Innovative antirheumatic drugs and infections: Problems and solutions

In recent decades, there has been clear progress in rheumatology related to the introduction of genetically engineered biological disease-modifying antirheumatic drugs (bDMARDs) and targeted disease-modifying antirheumatic drugs (tDMARDs) into practice. At the same time, the use of these drugs is associated with an increasing risk of developing infections of a diverse nature and localization, including opportunistic ones, as well as an increased risk of reactivation of latent infection, primarily tuberculosis (TB). In addition, cases of severe infections (pneumonia, sepsis, bacterial arthritis, skin and soft tissue lesions, etc.), including fatal ones, have been reported. To date, the mechanisms underlying the increasing risk of infectious complications associated with the use of b/tDMARDs have not been fully recognized. Within the framework of this narrative (non-systematic) review, modern data on the frequency and localization of major infections in rheumatological patients treated with various b/tDMARDs are presented. The need for wider use of immunization with various vaccines (primarily against influenza and pneumococcal infection) in patients with immuno-inflammatory rheumatic diseases is emphasized. In preparing the review, the authors conducted an exhaustive literature search (mainly in English) in MEDLINE databases (via PubMed) for the following keywords: “biologics/rheumatic diseases AND infection”, “tumor necrosis factor-α antagonists/rheumatic diseases AND infection”, “targeted synthetic disease modifying antirheumatic drugs/rheumatic diseases AND infection” with preferential selection of national and international registers, systematic reviews and meta-analyses. The materials of two major annual international rheumatological forums held under the auspices of the European Alliance of Rheumatology Associations (EULAR) and the American College of Rheumatology (ACR) were also reviewed. After eliminating duplicate materials, 168 relevant sources were selected for further analysis.

1. Krabbe S, Grøn KL, Glintborg B, Nørgaard M, Mehnert F, Jarbøl DE et al.. Risk of serious infections in arthritis patients treated with biological drugs: a matched cohort study and development of prediction model. Rheumatology. 2021;60(8):3834–3844. https://doi.org/10.1093/rheumatology/keaa876.

2. Salliot C, Gossec L, Ruyssen-Witrand A, Luc M, Duclos M et al. Infections during tumour necrosis factor-alpha blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients. Rheumatology. 2007;46(2):327–334. https://doi.org/10.1093/rheumatology/kel236.

3. Kroesen S, Widmer AF, Tyndall A, Hasler P. Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy. Rheumatology. 2003;42(5):617–621. https://doi.org/10.1093/rheumatology/keg263.

4. Zheng B, Liu M, Dai D, Shang Y, Dou X, Liu B et al. Safety of TNF-α inhibitors: A real-world study based on the US FDA Adverse Event Reporting System Database. Medicine. 2024;103(29):e39012. https://doi.org/10.1097/MD.0000000000039012.

5. Curtis JR, Patkar N, Xie A, Martin C, Allison JJ, Saag M et al. Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor alpha antagonists. Arthritis Rheum. 2007;56(4):1125–1133. https://doi.org/10.1002/art.22504.

6. Minozzi S, Bonovas S, Lytras T, Pecoraro V, González-Lorenzo M, Bastiampillai AJ et al. Risk of infections using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a systematic review and meta-analysis. Expert Opin Drug Saf. 2016;15(Suppl. 1):11–34. https://doi.org/10.1080/14740338.2016.1240783.

7. Cohen SB, Emery P, Greenwald MW, Dougados M, Furie RA, Genovese MC et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum. 2006;54(9):2793–2806. https://doi.org/10.1002/art.22025.

8. Winthrop KL, Saag K, Cascino MD, Pei J, John A, Jahreis A et al. Long-Term Safety of Rituximab in Rheumatoid Arthritis: Analysis From the SUNSTONE Registry. Arthritis Care Res. 2018;71(8):993–1003. https://doi.org/10.1002/acr.23781.

9. Mariette X, Gottenberg JE, Ravaud P, Combe B. Registries in rheumatoid arthritis and autoimmune diseases: data from the French registries. Rheumatology. 2011;50(1):222–229. https://doi.org/10.1093/rheumatology/keq368.

10. Gottenberg JE, Ravaud P, Cacoub P, Bardin T, Cantagrel AG, Combe B et al. The rate of serious infections remains stable in patients with multiple retreatments in real life: data from the Autoimmunity and rituximab: (AIR) registry. Arthritis Rheum. 2013;65(Suppl. 10):606–607.

