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Oftedal BE, Sjøgren T, Wolff ASB. Interferon autoantibodies as signals of a sick thymus. Front Immunol 2024; 15:1327784. [PMID: 38455040 PMCID: PMC10917889 DOI: 10.3389/fimmu.2024.1327784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
Type I interferons (IFN-I) are key immune messenger molecules that play an important role in viral defense. They act as a bridge between microbe sensing, immune function magnitude, and adaptive immunity to fight infections, and they must therefore be tightly regulated. It has become increasingly evident that thymic irregularities and mutations in immune genes affecting thymic tolerance can lead to the production of IFN-I autoantibodies (autoAbs). Whether these biomarkers affect the immune system or tissue integrity of the host is still controversial, but new data show that IFN-I autoAbs may increase susceptibility to severe disease caused by certain viruses, including SARS-CoV-2, herpes zoster, and varicella pneumonia. In this article, we will elaborate on disorders that have been identified with IFN-I autoAbs, discuss models of how tolerance to IFN-Is is lost, and explain the consequences for the host.
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Affiliation(s)
- Bergithe E. Oftedal
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Thea Sjøgren
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anette S. B. Wolff
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Kroenke MA, Milton MN, Kumar S, Bame E, White JT. Immunogenicity Risk Assessment for Multi-specific Therapeutics. AAPS JOURNAL 2021; 23:115. [PMID: 34741215 PMCID: PMC8571146 DOI: 10.1208/s12248-021-00642-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/23/2021] [Indexed: 01/12/2023]
Abstract
The objective of this manuscript is to provide the reader with a hypothetical case study to present an immunogenicity risk assessment for a multi-specific therapeutic as part of Investigational New Drug (IND) application. In order to provide context for the bioanalytical strategies used to support the multi-specific therapeutic presented herein, the introduction focuses on known immunogenicity risk factors. The subsequent hypothetical case study applies these principles to a specific example HC-12, based loosely on anti-TNFα and anti-IL-17A bispecific molecules previously in development, structured as an example immunogenicity risk assessment for submission to health authorities. The risk of higher incidence and safety impact of anti-drug antibodies (ADA) due to large protein complexes is explored in the context of multi-specificity and multi-valency of the therapeutic in combination with the oligomeric forms of the targets.
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Affiliation(s)
| | - Mark N Milton
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Seema Kumar
- EMD Serono Research & Development Institute, Inc, Billerica, Massachusetts, USA
| | - Eris Bame
- Biogen, Cambridge, Massachusetts, USA
| | - Joleen T White
- Bill & Melinda Gates Medical Research Institute, One Kendall Square, Building 600, Suite 6-301, Cambridge, Massachusetts, 02139, USA.
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Andlauer TFM, Link J, Martin D, Ryner M, Hermanrud C, Grummel V, Auer M, Hegen H, Aly L, Gasperi C, Knier B, Müller-Myhsok B, Jensen PEH, Sellebjerg F, Kockum I, Olsson T, Pallardy M, Spindeldreher S, Deisenhammer F, Fogdell-Hahn A, Hemmer B. Treatment- and population-specific genetic risk factors for anti-drug antibodies against interferon-beta: a GWAS. BMC Med 2020; 18:298. [PMID: 33143745 PMCID: PMC7641861 DOI: 10.1186/s12916-020-01769-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Upon treatment with biopharmaceuticals, the immune system may produce anti-drug antibodies (ADA) that inhibit the therapy. Up to 40% of multiple sclerosis patients treated with interferon β (IFNβ) develop ADA, for which a genetic predisposition exists. Here, we present a genome-wide association study on ADA and predict the occurrence of antibodies in multiple sclerosis patients treated with different interferon β preparations. METHODS We analyzed a large sample of 2757 genotyped and imputed patients from two cohorts (Sweden and Germany), split between a discovery and a replication dataset. Binding ADA (bADA) levels were measured by capture-ELISA, neutralizing ADA (nADA) titers using a bioassay. Genome-wide association analyses were conducted stratified by cohort and treatment preparation, followed by fixed-effects meta-analysis. RESULTS Binding ADA levels and nADA titers were correlated and showed a significant heritability (47% and 50%, respectively). The risk factors differed strongly by treatment preparation: The top-associated and replicated variants for nADA presence were the HLA-associated variants rs77278603 in IFNβ-1a s.c.- (odds ratio (OR) = 3.55 (95% confidence interval = 2.81-4.48), p = 2.1 × 10-26) and rs28366299 in IFNβ-1b s.c.-treated patients (OR = 3.56 (2.69-4.72), p = 6.6 × 10-19). The rs77278603-correlated HLA haplotype DR15-DQ6 conferred risk specifically for IFNβ-1a s.c. (OR = 2.88 (2.29-3.61), p = 7.4 × 10-20) while DR3-DQ2 was protective (OR = 0.37 (0.27-0.52), p = 3.7 × 10-09). The haplotype DR4-DQ3 was the major risk haplotype for IFNβ-1b s.c. (OR = 7.35 (4.33-12.47), p = 1.5 × 10-13). These haplotypes exhibit large population-specific frequency differences. The best prediction models were achieved for ADA in IFNβ-1a s.c.