Monoclonal antibodies are the most important type of a relatively new class of drugs, BIOLOGICS (the first being marketed in 1986) used to treat a wide range of diseases, from CANCER and MULTIPLE SCLEROSIS (MS) to RHEUMATOID ARTHRITIS and severe ASTHMA. They can be recognised as such by their generic drug names, all of which end in ‘mab’.
ANTIBODIES are proteins produced by certain blood cells in the immune system (B-lymphocytes) in response to something attacking the body, such as an infection or poison (see IMMUNITY). