Therapeutic monoclonal antibodies and multiple sclerosis

Abstract

Monoclonal antibodies (mAbs) are now established as targeted therapies for malignancies, transplant
rejection, autoimmune and infectious diseases. One mab are available for treatment and other antibodies
currently being tested in multiple sclerosis (MS) patients. With the introduction of mabs the treatment of
MS has entered a new era, both with respect to efficacy and target specificity. However, administration of
mAbs carries the risk of immune reactions such as acute anaphylaxis, serum sickness a, infection and other
autoimmune diseases. In addition, unexpected consequences arise from our incomplete knowledge of the
immune system. For example, natalizumab, a monoclonal antibody targeting a4-integrin on leukocytes
increases the risk of developing progressive multifocal leukoencephalopathy, without causing notable
immunosuppression. Here we review the immunologic and pharmacologic concepts of mabs and the
current status of the clinical development of mAbs in MS, with an emphasis on their efficacy and safety.