Laboratory Monitoring of Biological Therapies in Rheumatology: The Role of Immunogenicity

Abstract

Biological drugs, such as proteins and immunogens, are increasingly used to treat various diseases, including tumors and autoimmune diseases, and biological molecules have almost completely replaced synthetic drugs in rheumatology. Although biological treatments such as anti-tumor necrosis factor (TNF) drugs seem to be quite safe, they cause some undesirable effects, such as the onset of infections due to weakening of the immune system. Given the biological nature of these drugs, they might be recognized as extraneous; this would induce an immune reaction that neutralizes their effectiveness or lead to more serious consequences. Laboratories play a pivotal role in appropriate therapeutic management. The aim of this review was to underline the production of anti-drug antibodies during treatment with biological drugs and highlight the role of laboratories in ensuring appropriate use of these drugs.

Keywords: Anti-drug antibodies; Anti-tumor necrosis factor (TNF) drugs; Antibodies; Biological drugs.

Fig. 1. Biological disease-modifying anti-rheumatic drugs (bDMARDs) are associated with immunogenicity, leading to the development of anti-drug antibodies that affect drug efficacy and may affect drug safety and tolerability. The development of anti-drug antibodies seems to be influenced by multiple risk factors and may be modulated by the concomitant use of conventional synthetic DMARDs (cs-DMARDs).