Monoclonal antibody therapy in multiple sclerosis: critical appraisal and new perspectives

Abstract

Monoclonal antibodies (mAbs) have been used as experimental treatments of multiple sclerosis (MS) since the 1980s, with the advantage of a high specificity for their target but disadvantages due to their immunogenicity. A literature review of experimental and disposable mAbs in the treatment of MS was performed, putting into perspective the clinical impact that these novel therapies can have and the main challenges facing their use in the daily practice. mAbs therapy resulted in a clear paradigm shift in MS therapeutics. Their use in early, inflammatory phases could have the potential to prevent or delay disability. However, it is still unclear how and when these powerful biological weapons can be used safely in the management of MS. The challenge then is how to obtain the best benefit–risk ratio and how to monitor and prevent emergent safety concerns.

Keywords:

• immunogenicity
• induction therapy
• mAbs
• multiple sclerosis
• Phase III studies
• safety

Financial & competing interests disclosure

F Patti has received funding from and served as an advisor for Almirall, Bayer, Biogen, Merck Serono, Novartis and Sanofi Genzyme. C Caserta has monitored clinical trials for Merck Serono, Grifols and Baxter. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Monoclonal antibodies (mAbs) represent a new avenue in the treatment of multiple sclerosis.

• mAbs have shown the most efficacy in the early phases of the disease.

• Scarcely data are disposable about their ability to delay the disability progression.

• Safety concerns represent the most important limiting factor in their use in the clinical practice.

• mAbs could represent an ideal candidate for protocols of induction therapy.

Notes