article-title":"Translational and Clinical Advances in JAK-STAT Biology: The Present and Future of Jakinibs","volume":"104","author":"Gadina","year":"2018","journal-title":"J. Leukoc. Biol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1016\/j.jaci.2012.11.054","article-title":"Dominant Gain-of-Function STAT1 Mutations in FOXP3 Wild-Type Immune Dysregulation\u2013Polyendocrinopathy\u2013Enteropathy\u2013X-Linked\u2013like Syndrome","volume":"131","author":"Uzel","year":"2013","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.idc.2020.02.013","article-title":"Infections Related to Biologics: Agents Targeting B Cells","volume":"34","author":"Leandro","year":"2020","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Vassilopoulos, A., Shehadeh, F., Benitez, G., Kalligeros, M., Cunha, J.S., Cunha, C.B., and Mylonakis, E. (2022). The Incidence of Opportunistic Infections in Patients with Psoriatic Arthritis Treated with Biologic and Targeted Synthetic Agents: A Systematic Review and Meta-Analysis. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.992713"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/BOR.0000000000000389","article-title":"Infections in Rheumatoid Arthritis","volume":"29","author":"Atzeni","year":"2017","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1093\/cid\/ciu185","article-title":"Biologic Therapies in Rheumatoid Arthritis and the Risk of Opportunistic Infections: A Meta-Analysis","volume":"58","author":"Kourbeti","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.berh.2015.05.009","article-title":"Risk of Infection with Biologic Antirheumatic Therapies in Patients with Rheumatoid Arthritis","volume":"29","author":"Lahiri","year":"2015","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Bergmans, B., Jessurun, N., van Lint, J., Murk, J.-L., van Puijenbroek, E., and de Vries, E. (2024). Burden of Non-Serious Infections during Biological Use for Rheumatoid Arthritis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0296821"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1136\/annrheumdis-2020-217092","article-title":"Infectious Complications of Rheumatoid Arthritis and Psoriatic Arthritis during Targeted and Biological Therapies: A Viewpoint in 2020","volume":"79","author":"Lortholary","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Li, J., Zhang, Z., Wu, X., Zhou, J., Meng, D., and Zhu, P. (2021). Risk of Adverse Events After Anti-TNF Treatment for Inflammatory Rheumatological Disease. A Meta-Analysis. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.746396"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.cmi.2026.02.005","article-title":"Tumour Necrosis Factor-\u03b1 Inhibitors, Immune-Mediated Inflammatory Diseases, and Bloodstream Infections: Results from a Nationwide Case-Control Study","volume":"32","author":"Leding","year":"2026","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Jiang, Z., Zou, Y., Li, G., Zhao, S., and Zhang, W. (2024). Comparisons of Infection Events Associated with Tumor Necrosis Factor Inhibitors in Patients with Inflammatory Arthritis: A Systematic Review and Network Meta-Analysis. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1376262"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"6168","DOI":"10.1093\/rheumatology\/keaf419","article-title":"Non-Negligible Risk of HBV Reactivation among Rheumatoid Arthritis Patients Receiving JAK Inhibitors: Bridging the Evidence Gap","volume":"64","author":"Lan","year":"2025","journal-title":"Rheumatology"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"105945","DOI":"10.1016\/j.jbspin.2025.105945","article-title":"Risk of Non-Bacterial Opportunistic Infections Associated with Janus Kinase Inhibitors versus Tumor Necrosis Factor Inhibitors among Rheumatoid Arthritis Patients: A Cohort Study","volume":"93","author":"Shin","year":"2026","journal-title":"Jt. Bone Spine"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e70040","DOI":"10.1111\/myc.70040","article-title":"Fungal Infections Associated with TNF-Inhibitors: A 20-Year of a Systematic Review Fungal Infections and TNF-Inhibitors","volume":"68","author":"Barbosa","year":"2025","journal-title":"Mycoses"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1002\/ajh.25642","article-title":"Preventing Infectious Complications When Treating Non-malignant Immune-mediated Hematologic Disorders","volume":"94","author":"Malpica","year":"2019","journal-title":"Am. J. Hematol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Picchianti-Diamanti, A., Aiello, A., De Lorenzo, C., Migliori, G.B., and Goletti, D. (2025). Management of Tuberculosis Risk, Screening and Preventive Therapy in Patients with Chronic Autoimmune Arthritis Undergoing Biotechnological and Targeted Immunosuppressive Agents. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1494283"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1016\/S1473-3099(24)00595-4","article-title":"Review of the WHO Guideline on Preventive Chemotherapy for Public Health Control of Strongyloidiasis","volume":"25","author":"Lo","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"0132","DOI":"10.2340\/actadv.v106.adv-2025-0132","article-title":"Cutaneous Leishmaniasis in Patients under Biologic Therapies: A Spanish CLINI-AEDV Multicentre Study","volume":"106","author":"Ciudad","year":"2026","journal-title":"Acta Derm. Venereol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e00035-19","DOI":"10.1128\/CMR.00035-19","article-title":"Infectious Complications of Biological and Small Molecule Targeted Immunomodulatory Therapies","volume":"33","author":"Davis","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s10067-010-1523-2","article-title":"Use of Tumor Necrosis Factor \u03b1 Inhibitors in Hepatitis B Surface Antigen-Positive Patients: A Literature Review and Potential Mechanisms of Action","volume":"29","author":"Carroll","year":"2010","journal-title":"Clin. Rheumatol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"6072","DOI":"10.4049\/jimmunol.160.12.6072","article-title":"Blockade of Endogenous TNF-Alpha Exacerbates Primary and Secondary Pulmonary Histoplasmosis by Differential Mechanisms","volume":"160","author":"Allendoerfer","year":"1998","journal-title":"J. Immunol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/1756-185X.12970","article-title":"Comparison of the Risk of Infections in Different Anti-TNF Agents: A Meta-Analysis","volume":"20","author":"Liao","year":"2017","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1136\/annrheumdis-2017-212825","article-title":"Serious Infection across Biologic-Treated Patients with Rheumatoid Arthritis: Results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis","volume":"77","author":"Rutherford","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/S0140-6736(14)61704-9","article-title":"Risk of Serious Infection in Biological Treatment of Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis","volume":"386","author":"Singh","year":"2015","journal-title":"Lancet"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1002\/art.39399","article-title":"Comparative Risk of Hospitalized Infection Associated with Biologic Agents in Rheumatoid Arthritis Patients Enrolled in Medicare","volume":"68","author":"Yun","year":"2016","journal-title":"Arthritis Rheumatol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e70106","DOI":"10.1111\/myc.70106","article-title":"Drug-Related Candidiasis Risk Profiling: A Real-World Pharmacovigilance Study Leveraging the FDA Adverse Event Reporting System (FAERS)","volume":"68","author":"Yang","year":"2025","journal-title":"Mycoses"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1517\/14740338.2015.1009036","article-title":"Infection Risk Associated with Anti-TNF-\u03b1 Agents: A Review","volume":"14","author":"Murdaca","year":"2015","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ccm.2024.10.013","article-title":"Pulmonary Complications of Biological Therapies in Inflammatory and Autoimmune Diseases","volume":"46","author":"Yeo","year":"2025","journal-title":"Clin. Chest Med."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Li, X., Hu, Q., and Xu, T. (2025). Janus Kinase Inhibitors and the Risk of Infections: A Network Meta-Analysis across Disease Indications. Expert Opin. Drug Saf., 1\u201313.","DOI":"10.1080\/14740338.2025.2502037"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1159\/000337422","article-title":"Factors Associated with Severe Skin Infections in Patients Treated with Biologic Therapies for Inflammatory Rheumatic Diseases","volume":"224","author":"Farhi","year":"2012","journal-title":"Dermatology"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1002\/hep.31296","article-title":"Thyroid Hormone Signaling and the Liver","volume":"72","author":"Ritter","year":"2020","journal-title":"Hepatology"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1002\/art.41754","article-title":"Nonserious Infections in Patients with Rheumatoid Arthritis: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis","volume":"73","author":"Bechman","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s10067-024-07287-7","article-title":"Frequency of Severe Infections in Rheumatic Disease Patients Receiving bDMARDs Post-Kidney Transplantation: A Multicenter Study","volume":"44","author":"Basaran","year":"2025","journal-title":"Clin. Rheumatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00415-025-13133-w","article-title":"Real-World Observational Study of Infections in People Treated with Ocrelizumab for Multiple Sclerosis","volume":"272","author":"Davies","year":"2025","journal-title":"J. Neurol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1002\/art.41596","article-title":"American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 3","volume":"73","author":"Mikuls","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1001\/jama.2013.1099","article-title":"Association Between the Initiation of Anti\u2013Tumor Necrosis Factor Therapy and the Risk of Herpes Zoster","volume":"309","author":"Winthrop","year":"2013","journal-title":"JAMA"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1038\/nature21365","article-title":"Adipose-Derived Circulating miRNAs Regulate Gene Expression in Other Tissues","volume":"542","author":"Thomou","year":"2017","journal-title":"Nature"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"44109","DOI":"10.1074\/jbc.M112.408146","article-title":"Rescue of PINK1 Protein Null-Specific Mitochondrial Complex IV Deficits by Ginsenoside Re Activation of Nitric Oxide Signaling","volume":"287","author":"Kim","year":"2012","journal-title":"J. Biol. Chem."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1093\/rheumatology\/keaa636","article-title":"Risk Factors for Herpes Zoster in Patients with Rheumatic Diseases: A Nationwide Cohort Study in Korea","volume":"60","author":"Ryu","year":"2021","journal-title":"Rheumatology"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"103319","DOI":"10.1016\/j.eclinm.2025.103319","article-title":"Effectiveness of Recombinant Zoster Vaccine in Reducing Herpes Zoster Incidence and All-Cause Mortality among Patients with Rheumatoid Arthritis: A Retrospective Cohort Study of 21,046 Individuals from TriNetX U.S. Collaborative Network","volume":"85","author":"Lin","year":"2025","journal-title":"eClinicalMedicine"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"162","DOI":"10.55563\/clinexprheumatol\/cpu6r9","article-title":"Prevention and Management of Herpes Zoster in Patients with Rheumatoid Arthritis and Psoriatic Arthritis: A Clinical Review","volume":"40","author":"Winthrop","year":"2022","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1016\/S2665-9913(24)00019-5","article-title":"Time to Talk to Adults with Rheumatic Diseases about Herpes Zoster Vaccination","volume":"6","author":"Pier","year":"2024","journal-title":"Lancet Rheumatol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1128\/CMR.00040-08","article-title":"Infectious Complications Associated with Monoclonal Antibodies and Related Small Molecules","volume":"22","author":"Salvana","year":"2009","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1016\/j.cmi.2018.02.003","article-title":"ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the Safety of Targeted and Biological Therapies: An Infectious Diseases Perspective (Agents Targeting Lymphoid Cells Surface Antigens [I]: CD19, CD20 and CD52)","volume":"24","author":"Mikulska","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1182\/blood-2018-04-848044","article-title":"Risk of HBV Reactivation in Patients with B-Cell Lymphomas Receiving Obinutuzumab or Rituximab Immunochemotherapy","volume":"133","author":"Kusumoto","year":"2019","journal-title":"Blood"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1136\/annrheumdis-2016-210457","article-title":"Long-Term Safety of Tofacitinib for the Treatment of Rheumatoid Arthritis up to 8.5 Years: Integrated Analysis of Data from the Global Clinical Trials","volume":"76","author":"Cohen","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1002\/art.39670","article-title":"Risk of Herpes Zoster in Autoimmune and Inflammatory Diseases: Implications for Vaccination","volume":"68","author":"Yun","year":"2016","journal-title":"Arthritis Rheumatol."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Li, J., Han, Z.W., Gao, S.S., Guo, Q., and Cang, H.Q. (2025). Risk of Pulmonary Fungal Infections Associated with Biologics: A FAERS Database Disproportionality Analysis. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1672343"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1093\/cid\/ciae444","article-title":"Incidence and Risk Factors for Invasive Fungal Infections in Patients Initiating Tumor Necrosis Factor-Alpha Inhibitors for Inflammatory Bowel Disease and Rheumatoid Arthritis","volume":"80","author":"Hennessee","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1146\/annurev-med-050124-122000","article-title":"Invasive Fungal Infections as a Complication of New Therapies","volume":"77","author":"Pechacek","year":"2026","journal-title":"Annu Rev. Med."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1136\/annrheumdis-2018-214367","article-title":"Risk of Serious Infections in Tocilizumab versus Other Biologic Drugs in Patients with Rheumatoid Arthritis: A Multidatabase Cohort Study","volume":"78","author":"Pawar","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"e1913102","DOI":"10.1001\/jamanetworkopen.2019.13102","article-title":"Risk of Infections and Cancer in Patients with Rheumatologic Diseases Receiving Interleukin Inhibitors: A Systematic Review and Meta-Analysis","volume":"2","author":"Bilal","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/1744666X.2022.2014323","article-title":"The Infection Risks of JAK Inhibition","volume":"18","author":"Adas","year":"2022","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1001\/jama.2019.9055","article-title":"Effect of Filgotinib vs Placebo on Clinical Response in Patients with Moderate to Severe Rheumatoid Arthritis Refractory to Disease-Modifying Antirheumatic Drug Therapy: The FINCH 2 Randomized Clinical Trial","volume":"322","author":"Genovese","year":"2019","journal-title":"JAMA"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"e284","DOI":"10.1016\/S2665-9913(23)00091-7","article-title":"British Isles Lupus Assessment Group Biologics Register (BILAG-BR) consortium Early Infection Risk in Patients with Systemic Lupus Erythematosus Treated with Rituximab or Belimumab from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR): A Prospective Longitudinal Study","volume":"5","author":"Rodziewicz","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.idc.2020.02.010","article-title":"Fungal Infections Potentiated by Biologics","volume":"34","author":"Davis","year":"2020","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1136\/annrheumdis-2013-204960","article-title":"ARTIS Study Group Are Patients with Rheumatoid Arthritis Still at an Increased Risk of Tuberculosis and What Is the Role of Biological Treatments?","volume":"74","author":"Arkema","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.chest.2023.06.014","article-title":"Risk Factors for Nontuberculous Mycobacterial Pulmonary Disease: A Systematic Literature Review and Meta-Analysis","volume":"164","author":"Loebinger","year":"2023","journal-title":"Chest"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.anai.2023.02.010","article-title":"Secondary Immunodeficiencies and Infectious Considerations of Biologic Immunomodulatory Therapies","volume":"130","author":"Cannon","year":"2023","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"89","DOI":"10.4103\/trp.trp_33_24","article-title":"Subclinical Hypothyroidism and Type 2 Diabetes Mellitus: An Update","volume":"20","author":"Singh","year":"2024","journal-title":"Thyroid Res. Pract."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.14309\/ajg.0000000000003465","article-title":"ACG Clinical Guideline: Management of Crohn\u2019s Disease in Adults","volume":"120","author":"Lichtenstein","year":"2025","journal-title":"Am. J. Gastroenterol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00408-022-00528-z","article-title":"Strongyloides Stercoralis","volume":"200","author":"Czeresnia","year":"2022","journal-title":"Lung"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e295","DOI":"10.1016\/S2352-3026(23)00031-5","article-title":"Endemic or Regionally Limited Parasitic and Fungal Infections in Haematopoietic Stem-Cell Transplantation Recipients: A Worldwide Network for Blood and Marrow Transplantation (WBMT) Review","volume":"10","author":"Muhsen","year":"2023","journal-title":"Lancet Haematol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1128\/CMR.17.1.208-217.2004","article-title":"Strongyloides Stercoralis in the Immunocompromised Population","volume":"17","author":"Keiser","year":"2004","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"e291","DOI":"10.1016\/S1473-3099(23)00495-4","article-title":"Guidelines for the Management of Toxoplasma gondii Infection and Disease in Patients with Haematological Malignancies and after Haematopoietic Stem-Cell Transplantation: Guidelines from the 9th European Conference on Infections in Leukaemia, 2022","volume":"24","author":"Aerts","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_118","first-page":"292","article-title":"Toxoplasmosis in Pediatric Hematopoietic Stem Cell Transplantation Patients","volume":"27","author":"Schwenk","year":"2021","journal-title":"Transpl. Cell Ther."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"e202","DOI":"10.1093\/cid\/ciw670","article-title":"Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"63","author":"Aronson","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"e0009923","DOI":"10.1128\/cmr.00099-23","article-title":"Chagas Disease in Immunocompromised Patients","volume":"37","author":"Clark","year":"2024","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/QCO.0000000000001035","article-title":"Chagas Disease in the Immunocompromised Host","volume":"37","author":"Clark","year":"2024","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_122","first-page":"752","article-title":"Recommendations for Infectious Disease Screening in Migrants to Western Europe with Inflammatory Arthropathies before Starting Biologic Agents. Results from a Multidisciplinary Task Force of Four European Societies (SIR, SER, SIMET, SEMTSI) Facing the Largest Impact of the Flow of Migrants Today","volume":"35","author":"Bartalesi","year":"2017","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1136\/annrheumdis-2013-203848","article-title":"The Emerging Problem of Biological Treatment in Migrant and Travelling Populations: It Is