New immunomodulating approaches to neuroinflammatory diseases require new approaches to clinical risk management. This presentation will review current themes in the risk of immune intervention and will address two questions that are current in clinical practice:

1. How safe does an intervention need to be to be safe enough to use?
2. What practical tools can be used to ensure reasonable steps have been taken to prevent adverse patient outcomes?

Although individual immunomodulatory agents affect the immune system in different
ways, there are common themes in patient risk. For example, impairment of immunity is primarily responsible for an increased risk of infection-related cancers, opportunistic infections, vaccine preventable disease, cardiovascular and metabolic risk, impairment of fertility, and immune dysregulation resulting in autoimmune and immune reconstitution inflammatory
syndromes.

Physicians are known to be imperfect in making judgments about which risks matter in a manner that may bias the way they assess and prepare individual patients for treatment. Current systems of drug safety alerts, specialist position papers and medication-specific risk evaluation do not necessarily enable better practice in busy clinics. In response to these problems, Stephen Reddel and I have developed an online immunosuppression screening tool (www.immunosuppressionscreen.net.au) that may help reduce omissions in individual patient-specific risk assessment. This will be presented as one option in improving practice.

Ultimately, the risk: benefit equation is most effectively influenced by modifying risk - an essential activity if we are to avoid "amateur mistakes" in neuroimmunology.