Infectious adverse events in patients treated with biotherapies in a tropical Amazonian context, French Guiana

Background Data on infectious complications associated with biologic therapies in tropical settings are scarce. French Guiana, an Amazonian French overseas territory, combines an important burden of infectious diseases with a high use of biologic therapies. Our objective was to assess the incidence, spectrum, and risk factors for infections in patients treated with biotherapies for inflammatory and autoimmune diseases in French Guiana. Methods We performed a multicentre retrospective study of adult patients receiving biotherapies between January 2021 and December 2023 in the French Guiana University Hospital (including its main site in Cayenne, its three local hospitals and 15 remote health centres). The primary outcome was the occurrence of any infectious event. Secondary outcomes included the severity of infection and identification of clinical and epidemiological risk factors. Results 146 patients (mean age 44.1 years, 61.6% female) were included. 48.0% of patients included had at least one infectious event. Most infections were mild (90.4%) and significantly associated with concomitant immunosuppressants (35.7%) or with remote health centres follow-up (11.4%). The tropical context revealed a distinct epidemiology, with five cases of dengue fever, two cases of scabies and one histoplasmosis. The majority (55%) of events occurred under first-generation biotherapies (notably rituximab and anti-TNF agents). The most frequent type of infection was cutaneous (27.2%), particularly in patients with a dermatological indication. Conclusions Biotherapies appear generally well tolerated in this tropical setting, but patients living in remote areas or with concomitant immunosuppressant therapies remain vulnerable. Specific awareness should be dedicated to secondary cutaneous infections in patients treated for dermatological indications. Clinical trial number Not applicable.