11. Diaz-Lagares C, Perez-Alvarez R, Garcia-Hernandez FJ, Ayala-Gutiérrez MM, Callejas JL, Martínez-Berriotxoa A et al. Rates of, and risk factors for, severe infections in patients with systemic autoimmune diseases receiving biological agents off-label. Arthritis Res Ther. 2011;13(4):R112. https://doi.org/10.1186/ar3397.

12. Ananieva LP, Soloviyov SK, Beketova TV, Vasiliev VI, Antelava OA, Aleksandrova EN et al. Anti-B-cell therapy at immune inflammatory rheumatic diseases: efficacy and tolerability in 229 patients. Rheumatology Science and Practice. 2014;52(5):495–506 (In Russ.) https://doi.org/10.14412/1995-4484-2014-495-506.

13. Merrill J, Buyon J, Furie R, Latinis K, Gordon C, Hsieh HJ, Brunetta P. Assessment of flares in lupus patients enrolled in a phase II/III study of rituximab (EXPLORER). Lupus. 2011;20(7):709–716. https://doi.org/10.1177/0961203310395802.

14. Rovin BH, Furie R, Latinis K, Looney RJ, Fervenza FC, Sanchez-Guerrero J et al. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study. Arthritis Rheum. 2012;64(4):1215–1226. https://doi.org/10.1002/art.34359.

15. Charles P, Neel A, Tieulie N, Hot A, Pugnet G, Decaux O et al. Rituximab for induction and maintenance treatment of ANCA-associated vasculitides: a multicentre retrospective study on 80 patients. Rheumatology. 2014;53(3):532–539. https://doi.org/10.1093/rheumatology/ket381.

16. Beketova TV, Aleksandrova EN, Novoselova TM, Sazhina EG, Nikolaeva EV, Smirnov AV et al. Russian experience with using monoclonal antibodies to B-lymphocytes (rituximab) in systemic vasculitides associated with neutrophil cytoplasmic antibodies (preliminary results of the Russian Register NORMA). Rheumatology Science and Practice. 2014;52(2):147–158. (In Russ.) https://doi.org/10.14412/1995-4484-2014-147-158.

17. Wu C, Wang Y, Chen S, Lin Y, Du F, Wang X et al. Obinutuzumab in systemic lupus erythematosus: a real-world experience. Front Immunol. 2025;16:1702550. https://doi.org/10.3389/fimmu.2025.1702550.

18. Zhao Y, Chi G, Xia S, Wang X, Fan Y, Ma C et al. Infectious complications of Belimumab with standard care in systemic lupus erythematosus: a systematic review and meta-analysis. Semin Arthritis Rheum. 2025;73:152754. https://doi.org/10.1016/j.semarthrit.2025.152754.

19. Weinblatt ME, Moreland LW, Westhovens R, Cohen RB, Kelly SM, Khan N et al. Safety of abatacept administered intravenously in treatment of rheumatoid arthritis: integrated analyses of up to 8 years of treatment from the abatacept clinical trial program. J Rheumatol. 2013;40(6):787–797. https://doi.org/10.3899/jrheum.120906.

20. Salmon JH, Gottenberg JE, Ravaud P, Cantagrel A, Combe B, Flipo RM et al. Predictive risk factors of serious infections in patients with rheumatoid arthritis treated with abatacept in common practice: results from the Orencia and Rheumatoid Arthritis (ORA) registry. Ann Rheum Dis. 2016;75(6):1108–1113. https://doi.org/10.1136/annrheumdis-2015-207362.

21. Sibilia J, Westhovens R. Safety of T-cell co-stimulation modulation with abatacept in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2007;(Suppl. 46):46–56. Available at: https://pubmed.ncbi.nlm.nih.gov/17977488.

22. Schiff MN. Abatacept treatment for rheumatoid arthritis. Rheumatology. 2011;50(3):437–449. https://doi.org/10.1093/rheumatology/keq287.

23. Schiff MN Subcutaneous abatacept for the treatment of rheumatoid arthritis. Rheumatology. 2013;52(6):986–997. https://doi.org/10.1093/rheumatology/ket018.

24. Koike T, Harigai M, Inokuma S, Ishiguro N, Ryu J, Takeuchi T et al. Effectiveness and safety of tocilizumab: postmarketing surveillance of 7901 patients with rheumatoid arthritis in Japan. J Rheumatol. 2014;41(1):15–23. https://doi.org/10.3899/jrheum.130466.

