A basic understanding and review of immunosuppression is crucial for all healthcare providers who care for patients taking biologic therapies. Two types of immunosuppression include primary and secondary, or acquired immunosuppression. Acquired immunodeficiency has many causes such as malnutrition, HIV/AIDS, and those who take drugs to suppress the immune system. Transplant recipients, chemo patients and those who take biologics are all examples of acquired immunodeficiency.

Biologic medications are now commonplace - used all over the world and increasing rapidly. These drugs have greatly improved the management of several diseases and conditions. The majority of these new biologics are monoclonal antibodies or MABs. These MABs may be further classified as anti-tumor necrosis factor alfa drugs (anti-TNF-alpha), which carry the greatest risk of adverse effects due to immunosuppression. Patients on biologics – especially MABs and anti-TNF-alpha drugs are immunnosuppressed and should be managed as such. Several drugs have black box warnings – mostly related to TB, lymphomas and serious bacterial and fungal respiratory infections.

The nurse should always be thinking immunosuppression when managing patients on biologics, no matter what the admitting diagnosis is. Thorough assessment of the patient’s medical history and medications are crucial in determining patient needs and education. The care plan should always indicate "risk for infection due to immunodeficiency" so continuity of care and appropriate education can be implemented. Since new black box warnings and recommendations are frequently updated by the FDA – sometimes years after the drug has been on the market, biologic medications must be continuously reviewed prior to administration.

Because these patients are not always placed on isolation, nurses must advocate for patients to prevent hospital acquired infections while hospitalized in terms of in-unit bed placement and staff assignments. Patient education should always include a review of the biologics, what to report, and empowering patients to advocate for themselves so they can make others aware of their immunosuppressive status.

Biologic MAB


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