The comparative immunogenicity of biologic therapy and its clinical relevance in psoriatic arthritis: a systematic review of the literature

ABSTRACT

Introduction: Biologic agents have demonstrated efficacy in treating patients with psoriatic arthritis (PsA). Biologic agents also have an intrinsic capacity to induce an immune response in patients that could result in unwanted adverse events and/or treatment failure.

Areas covered: In this systematic literature review, the authors document the incidence of immune responses, primarily anti-drug antibodies (ADA), to the biologic therapeutic agents currently in clinical practice for the treatment of PsA. The authors discuss the importance of these responses with respect to clinical practice.

Expert opinion: Our evaluation of the published literature shows that the immune responses to the various biologic therapeutic agents currently being used to treat PsA are similar to those observed for these agents in other rheumatic diseases. Moreover, similar to observations in other rheumatic diseases, the incidence of ADA formation to biologic agents in patients with PsA is often decreased when patients are given concomitant treatment with disease-modifying anti-rheumatic drugs. These data strongly suggest that the immune response is a characteristic of the biologic agent. Using therapeutic drug monitoring may be an approach to assess the immune response to the agent and to mitigate the potential impact on efficacy and safety, and consequently optimize treatment.

KEYWORDS:

• Psoriatic arthritis
• biologic therapeutic agents
• anti-drug antibodies
• altering immune response
• safety

Article highlights

• Biologic therapeutic agents are inherently immunogenic.

• Development of anti-drug antibodies can lead to increased incidence of adverse events.

• Development of anti-drug antibodies can also result in decreased or complete loss of efficacy of the biologic agent being used.

• Among patients with psoriatic arthritis, the incidence of anti-drug antibodies to the therapeutic biologic agent being administered is similar to that observed for these agents in other rheumatic diseases.

• The effect of developing anti-drug antibodies on efficacy and safety in patients with psoriatic arthritis is similar to that observed for the same biologic agents in other rheumatic diseases.

• Immunogenicity seems to be an intrinsic characteristic of each biologic agent.

• Immunogenicity may play a role in the selection of the biologic agent.

• Using therapeutic drug monitoring may be an approach for assessing the immune response to a biologic agent, using suitable approaches to mitigate the potential impact on efficacy and safety, and consequently optimize treatment.

Declaration of interest

A Balsa reports receiving grant/research support from Pfizer, Roche, UCB, BMS, Novartis and consultancy fees from AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and USB. During development of the systematic literature review analysis, S Lula was an employee of Envision Pharma Group which was paid to perform the systematic literature review. L Marshall, P Szczypa, and L Aikman are all employed by Pfizer and all have stock in Pfizer. Medical writing support was provided by Mukund Nori, PhD, MBA, CMPP, of Engage Scientific Solutions and was funded by Pfizer. Carole Jones of Envision Pharma Group was involved with the development of the systematic literature review, which was funded by Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. One peer reviewer has been an investigator and unpaid consultant for most of the companies making biologics for psoriasis.

Additional information

Funding

This systematic literature review and support for medical writing were funded by Pfizer.