25. Koike R, Harigai M, Atsumi T, Amano K, Kawai S, Saito K et al. Japan College of Rheumatology 2009 guidelines for the use of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, in rheumatoid arthritis. Mod Rheumatol. 2009;19(4):351–357. https://doi.org/10.1007/s10165-009-0197-6.

26. Fujiwara H, Nishimoto N, Hamano Y, Asanuma N, Miki S, Kasayama S, Suemura M. Masked early symptoms of pneumonia in patients with rheumatoid arthritis during tocilizumab treatment: a report of two cases. Mod Rheumatol. 2009;19(1):64–68. https://doi.org/10.1007/s10165-008-0111-7.

27. Akatova EV, Bakhareva YuS, Bugrova OV, Vinogradova IB, Gerasimova EV, Drevina Yu et al. Comparative study of the clinical efficacy of the first domestic bioanalogue of tocilizumab based on the results of a randomized clinical trial of phase III. Sovremennaya Revmatologiya. 2024;18(6):36–45. (In Russ.) https://doi.org/10.14412/1996-7012-2024-6-36-45.

28. Genovese MC, Fleischmann R, Kivitz AJ, Rell-Bakalarska M, Martincova R, Fiore S et al. Sarilumab plus methotrexate in patients with active rheumatoid arthritis and inadequate response to methotrexate: results of a phase III study. Arthritis Rheumatol. 2015;67(6):1424–1437. https://doi.org/10.1002/art.39093.

29. Fleischmann R, Genovese MC, Lin Y, St John G, van der Heijde D, Wang S et al. Long-term safety of sarilumab in rheumatoid arthritis: an integrated analysis with up to 7 years’ follow-up. Rheumatology. 2020;59(2):292–302. https://doi.org/10.1093/rheumatology/kez265.

30. McKeage K. Ustekinumab: a review of its use in psoriatic arthritis. Drugs. 2014;74(9):1029–1039. https://doi.org/10.1007/s40265-014-0242-4.

31. Kalb RE, Fiorentino DF, Lebwohl MG, Toole J, Poulin Y, Cohen AD et al. Risk of Serious Infection With Biologic and Systemic Treatment of Psoriasis: Results From the Psoriasis Longitudinal Assessment and Registry (PSOLAR). JAMA Dermatol. 2015;151(9):961–969. https://doi.org/10.1001/jamadermatol.2015.0718.

32. Park SK, Ahuja D, Yeh KH, Patel SB, Goodwin SW, Ma C et al. Comparative Safety of Advanced Therapies for Crohn Disease. JAMA Netw Open. 2026;9(2):e2557922. https://doi.org/10.1001/jamanetworkopen.2025.57922.

33. He C, Xue C, Zhu G, Kang P. Efficacy and safety of interleukin-17 inhibitors in the treatment of chronic rheumatic diseases: A combined and updated meta-analysis. J Clin Pharm Ther. 2021;46(4):895–906. https://doi.org/10.1111/jcpt.13416.

34. Schwarz CW, Näslund-Koch C, Zachariae C, Seidelin JB, Nielsen SD, Ostrowski SR et al. Adverse Events and Immune Response in Psoriasis Patients Receiving Interleukin-17 Inhibitors. Acta Derm Venereol. 2025;105:adv43685. https://doi.org/10.2340/actadv.v105.43685.

35. Baeten D, Sieper J, Braun J, Baraliakos X, Dougados M, Emery P et al. Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis. N Engl J Med. 2015;373(26):2534–2548. https://doi.org/10.1056/NEJMoa1505066.

36. Langley RG, Elewski BE, Lebwohl M, Reich K, Griffiths CE, Papp K et al. Secukinumab in plaque psoriasis – results of two phase 3 trials. N Engl J Med. 2014;371(4):326–338. https://doi.org/10.1056/NEJMoa1314258.

37. McInnes IB, Mease PJ, Kirkham B, Kavanaugh A, Ritchlin CT, Rahman P et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;386(9999):1137–1146. https://doi.org/10.1016/S0140-6736(15)61134-5.

38. Blauvelt A, Lebwohl MG, Mabuchi T, Leung A, Garrelts A, Crane H et al. Long-term efficacy and safety of ixekizumab: A 5-year analysis of the UNCOVER-3 randomized controlled trial. J Am Acad Dermatol. 2021;85(2):360–368. https://doi.org/10.1016/j.jaad.2020.11.022.

