Practical guidance on immunogenicity to biologic agents used in the treatment of psoriasis: What can be learnt from other diseases?

Abstract

The clinical efficacy of biologic agents for the treatment of moderate to severe psoriasis is well proven in clinical studies, but patients may lose response over time. Loss of response may be due to immunogenicity and the formation of anti-drug antibodies (ADA). Although data on the immunogenicity of drugs used to treat psoriasis are now emerging, more information on the impact of factors, such as dosing regimens and concomitant immunosuppressive therapy is needed. Exploring research from other disease areas where immunogenicity has long been recognised as a significant clinical issue may help in developing future strategies for using drug level and ADA measurements to help tailor biologic therapy to meet individual needs. To this end, we analyse what is known about biologics and immunogenicity in psoriasis. In order to learn from other indications, we then address the issue of immunogenicity for three different types of biologic treatments. First, factor VIII-substitution in haemophilia, where the immune system is newly exposed to a physiologic but formerly absent protein. Second, the use of biologics in inflammatory bowel disease, where similar treatment challenges apply as observed in psoriasis. Third, immunogenicity in multiple sclerosis caused by therapeutic antibodies or interferons. Immunogenicity strategies used in other disease areas will need to be tested in psoriasis before they can be widely adopted in routine clinical practice.

• Anti-drug antibodies
• biologic
• immunogenicity
• psoriasis

Acknowledgements

Medical writing support was provided by Synergy Medical.

Declaration of interest

Pfizer provided an unrestricted grant for the development of this manuscript.

Professor Jo Lambert had paid consultancies from Pfizer, Novartis, AbbVie, Janssen Cilag, LEO Pharma, and received unrestricted grants from Janssen Cilag, AbbVie and Pfizer. She is involved in performing clinical trials with Janssen-Cilag, Merck Serono, Amgen, Pfizer, AbbVie, Celgene and Novartis.

Professor Jörg Prinz has served as a consultant, investigator, speaker or advisory board member for Biogen-Idec (formerly Biogen), Novartis, Wyeth, Pfizer, Merk-Serono (formerly Serono), Essex pharma, MSD, Galderma, Centocor, Abbott, Janssen-Cilag/Janssen-Ortho, Amgen. Furthermore, he had received an unrestricted research grant from Biogen-Idec and Wyeth in the past.

Dr Alexander Nast has received honoraria for CME certified educational talks and educational activities that received direct or indirect sponsoring from Abbott (now AbbVie) and Pfizer. The Division of Evidence Based Medicine has received unrestricted research grants from Pfizer.

Professor Frank O. Nestle has acted as a consultant for Abbott, AbbVie, Celgene, Janssen, Novartis and Pfizer.