-treated patients. Here, the prediction in the Swedish cohort showed AUC = 0.91 (0.85-0.95), sensitivity = 0.78, and specificity = 0.90; patients with the top 30% of genetic risk had, compared to patients in the bottom 30%, an OR = 73.9 (11.8-463.6, p = 4.4 × 10-6) of developing nADA. In the German cohort, the AUC of the same model was 0.83 (0.71-0.92), sensitivity = 0.80, specificity = 0.76, with an OR = 13.8 (3.0-63.3, p = 7.5 × 10-4). CONCLUSIONS We identified several HLA-associated genetic risk factors for ADA against interferon β, which were specific for treatment preparations and population backgrounds. Genetic prediction models could robustly identify patients at risk for developing ADA and might be used for personalized therapy recommendations and stratified ADA screening in clinical practice. These analyses serve as a roadmap for genetic characterizations of ADA against other biopharmaceutical compounds.
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Affiliation(s)
- Till F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany.
- Max Planck Institute of Psychiatry, Kraepelinstr 2-10, 80804, Munich, Germany.
| | - Jenny Link
- Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18, 17176, Stockholm, Sweden
| | - Dorothea Martin
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Malin Ryner
- Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18, 17176, Stockholm, Sweden
| | - Christina Hermanrud
- Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18, 17176, Stockholm, Sweden
| | - Verena Grummel
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Anichstr 35, 6020, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Anichstr 35, 6020, Innsbruck, Austria
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
- Institute of Experimental Neuroimmunology, Technical University of Munich, Trogerstr 9, 81675, Munich, Germany
| | - Christiane Gasperi
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
- Institute of Experimental Neuroimmunology, Technical University of Munich, Trogerstr 9, 81675, Munich, Germany
| | - Bertram Müller-Myhsok
- Max Planck Institute of Psychiatry, Kraepelinstr 2-10, 80804, Munich, Germany
- Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, L69 3BX, UK
- Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | | | - Finn Sellebjerg
- DMSC, Department of Neurology, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18, 17176, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18, 17176, Stockholm, Sweden
| | - Marc Pallardy
- Inflammation, Microbiome and Immunosurveillance, Université Paris-Saclay, INSERM, Faculté de Pharmacie, rue JB Clément, 92290, Châtenay-Malabry, France
| | - Sebastian Spindeldreher
- Novartis Institutes for Biomedical Research, Novartis Pharma AG, 4056, Basel, Switzerland
- Integrated Biologix GmbH, Steinenvorstadt 33, 4051, Basel, Switzerland
| | - Florian Deisenhammer
- Department of Neurology, Medical University of Innsbruck, Anichstr 35, 6020, Innsbruck, Austria
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18, 17176, Stockholm, Sweden
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany.
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Buck D, Andlauer TF, Igl W, Wicklein EM, Mühlau M, Weber F, Köchert K, Pohl C, Arnason B, Comi G, Cook S, Filippi M, Hartung HP, Jeffery D, Kappos L, Barkhof F, Edan G, Freedman MS, Montalbán X, Müller-Myhsok B, Hemmer B. Effect of HLA-DRB1 alleles and genetic variants on the development of neutralizing antibodies to interferon beta in the BEYOND and BENEFIT trials. Mult Scler 2018. [PMID: 29521573 DOI: 10.1177/1352458518763089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment of multiple sclerosis (MS) with interferon β can lead to the development of antibodies directed against interferon β that interfere with treatment efficacy. Several observational studies have proposed different HLA alleles and genetic variants associated with the development of antibodies against interferon β. OBJECTIVE To validate the proposed genetic markers and to identify new markers. METHODS Associations of genetic candidate markers with antibody presence and development were examined in a post hoc analysis in 941 patients treated with interferon β-1b in the Betaferon® Efficacy Yielding Outcomes of a New Dose (BEYOND) and BEtaseron®/BEtaferon® in Newly Emerging multiple sclerosis For Initial Treatment (BENEFIT) prospective phase III trials. All patients were treated with interferon β-1b for at least 6 months. In addition, a genome-wide association study was conducted to identify new genetic variants. RESULTS We confirmed an increased risk for carriers of HLA-DRB1*04:01 (odds ratio (OR) = 3.3, p = 6.9 × 10-4) and HLA-DRB1*07:01 (OR = 1.8, p = 3.5 × 10-3) for developing neutralizing antibodies (NAbs). Several additional, previously proposed HLA alleles and genetic variants showed nominally significant associations. In the exploratory analysis, variants in the HLA region were associated with NAb development at genome-wide significance (OR = 2.6, p = 2.30 × 10-15). CONCLUSION The contribution of HLA alleles and HLA-associated single-nucleotide polymorphisms (SNPs) to the development and titer of antibodies against interferon β was confirmed in the combined analysis of two multi-national, multi-center studies.
