Partridge Michael A, Kamen Lynn, Wu Bonnie, Solberg Helene, McNally Jim, Stevenson Lauren, Gupta Shalini, Liu Susana, Xu Weifeng, Wu Yuling, White Joleen
Regeneron Pharmaceuticals, Tarrytown, New York, USA.
BioAgilytix Labs, Durham, North Carolina, USA.
AAPS J. 2025 Aug 13;27(5):132. doi: 10.1208/s12248-025-01118-6.
Neutralizing antibodies (NAbs) to protein therapeutics have traditionally been assumed to be the most impactful subset of anti-drug-antibodies (ADA). NAbs can block the biotherapeutic from engaging its target impacting efficacy and may also cause serious safety events. Stand-alone NAb assays have been employed to detect neutralizing responses, often with reconfigured versions of other assays. These methods have historically been implemented in registrational trials for all molecules, and in early-stage studies for high risk biotherapeutics. However, data has demonstrated that NAb response and ADA magnitude are highly correlated. Additionally, the use of other markers to identify clinically relevant immunogenicity, such as apparent impact on pharmacokinetics (PK) or pharmacodynamics (PD), has been increasing. This manuscript reviews the available data on clinically meaningful immunogenic responses to biologics and proposes a risk-based strategy to determine if and when to employ a stand-alone NAb assay. For molecules with a high risk of safety consequences of immunogenicity (e.g., biological mimics) a NAb assay is recommended. However, for lower-safety risk molecules a stand-alone NAb assay does not enhance the interpretation of clinical data and is likely not needed. A combination of other assessments including ADA status, magnitude and persistence, PK, and PD (and efficacy) can be used as a surrogate for NAb assay data. Integration of data from all clinical evaluations is recommended by Health Authorities and can provide a more accurate overall assessment of neutralizing activity. This approach identifies clinically impactful downstream readouts of neutralizing activity without the need for a stand-alone NAb assay.
传统上认为,针对蛋白质治疗药物的中和抗体(NAb)是抗药物抗体(ADA)中影响最大的子集。中和抗体可阻止生物治疗药物作用于其靶点,从而影响疗效,还可能引发严重的安全事件。一直以来,独立的中和抗体检测方法被用于检测中和反应,通常是对其他检测方法进行重新配置。从历史上看,这些方法已在所有分子的注册试验以及高风险生物治疗药物的早期研究中得到应用。然而,数据表明中和抗体反应与ADA水平高度相关。此外,使用其他标志物来识别具有临床相关性的免疫原性,如对药代动力学(PK)或药效学(PD)的明显影响,也越来越普遍。本文综述了有关生物制品临床意义上的免疫原性反应的现有数据,并提出了一种基于风险的策略,以确定是否以及何时采用独立的中和抗体检测方法。对于具有免疫原性安全后果高风险的分子(如生物模拟物),建议进行中和抗体检测。然而,对于安全性风险较低的分子,独立的中和抗体检测并不能增强对临床数据的解读,可能也不需要。包括ADA状态、水平和持久性、PK以及PD(和疗效)在内的其他评估组合可用作中和抗体检测数据的替代指标。卫生当局建议整合所有临床评估的数据,这样可以对中和活性进行更准确的总体评估。这种方法无需独立的中和抗体检测就能识别出具有临床影响的中和活性下游读数。
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