39. Bright HRB, Phan DB, Zahid A, Motedayen Aval L, Manupati S, Smith CH et al. Serious Infection Risk with Systemic Treatments for Psoriasis: A Systematic Review and Network Meta-analysis Combining Randomised and Non-randomised Evidence. Dermatol Ther. 2026;16(1):191–204. https://doi.org/10.1007/s13555-025-01578-w.

40. Cohen SB, Tanaka Y, Mariette X, Curtis JR, Lee EB, Nash P et al. Long-term safety of tofacitinib up to 9.5 years: a comprehensive integrated analysis of the rheumatoid arthritis clinical development programme. RMD Open. 2020;6(3):e001395. https://doi.org/10.1136/mdopen2020–001395.

41. Winthrop KL, Harigai M, Genovese MC, Lindsey S, Takeuchi T, Fleischmann R et al. Infections in baricitinib clinical trials for patients with active rheumatoid arthritis. Ann Rheum Dis. 2020;79(10):1290–1297. https://doi.org/10.1136/annrheumdis2019-216852.

42. Burmester GR, Cohen SB, Winthrop KL, Nash P, Irvine AD, Deodhar A et al. Safety profile of upadacitinib over 15 000 patient-years across rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and atopic dermatitis. RMD Open. 2023;9(1):e002735. https://doi.org/10.1136/rmdopen-2022-002735.

43. Tubach F, Salmon D, Ravaud P, Allanore Y, Goupille P, Bréban M et al. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French research axed on tolerance of biotherapies registry. Arthritis Rheum. 2009;60(7):1884–1894. https://doi.org/10.1002/art.24632.

44. Лукина ГВ, Борисов СЕ. Скрининг и мониторинг туберкулезной инфекции у больных ревматическими заболеваниями, получающих генно-инженерные биологические препараты. В: Насонов ЕЛ (ред.). Российские клинические рекомендации. Ревматология. М.: ГЭОТАР-Медиа; 2020. С. 396–412.

45. Борисов СЕ, Слогоцкая ЛВ, Лукина ГВ, Гунтупова ЛД, Фомина ТА, Фролова КС, Львов АН. Скрининг и мониторинг туберкулезной инфекции у больных, получающих иммуносупрессивные генно-инженерные биологические препараты. М.; 2019. 33 с.

46. Listing J, Strangfeld A, Kary S, Rau R, von Hinueber U, Stoyanova-Scholz M et al. Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum. 2005;52(11):3403–3412. https://doi.org/10.1002/art.21386.

47. Lane MA, McDonald JR, Zeringue AL, Kaplan L, Curtis JR, Ranganathan P, Eisen SA. TNF-α antagonist use and risk of hospitalization for infection in a national cohort of veterans with rheumatoid arthritis. Medicine. 2011;90(2):139–145. https://doi.org/10.1097/MD.0b013e318211106a.

48. Van Vollenhoven RF, Emery P, Bingham CO, Keystone E, Fleischmann R, Furst D et al. SAT0131 Long-term safety of rituximab: pooled analysis of the rheumatoid arthritis global clinical trial program over 11 years. Ann Rheum Dis. 2013;72(Suppl. 3):A625–A626. https://doi.org/10.1136/ann-rheumdis-2013-eular.1857.

49. Yun H, Xie F, Delzell E, Levitan EB, Chen L, Lewis JD et al. Comparative Risk of Hospitalized Infection Associated With Biologic Agents in Rheumatoid Arthritis Patients Enrolled in Medicare. Arthritis Rheumatol. 2016;68(1):56–66. https://doi.org/10.1002/art.39399.

50. Ward MM, Donald F. Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality. Arthritis Rheum. 1999;42(4):780–789. Available at: https://pubmed.ncbi.nlm.nih.gov/10211894.

51. Sonomoto K, Tanaka H, Nguyen TM, Yoshinari H, Nakano K, Nakayamada S et al. Prophylaxis against pneumocystis pneumonia in rheumatoid arthritis patients treated with b/tsDMARDs: insights from 3787 cases in the FIRST registry. Rheumatology. 2022;61(5):1831–1840. https://doi.org/10.1093/rheumatology/keab647.

52. Belov BS, Abdurakhmanov DT. Hepatitis B virus and rheumatic diseases. Rheumatology Science and Practice. 2020;58(2):207–213. (In Russ.) https://doi.org/10.14412/1995-4484-2020-207-213.

53. Ridola L, Zullo A, Laganà B, Lorenzetti R, Migliore A, Pica R et al. Hepatitis B (HBV) reactivation in patients receiving biologic therapy for chronic inflammatory diseases in clinical practice. Ann Ist Super Sanita. 2021;57(3):244–248. https://doi.org/10.4415/ANN_21_03_08.

54. Perrillo RP, Gish R, Falck-Ytter YT. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148(1):221–244. https://doi.org/10.1053/j.gastro.2014.10.038.

55. Gridneva GI, Belov BS, Aronova ES. Chronic viral hepatitis B and rheumatic diseases: Modern view on problem. Medical Alphabet. 2022;(29):20–28. (In Russ.) https://doi.org/10.33667/2078-5631-2022-29-20-28.

56. Hou KC, Su TH, Kao CN, Cheng HR, Tseng TC, Liu CJ et al. Rituximab carries high risks of hepatitis B virus reactivation in hematologic and rheumatic patients with chronic or resolved hepatitis B. J Gastroenterol Hepatol. 2024;39(11):2447–2455. https://doi.org/10.1111/jgh.16725.

57. Sisi W, Sheng D, Yuting H, Rong Y, Shao L. A real-world safety analysis of infection-related adverse events associated with belimumab, rituximab, and TNF inhibitors using the FAERS database. Sci Rep. 2025;15(1):43048. https://doi.org/10.1038/s41598-025-26999-7.

58. Belov BS, Muravyeva NV, Tarasova GM. Regarding the problem of viral hepatitis reactivation in rheumatic diseases: risks and curation issues. Meditsinskiy Sovet. 2020;(19):98–106. (In Russ.) https://doi.org/10.21518/2079-701X-2020-19-98-106.

59. Chiu HY, Hui RC, Huang YH, Huang RY, Chen KL, Tsai YC et al. Safety Profile of Secukinumab in Treatment of Patients with Psoriasis and Concurrent Hepatitis B or C: A Multicentric Prospective Cohort Study. Acta Derm Venereol. 2018;98(9):829–834. https://doi.org/10.2340/00015555-2989.

60. Inanc N, Direskeneli H. Serious infections under treatment with TNF-alpha antagonists compared to traditional DMARDs in patients with rheumatoid arthritis. Rheumatol Int. 2006;27(1):67–71. https://doi.org/10.1007/s00296-006-0165-9.

61. Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, Zink A. Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA. 2009;301(7):737–744. https://doi.org/10.1001/jama.2009.146.

62. Che H, Lukas C, Morel J, Combe B. Risk of herpes/herpes zoster during antitumor necrosis factor therapy in patients with rheumatoid arthritis. Systematic review and meta-analysis. Joint Bone Spine. 2014;81(3):215–221. https://doi.org/10.1016/j.jbspin.2013.07.009.

63. Cohen S, Radominski SC, Gomez-Reino JJ, Wang L, Krishnaswami S, Wood SP et al. Analysis of infections and all-cause mortality in phase II, phase III, and long-term extension studies of tofacitinib in patients with rheumatoid arthritis. Arthritis Rheum. 2014;66(11):2924–2937. https://doi.org/10.1002/art.38779.

64. Curtis JR, Xie F, Yun H, Bernatsky S, Winthrop KL. Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis. Ann Rheum Dis. 2016;75(10):1843–1847. https://doi.org/10.1136/annrheumdis-2016-209131.

65. Winthrop KL, Harigai M, Genovese MC, Lindsey S, Takeuchi T, Fleischmann R et al. Infections in baricitinib clinical trials for patients with active rheumatoid arthritis. Ann Rheum Dis. 2020;79(10):1290–1297. https://doi.org/10.1136/annrheumdis-2019–216852.

66. Frisell T, Bower H, Morin M, Baecklund E, Di Giuseppe D, Delcoigne B et al. Safety of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis as used in clinical practice: results from the ARTIS programme. Ann Rheum Dis. 2023;82(5):601–610. https://doi.org/10.1136/ard-2022-223762.

67. Cohen SB, van Vollenhoven RF, Winthrop KL, Zerbini CAF, Tanaka Y, Bessette L et al. Safety profile of upadacitinib in rheumatoid arthritis: integrated analysis from the SELECT phase III clinical programme. Ann Rheum Dis. 2021;80(3):304–311. https://doi.org/10.1136/annrheumdis-2020-218510.