Time to Extend Guidelines for the Screening of Infectious Diseases","volume":"73","author":"Bartalesi","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_124","first-page":"587","article-title":"Rheumatological Patients Undergoing Immunosuppressive Treatments and Parasitic Diseases: A Review of the Literature of Clinical Cases and Perspectives to Screen and Follow-up Active and Latent Chronic Infections","volume":"32","author":"Fabiani","year":"2014","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"e2531204","DOI":"10.1001\/jamanetworkopen.2025.31204","article-title":"Comparative Safety of JAK Inhibitors vs TNF Antagonists in Immune-Mediated Inflammatory Diseases: A Systematic Review and Meta-Analysis","volume":"8","author":"Solitano","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s13075-015-0583-8","article-title":"Head-to-Head Comparison of the Safety of Tocilizumab and Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis Patients (RA) in Clinical Practice: Results from the Registry of Japanese RA Patients on Biologics for Long-Term Safety (REAL) Registry","volume":"17","author":"Sakai","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1002\/cpt.70172","article-title":"Serious Infection Risk with TNF Inhibitors vs. JAK Inhibitors in Rheumatoid Arthritis: A Nationwide Claims-Based Cohort Study","volume":"119","author":"Ota","year":"2026","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_128","first-page":"3834","article-title":"Risk of Serious Infections in Arthritis Patients Treated with Biological Drugs: A Matched Cohort Study and Development of Prediction Model","volume":"60","author":"Krabbe","year":"2021","journal-title":"Rheumatology"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/j.cgh.2018.12.032","article-title":"Safety of Biologic Therapy in Older Patients with Immune-Mediated Diseases: A Systematic Review and Meta-Analysis","volume":"17","author":"Borren","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S2468-1253(22)00317-X","article-title":"Global Prevalence of Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis in the Overweight and Obese Population: A Systematic Review and Meta-Analysis","volume":"8","author":"Quek","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"keaf644","DOI":"10.1093\/rheumatology\/keaf644","article-title":"Development and Validation of a Predictive Model for the Risk of Serious Infection in Patients with Rheumatoid Arthritis Initiating a Biologic or Targeted Synthetic DMARD: A Nationwide Cohort Study","volume":"65","author":"Abboud","year":"2026","journal-title":"Rheumatology"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"e724","DOI":"10.1016\/S2665-9913(21)00247-2","article-title":"COVID-19 and Immune-Mediated Inflammatory Diseases: Effect of Disease and Treatment on COVID-19 Outcomes and Vaccine Responses","volume":"3","author":"Fagni","year":"2021","journal-title":"Lancet Rheumatol."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1513\/AnnalsATS.202212-1019ST","article-title":"Immunocompromised Host Pneumonia: Definitions and Diagnostic Criteria: An Official American Thoracic Society Workshop Report","volume":"20","author":"Cheng","year":"2023","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1093\/rheumatology\/kez530","article-title":"Overall Infection Risk in Rheumatoid Arthritis during Treatment with Abatacept, Rituximab and Tocilizumab; an Observational Cohort Study","volume":"59","author":"Glintborg","year":"2020","journal-title":"Rheumatology"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1001\/jama.2018.13103","article-title":"Diagnosis and Management of Rheumatoid Arthritis: A Review","volume":"320","author":"Aletaha","year":"2018","journal-title":"JAMA"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1093\/cid\/ciaf491","article-title":"Prevention of Tuberculosis in Patients Treated with Biological Therapies: 20 Years\u2019 Experience in a Specialized Tuberculosis Clinic in a Low-Prevalence Country","volume":"82","author":"Guardiola","year":"2026","journal-title":"Clin. Infect. Dis."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/S0140-6736(22)01468-4","article-title":"Hepatitis B","volume":"401","author":"Jeng","year":"2023","journal-title":"Lancet"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"3698","DOI":"10.1200\/JCO.20.01757","article-title":"Hepatitis B Virus Screening and Management for Patients with Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update","volume":"38","author":"Hwang","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_139","first-page":"515","article-title":"Rheumatoid Arthritis: Diagnosis and Management for the Family Physician","volume":"110","author":"Peterson","year":"2024","journal-title":"Am. Fam. Physician"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/j.semarthrit.2020.03.003","article-title":"RISE Registry Reveals Potential Gaps in Medication Safety for New Users of Biologics and Targeted Synthetic DMARDs","volume":"50","author":"Schmajuk","year":"2020","journal-title":"Semin Arthritis Rheum."