Immune responses in the patient population during clinical trials or during post-market pharmacovigilance are a serious issue facing biologic therapeutics. A similarity to critical proteins in human physiology or possible interference with endogenous pathways increases the risk of immunogenic responses. Changes in protein modification or formulation may not diminish the risk sufficiently. During the drug development process, regulatory agencies expect biopharmaceutical/pharmaceutical companies to fully assess the potential for immunogenicity in large molecule therapeutics. Understanding agency expectations should allow a reasoned and risk-based approach to assessing potential problems with immunogenicity.
In a risk-based approach, the structure of the biologic compared with any endogenous proteins in the same family and the function within physiological pathways are critical analyses necessary to determine the potential level of risk. Understanding the risk, even if assumed to be low, does not preclude developing selective and specific validated methods that provide data on the presence of anti-drug antibodies. These methods must detect low levels of antibodies in different matrices as well as in the presence of the drug load. The methods can have false positives but the expectation is a low tolerance for false negative samples. Testing for immunogenicity is a matter of safety and must be rigorously assessed. A multi-tiered approach is typical. Successful implementation of a risk-based approach to immunogenicity to biological drugs promotes safety by having validated methods in place to quickly identify anti-drug immune responses in the patient population.