68. Atzeni F, Talotta R, Nucera V, Marino F, Gerratana E, Sangari D et al. Adverse events, clinical considerations and management recommendations in rheumatoid arthritis patients treated with JAK inhibitors. Expert Rev Clin Immunol. 2018;14(11):945–956. https://doi.org/10.1080/1744666X.2018.1504678.

69. Almanzar G, Kienle F, Schmalzing M, Maas A, Tony HP, Prelog M et al. Tofacitinib modulates the VZV-specific CD 4+ T cell immune response in vitro in lymphocytes of patients with rheumatoid arthritis. Rheumatology. 2019;58(11):2051–2060. https://doi.org/10.1093/rheumatology/kez175.

70. Vital EM, Merrill JT, Morand EF, Furie RA, Bruce IN, Tanaka Y et al. Anifrolumab efficacy and safety by type I interferon gene signature and clinical subgroups in patients with SLE: post hoc analysis of pooled data from two phase III trials. Ann Rheum Dis. 2022;81(7):951–961. https://doi.org/10.1136/annrheumdis-2021-221425.

71. Bennett CL, Focosi D, Socal MP, Bian JC, Nabhan C, Hrushesky WJ et al. Progressive multifocal leukoencephalopathy in patients treated with rituximab: a 20-year review from the Southern Network on Adverse Reactions. Lancet Haematol. 2021;8(8):e593–e604. https://doi.org/10.1016/S2352-3026(21)00167-8.

72. Kulikov AN, Muravyeva NV, Belov BS. Risk factors for severe COVID-19 in patients with rheumatic diseases. Rheumatology Science and Practice. 2024;62(1):24–31. (In Russ.) https://doi.org/10.47360/1995-4484-2024-24-31.

73. Strangfeld A, Schäfer M, Gianfrancesco MA, Lawson-Tovey S, Liew JW, Ljung L et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2021;80(7):930–942. https://doi.org/10.1136/annrheumdis-2020-219498.

74. Isnardi CA, Alpizar-Rodriguez D, Calderaro DC, Marques CDL, Pons-Estel GJ, Xavier RM et al. Factors Associated With Mortality in Patients With Immune-Mediated Rheumatic Diseases and COVID-19 From Latin America: Data From Argentina, Mexico, and Brazil. J Clin Rheumatol. 2024;30(1):e9–e17. https://doi.org/10.1097/RHU.0000000000002038.

75. Yazdany J, Ware A, Wallace ZS, Bhana S, Grainger R, Hachulla E et al. Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID-19 Global Rheumatology Alliance Registry. Arthritis Care Res. 2024;76(2):274–287. https://doi.org/10.1002/acr.25220.

76. O’Halloran JA, Ko ER, Anstrom KJ, Kedar E, McCarthy MW, Panettieri RAJr et al. Abatacept, Cenicriviroc, or Infliximab for Treatment of Adults Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial. JAMA. 2023;330(4):328–339. https://doi.org/10.1001/jama.2023.11043.

77. Nasonov EL, Lila AM, Mazurov VI, Belov BS, Karateev AE, Dubinina TV et al. Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia. Rheumatology Science and Practice. 2021;59(3):239–254. (In Russ.) https://doi.org/10.47360/1995-4484-2021-239-254.

78. Landewé RBM, Kroon FPB, Alunno A, Najm A, Bijlsma JW, Burmester GR et al. EULAR recommendations for the management and vaccination of people with rheumatic and musculoskeletal diseases in the context of SARS-CoV-2: the November 2021 update. Ann Rheum Dis. 2022;81(12):1628–1639. https://doi.org/10.1136/annrheumdis-2021-222006.

79. Mikuls TR, Johnson SR, Fraenkel L, Arasaratnam RJ, Baden LR, Bermas BL et al. American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 3. Arthritis Rheumatol. 2021;73(2):e1–e12. https://doi.org/10.1002/art.41596.

80. Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(1):39–52. https://doi.org/10.1136/annrheumdis-2019-215882.

81. Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC et al. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2023;75(3):333–348. https://doi.org/10.1002/art.42386.

82. Алексеева ЕИ, Балдуева ИА, Белов БС, Бернс СА, Веселова ЕИ, Васильева ВА и др. Иммунизация иммунокомпрометированных пациентов. М.; 2025. 221 с. Режим доступа: https://edu.nasci.ru/libs/files/mr_immunizaciya_immunokomprometirovannyh_pacientov.pdf.