The biological drugs have all been successfully used to treat rheumatoid arthritis (RA)
and have led to fair rates of clinical remission; however, the possible occurrence of adverse events
such as infectious diseases or cancers means that the patients undergoing treatment need to be
closely monitored. Anti-TNF agents, first appeared in the pharmacological algorithm of RA in the
early 2000s, seem to lead to a higher risk of reactivated tubercular infection than the biological
agents with different mechanism of action (abatacept or rituximab). Although the data on anti-TNF
agents and cancer are controversial, their use is currently not recommended in neoplastic patients
because of their uncertain effects on immune-surveillance. The safety profile of abatacept is similar
to that of other biological agents, while rituximab is used to treat non-Hodgkin lymphomas and is
also considered in the case of RA patients with previous hematological or non-hematological malignancies.
The risk of infections and new-onset cancers during tocilizumab treatment is similar to
that associated with other biological therapies. Finally, under particular circumstances, such as in
the presence of infections or malignancies, blocking a specific immunological pathway may be simultaneously
successful and detrimental. The only thing that can be done at the moment is to continue
to look for adverse events in order to discover these complications as soon as possible, and
then develop the most appropriate means of treating (and even preventing) them.
Keywords: Abatacept, anti-TNF agents, biological agents, infections, malignancies, rituximab, tocilizumab.
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