Version July 2025
| Medication | Effect on immune system | Associated infections* | Pre-treatment testing¶ | Pre-treatment vaccinationsΔ | Comments |
| IL-1 inhibitors | |||||
| Anakinra | Inhibits IL-1 and prevents activation of proinflammatory cytokine pathways | Bacterial:
Viral:
Fungal:
| Test for:
|
|
|
| Canakinumab | |||||
| Rilonacept | |||||
| IL-6 inhibitors | |||||
| Sarilumab | Inhibits IL-6 and prevents proinflammatory cytokine release | Bacterial:
Viral:
Fungal:
| Test for:
|
| |
| Tocilizumab | |||||
| IL-17 inhibitors | |||||
| Secukinumab (IL-17) | Inhibits IL-17 and prevents release of proinflammatory cytokines | Bacterial:
Fungal:
| Test for:
|
| |
| Ixekizumab (IL-17) | |||||
| Brodalumab (IL-17) Bimekizumab (IL-17) | |||||
| IL-12 and IL-23 inhibitors | |||||
| Ustekinumab (IL-12, IL-23) | Inhibits IL-12 and IL23 and interferes with NK cell activation and CD4 T cell differentiation | Fungal:
| Test for:◊
|
| |
| Guselkumab (IL-23) | Inhibits IL-23 and prevents proinflammatory cytokine release | ||||
| Risankizumab (IL-23) | Binds to the p19 subunit of IL-23 and inhibits its interaction with the IL-23 receptor | Bacterial:
Fungal:
| Test for:§
| ||
HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; IL: interleukin; NK cells: natural killer cells; RZV: recombinant (non-live) zoster vaccine (Shingrix); TBI: latent tuberculosis infection.
* In addition to the infections listed, typical, common bacterial and viral infections should also be considered in the differential when infection is suspected in a patient taking the specified agent.
¶ For patients who do not have a negative HIV test documented in their records or are at increased risk of acquiring HIV (eg, men who have sex with men, engagement in sex work), the pre-treatment infectious testing process is a good opportunity to provide routine HIV screening prior to the initiation of immunosuppression. Treat any latent or active infections found on pre-treatment testing. Control of infection should be demonstrated prior to initiating immunosuppressive therapy.
Δ Live and non-live vaccines should be administered no later than 4 and 2 weeks, respectively, prior to initiating therapy. Vaccine responses may be attenuated while on therapy.
◊ Although the drug labels for these agents warns that the risk of TBI and HBV reactivation may be increased, post-marketing data has not shown a significantly increased risk of infection with these agents. Nevertheless, we continue to test for these infections because the benefit of testing outweighs the harms.
§ Risankizumab (an IL-23 inhibitor) appears to have a lower risk for HBV and HCV reactivation compared with guselkumab or ustekinumab, thus we do not test for HBV or HCV in patients starting risankizumab.