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/acr.25045","article-title":"2022 American College of Rheumatology Guideline for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases","volume":"75","author":"Bass","year":"2023","journal-title":"Arthritis Care Res."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1136\/annrheumdis-2019-215882","article-title":"2019 Update of EULAR Recommendations for Vaccination in Adult Patients with Autoimmune Inflammatory Rheumatic Diseases","volume":"79","author":"Furer","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1002\/art.42372","article-title":"American College of Rheumatology Guidance for COVID-19 Vaccination in Patients with Rheumatic and Musculoskeletal Diseases: Version 5","volume":"75","author":"Curtis","year":"2023","journal-title":"Arthritis Rheumatol."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1016\/j.chest.2020.05.558","article-title":"Risk Factors and Prevention of Pneumocystis jirovecii Pneumonia in Patients with Autoimmune and Inflammatory Diseases","volume":"158","author":"Ghembaza","year":"2020","journal-title":"Chest"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1016\/j.dld.2017.09.002","article-title":"Screening, Prophylaxis and Counselling before the Start of Biological Therapies: A Practical Approach Focused on IBD Patients","volume":"49","author":"Abreu","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.jaad.2018.11.057","article-title":"Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Biologics","volume":"80","author":"Menter","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"i1927","DOI":"10.1093\/ecco-jcc\/jjae190.1219","article-title":"\u201cAssiut Tropical IBD Study Group\u201d (ATISG) P1045 Treat-Smart Study: Leveraging Individual Inflammatory Markers for Personalized Therapy in Patients with IBD","volume":"19","author":"Medhat","year":"2025","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1001\/jama.2021.4172","article-title":"Effect of Therapeutic Drug Monitoring vs Standard Therapy During Infliximab Induction on Disease Remission in Patients with Chronic Immune-Mediated Inflammatory Diseases: A Randomized Clinical Trial","volume":"325","author":"Syversen","year":"2021","journal-title":"JAMA"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1053\/j.gastro.2019.09.041","article-title":"HLA-DQA1*05 Carriage Associated with Development of Anti-Drug Antibodies to Infliximab and Adalimumab in Patients with Crohn\u2019s Disease","volume":"158","author":"Sazonovs","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Xu, H., Xu, L., Jiang, S., Yu, Y., and Zhao, H. (2025). Multi-Omics-Driven Biomarker Discovery in Autoimmune Diseases: A Comprehensive Review. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1652211"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"116530","DOI":"10.1016\/j.intimp.2026.116530","article-title":"Next 5 Years in Autoimmunity: Predictive Diagnostics, Immune Signatures, and Personalized Immune Therapy","volume":"179","author":"Usmani","year":"2026","journal-title":"Int. Immunopharmacol."},{"key":"ref_152","first-page":"CD012437","article-title":"Biologic or Tofacitinib Monotherapy for Rheumatoid Arthritis in People with Traditional Disease-Modifying Anti-Rheumatic Drug (DMARD) Failure: A Cochrane Systematic Review and Network Meta-Analysis (NMA)","volume":"11","author":"Singh","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/BOR.0000000000000995","article-title":"Long-Term Safety of Biologic and Targeted Synthetic Disease Modifying Drugs in Rheumatology","volume":"36","author":"Barth","year":"2024","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_154","doi-asserted-by":"crossref","unstructured":"De Queiroz, M.J., de Castro, C.T., Albuquerque, F.C., Brand\u00e3o, C.C., Gerlack, L.F., Pereira, D.C.R., Barros, S.C., Andrade, W.W., Bastos, E.d.A., and Azevedo, J.d.N.B. (2022). Safety of Biological Therapy in Patients with Rheumatoid Arthritis in Administrative Health Databases: A Systematic Review and Meta-Analysis. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.928471"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1016\/j.jid.2021.02.743","article-title":"New Frontiers in Psoriatic Disease Research, Part II: Comorbidities and Targeted Therapies","volume":"141","author":"Yan","year":"2021","journal-title":"J. Investig. Dermatol."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/6\/1250\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:40:10Z","timestamp":1780396810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/6\/1250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":155,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["microorganisms14061250"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14061250","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]}}}