Abstract
Monoclonal antibodies have different pharmacological and immunological modes of actions and targets and can be used to treat many diseases. In auto-immune diseases monoclonal antibodies can be used to disrupt pro-inflammatory pathways and thereby suppressing auto-immune reactions. Because of this, patients have an increased infection risk during treatment with these biologicals. Infectious complications of monoclonal antibodies in oncology predominantly occur in hemato102 oncology patients where monoclonal antibodies are used to deplete immune cells. Monoclonal antibodies that interfere in allergy pathways can also cause infections. For the safe application of these biologicals a risk assessment of potential infectious complications is required since a part of these complications can be mitigated by adequate screening and antimicrobial prophylaxis. Conversely, the (composition of the) gut microbiome can also affect efficacy of monoclonal antibody therapy, predominantly for antibodies in which Fc-effector functions are required for therapeutic efficacy. Infusion reactions to monoclonal antibodies are also immunological adverse events since these are mostly due to the cytokine-release syndrome. Routine prophylaxis is recommended for drugs with a high incidence of infusion reactions.