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Affiliation(s)
- Dorothea Buck
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany/German Competence Network Multiple Sclerosis (KKNMS), München, Germany
| | - Till Fm Andlauer
- German Competence Network Multiple Sclerosis (KKNMS), München, Germany/Max Planck Institute of Psychiatry, Munich, Germany/Munich Cluster for Systems Neurology (SyNergy), Munich, Germany/Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany/German Competence Network Multiple Sclerosis (KKNMS), München, Germany
| | - Frank Weber
- German Competence Network Multiple Sclerosis (KKNMS), München, Germany/Max Planck Institute of Psychiatry, Munich, Germany/Neurological Clinic, Medical Park Bad Camberg, Bad Camberg, Germany
| | | | - Christoph Pohl
- Bayer AG, Berlin, Germany/Department of Neurology, University Hospital of Bonn, Bonn, Germany
| | - Barry Arnason
- Department of Neurology, Surgery Brain Research Institutes, University of Chicago, Chicago, IL, USA
| | - Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Stuart Cook
- Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | - Frederik Barkhof
- Radiology and Nuclear Medicine, VU University Medical Centre Amsterdam, The Netherlands/UCL Institutes of Neurology and Healthcare Engineering, London, UK
| | | | - Mark S Freedman
- University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Xavier Montalbán
- Department of Clinical Neuroimmunology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Bertram Müller-Myhsok
- German Competence Network Multiple Sclerosis (KKNMS), München, Germany/Max Planck Institute of Psychiatry, Munich, Germany/Munich Cluster for Systems Neurology (SyNergy), Munich, Germany/Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany/German Competence Network Multiple Sclerosis (KKNMS), München, Germany/Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Grossman I, Knappertz V, Laifenfeld D, Ross C, Zeskind B, Kolitz S, Ladkani D, Hayardeny L, Loupe P, Laufer R, Hayden M. Pharmacogenomics strategies to optimize treatments for multiple sclerosis: Insights from clinical research. Prog Neurobiol 2017; 152:114-130. [DOI: 10.1016/j.pneurobio.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/10/2016] [Accepted: 02/27/2016] [Indexed: 12/13/2022]
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Bachelet D, Hässler S, Mbogning C, Link J, Ryner M, Ramanujam R, Auer M, Hyldgaard Jensen PE, Koch-Henriksen N, Warnke C, Ingenhoven K, Buck D, Grummel V, Lawton A, Donnellan N, Hincelin-Mery A, Sikkema D, Pallardy M, Kieseier B, Hemmer B, Hartung HP, Soelberg Sorensen P, Deisenhammer F, Dönnes P, Davidson J, Fogdell-Hahn A, Broët P. Occurrence of Anti-Drug Antibodies against Interferon-Beta and Natalizumab in Multiple Sclerosis: A Collaborative Cohort Analysis. PLoS One 2016; 11:e0162752. [PMID: 27806057 PMCID: PMC5091903 DOI: 10.1371/journal.pone.0162752] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/26/2016] [Indexed: 11/20/2022] Open
Abstract
Immunogenicity of biopharmaceutical products in multiple sclerosis is a frequent side effect which has a multifactorial etiology. Here we study associations between anti-drug antibody (ADA) occurrence and demographic and clinical factors. Retrospective data from routine ADA test laboratories in Sweden, Denmark, Austria and Germany (Dusseldorf group) and from one research study in Germany (Munich group) were gathered to build a collaborative multi-cohort dataset within the framework of the ABIRISK project. A subset of 5638 interferon-beta (IFNβ)-treated and 3440 natalizumab-treated patients having data on at least the first two years of treatment were eligible for interval-censored time-to-event analysis. In multivariate Cox regression, IFNβ-1a subcutaneous and IFNβ-1b subcutaneous treated patients were at higher risk of ADA occurrence compared to IFNβ-1a intramuscular-treated patients (pooled HR = 6.4, 95% CI 4.9-8.4 and pooled HR = 8.7, 95% CI 6.6-11.4 respectively). Patients older than 50 years at start of IFNβ therapy developed ADA more frequently than adult patients younger than 30 (pooled HR = 1.8, 95% CI 1.4-2.3). Men developed ADA more frequently than women (pooled HR = 1.3, 95% CI 1.1-1.6). Interestingly we observed that in Sweden and Germany, patients who started IFNβ in April were at higher risk of developing ADA (HR = 1.6, 95% CI 1.1-2.4 and HR = 2.4, 95% CI 1.5-3.9 respectively). This result is not confirmed in the other cohorts and warrants further investigations. Concerning natalizumab, patients older than 45 years had a higher ADA rate (pooled HR = 1.4, 95% CI 1.0-1.8) and women developed ADA more frequently than men (pooled HR = 1.4, 95% CI 1.0-2.0). We confirmed previously reported differences in immunogenicity of the different types of IFNβ. Differences in ADA occurrence by sex and age are reported here for the first time. These findings should be further investigated taking into account other exposures and biomarkers.
