Immunogenicity and autoimmunity during anti-TNF therapy

Cytokines as Therapeutic Targets in Rheumatoid Arthritis and Other Inflammatory Diseases

“…It is, however, clear that the TNF inhibitors differ in their immunogenicity, which is influenced by factors that include the structure of the drug; route, dose, and schedule of administration; concomitant medications; underlying disease; age; immune status; and genetics (Garces et al, 2013). Infliximab is the most immunogenic, consistent with its chimeric structure containing 25% murine sequences, leading to development of human anti-chimeric antibodies (Atzeni et al, 2013). The reported prevalence of anti-infliximab antibodies varies greatly depending on the assay and timing, but appears to be around 30% in RA (PascualSalcedo et al, 2011) and may be as high as 61% in Crohn's disease (Baert et al, 2003), with this latter high prevalence most likely due to the episodic dosing schedule used in Crohn's.…”

Is it time for biosimilars in autoimmune diseases?

“…The number and diversity of reported autoimmune diseases triggered by biological agents has increased in parallel with their increasing use [18] and [19]. Biological agents have been related with the development of advert events including autoimmune process [20]and physicians should bear this in mind when biosimilars are postulated as therapies for autoimmune diseases.…”

Rheumatoid arthritis: Biological therapy other than anti-TNF

“…Of interest, cohort studies suggest a role for ABA administered as a monotherapy, and we achieved results comparable to the combination therapy in five patients who had experienced a definite increase of liver enzymes by both MTX and Azatioprine (manuscript submitted). ABA has a favorable safety profile, particularly in relation to serious (including opportunistic) infections in comparison with anti-TNF agents [14], [15], [16], [17] and [18]. The most common infections reported are pneumonia, urinary tract infection and cellulitis.…”