Immunogenicity, the elephant in the room. Comment on 'drug levels, anti-drug antibodies and clinical efficacy of the anti-TNFα biologics in rheumatic diseases'

摘要

Biologic therapy has been a major advance in the treatment of patients with immune diseases. Yet, it is clear that long-term disease management requires a more detailed understanding of factors that influence these drugs' effectiveness. The authors confirm at least 10 years of observations that immunogenicity most notably with monoclonal antibody therapies results in treatment failure [1]. By contrast, receptor-based constructs seem less likely to be associated with the development of patient-derived antibody failure [2-4]. Also as pointed out by the authors, the development of neutralizing antibodies is independent of underlying immune disease. It is interesting to note that a recently commissioned consensus statement on biologic treatment of rheumatic disease mentioned immunogenicity two times (one time with regard to abatacept and the other time with regard to concomitant methotrexate). A simultaneous search for neutralizing antibodies was fruitless [5].