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Affiliation(s)
- Delphine Bachelet
- CESP, Université Pa ris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Signe Hässler
- CESP, Université Pa ris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Cyprien Mbogning
- CESP, Université Pa ris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Jenny Link
- Karolinska Institutet, Department of Clinical Neuroscience, Clinical Neuroimmunology, Stockholm, Sweden
| | - Malin Ryner
- Karolinska Institutet, Department of Clinical Neuroscience, Clinical Neuroimmunology, Stockholm, Sweden
| | - Ryan Ramanujam
- Karolinska Institutet, Department of Clinical Neuroscience, Clinical Neuroimmunology, Stockholm, Sweden
- KTH—Royal Institute of Technology, Stockholm, Sweden
| | - Michael Auer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Poul Erik Hyldgaard Jensen
- Danish MS Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nils Koch-Henriksen
- Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Epidemiology, University of Aarhus, Aarhus, Denmark
| | - Clemens Warnke
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | - Kathleen Ingenhoven
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | - Dorothea Buck
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Verena Grummel
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Andy Lawton
- GlaxoSmithKline, Uxbridge, Middlesex, United Kingdom
| | | | | | - Dan Sikkema
- GlaxoSmithKline, Uxbridge, Middlesex, United Kingdom
| | - Marc Pallardy
- INSERM UMR 996, Univ. Paris-Sud, Faculty of Pharmacy, Université Paris-Saclay, Châtenay-Malabry, France
| | - Bernd Kieseier
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | - Bernard Hemmer
- Department of Neurology, Technische Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Hans Peter Hartung
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | - Per Soelberg Sorensen
- Danish MS Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Anna Fogdell-Hahn
- Karolinska Institutet, Department of Clinical Neuroscience, Clinical Neuroimmunology, Stockholm, Sweden
| | - Philippe Broët
- CESP, Université Pa ris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Assistance Publique—Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
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Unraveling the Effect of Immunogenicity on the PK/PD, Efficacy, and Safety of Therapeutic Proteins. J Immunol Res 2016; 2016:2342187. [PMID: 27579329 PMCID: PMC4992793 DOI: 10.1155/2016/2342187] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022] Open
Abstract
Biologics have emerged as a powerful and diverse class of molecular and cell-based therapies that are capable of replacing enzymes, editing genomes, targeting tumors, and more. As this complex array of tools arises a distinct set of challenges is rarely encountered in the development of small molecule therapies. Biotherapeutics tend to be big, bulky, polar molecules comprised of protein and/or nucleic acids. Compared to their small molecule counterparts, they are fragile, labile, and heterogeneous. Their biodistribution is often limited by hydrophobic barriers which often restrict their administration to either intravenous or subcutaneous entry routes. Additionally, their potential for immunogenicity has proven to be a challenge to developing safe and reliably efficacious drugs. Our discussion will emphasize immunogenicity in the context of therapeutic proteins, a well-known class of biologics. We set out to describe what is known and unknown about the mechanisms underlying the interplay between antigenicity and immune response and their effect on the safety, efficacy, pharmacokinetics, and pharmacodynamics of these therapeutic agents.
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Eckstein C, Bhatti MT. Currently approved and emerging oral therapies in multiple sclerosis: An update for the ophthalmologist. Surv Ophthalmol 2016; 61:318-32. [DOI: 10.1016/j.survophthal.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/07/2015] [Indexed: 12/14/2022]
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