Antibody-based therapies for infectious diseases : renaissance for an abandoned arsenal?

The birth pangs of monoclonal antibody therapeutics: the failure and legacy of Centoxin

This paper examines the development and termination of nebacumab (Centoxin®), a human IgM monoclonal antibody (mAb) drug frequently cited as one of the notable failures of the early biopharmaceutical industry. The non-approval of Centoxin in the United States in 1992 generated major concerns at the time about the future viability of any mAb therapeutics. For Centocor, the biotechnology company that developed Centoxin, the drug posed formidable challenges in terms of safety, clinical efficacy, patient selection, the overall economic costs of health care, as well as financial backing. Indeed, Centocor's development of the drug brought it to the brink of bankruptcy. This article shows how many of the experiences learned with Centoxin paved the way for the current successes in therapeutic mAb development.

Adjunctive immune therapy for fungal infections

Fungal infections in immunocompromised patients can pose difficult problems in clinical management, because the available antifungal chemotherapy is often unable to eradicate the infection in these people. Hence, the use of immune modulating therapy to augment impaired host immune responses--and thus enhance the efficacy of antifungal drugs--is a reasonable approach to improve the prognosis of fungal infections. Advances in biotechnology have produced a variety of biological response modifiers with the potential to serve as adjunctive immune therapy for the treatment of fungal infections, including cytokines, monoclonal antibodies, and cell growth factors. In recent years, immune-modulating therapies have been studied in an effort to define their potential use for the treatment of fungal infections. Much of the available information on the use of this approach is encouraging and invites further investigation--with the caveats that the information is mostly anecdotal and that immune-modulating therapy occasionally has produced adverse effects.

Passive antibody therapies: progress and continuing challenges

In recent years antibody-based therapies have returned as first-line therapy for a variety of diverse conditions that include viral infections, inflammatory disorders, and certain malignancies. Renewed interest in antibody-based therapies is a consequence of major advances in the technology of antibody production and the need for new therapeutic agents. Dozens of antibody preparations are in clinical use. Several monoclonal antibodies are now licensed for clinical use and many are in advanced clinical development. Antibody-based therapies have both significant advantages and disadvantages relative to conventional chemotherapy. Advantages include versatility, specificity, and biological functions not replicated by available chemotherapeutic drugs. Disadvantages include high cost and small markets that hinder commercial development. The available experience suggests that antibody-based therapies can be successfully developed for use in clinical situations where no effective therapy is available. Continued success in the development of antibody-based therapies will require extensive clinical research to learn how to use these compounds optimally and basic immunological research to define the basic mechanisms of antibody action.