Monoclonal antibodies — a revolutionary therapy in multiple sclerosis

Abstract

Introduction.Multiple sclerosis (MS) has an increasing incidence and affects a young segment of the population, having a major impact on patients and consequently on society. The multifactorial aetiology and pathogenesis of this disease are incompletely known at present, but autoimmune aggression has a documented mechanism.State of the art. Since the 1990s, immunomodulatory drugs of high efficacy and a good safety profile have been launched. But the concept of NEDA (No Evidence of Disease Activity) remains the target to achieve. Thus, the new revolutionary class of monoclonal antibodies (moAbs) used in multiple medical fields, from this perspective represents a challenge even for multiple sclerosis, including the primary progressive form, for which there has been no treatment until recently. Clinical implications.In this article, we will review monoclonal antibodies' use for MS, presenting their advantages and disadvantages, based on data accumulated since 2004 when the first monoclonal antibody was approved for active forms of the disease.Future directions. There is still a need for personalised medicines, with a specific target, which should have fewer adverse effects and drug interactions.

Neuropathophysiology of coronavirus disease 2019: neuroinflammation and blood brain barrier disruption are critical pathophysiological processes that contribute to the clinical symptoms of SARS-CoV-2 infection

“…However, due to the relatively long period required in getting approval for these drugs (Table 1), already approved monoclonal antibodies, especially those that inhibit IL-6 and TNF, as well as Bevacizumab (Food and Drug Administration, FDA, 2018), Ruxolitinib (FDA, 2019), Baricitinib (FDA, 2018), and Emapalumab (FDA, 2019) may be considered for possible use in the treatment of SARS-CoV-2 infection with associated inflammatory stress or cytokine storm. Even though the effects of these antibodies on neuroinflammation are not known, previous studies have demonstrated a beneficial role of monoclonal antibodies in psychopathological illnesses (Essali et al 2019) and multiple sclerosis (Sirbu and Budisteanu 2020), which are characterized by neuroinflammatory response and blood brain barrier disruption (Welcome 2020a, b).…”

SARS‑CoV‑2, multiple sclerosis, and focal deficit in a postpartum woman: A case report

“…While waiting for a vaccine, the completion of which has not materialized for SARS or MERS, so far, a balanced lifestyle, with physical therapy, melotherapy, healthy eating, can lead to a natural increase in immunity (11)(12)(13)(14). Also, new monoclonal antibody therapies that reduce lymphocytes must be weighed well before administration during the pandemic (15).…”

Active Pulmonary Tuberculosis Triggered by Interferon Beta-1b Therapy of Multiple Sclerosis: Four Case Reports and a Literature Review

“…There is no test predictive of the progression from LTBI to active disease, which is the reason prevention plays an important role. Screening for LTBI is currently recommended before starting daclizumab and alemtuzumab therapy, but not before initiating CD20-acting DMTs (rituximab, ocrelizumab) [26,27]. Additionally, the screening of high-risk groups in the population and the use of infection control measures or chemoprophylaxis are indicated [23].…”