The development of biologic therapies targeting proinflammatory mediators has led to significant advances in the treatment of immune-mediated inflammatory diseases (IMIDs). Blocking undesired inflammatory effects also has the potential to disrupt the body's immune response and increase the risk for infections, including fungal infections. This review summarizes the published data on the frequency and risk for fungal infections among patients treated with biologics, with a focus on the newer therapies approved for use with IMIDs in the last 10 years. The use of biologics is associated with a small but important risk of fungal infections. Pneumocystis jirovecii pneumonia, histoplasmosis, and candidiasis are some of the most common fungal infections associated with biologics. Providers should be vigilant for fungal infection among patients taking biologics, be aware that biologic agents may alter the typical presentation of fungal infections, and take timely steps to diagnose and treat fungal infection to reduce resultant morbidity and mortality.
Keywords: Abatacept; Anakinra; Aspergillosis; Biologics; Candidiasis; Coccidioidomycosis; Cryptococcosis; Fungal infections; Histoplasmosis; Incidence; Ixekizumab; Prevention; Risk; Rituximab; Secukinumab; TNF-alpha inhibitors; Tocilizumab; Tofacitinib; Ustekinumab; Vedolizumab.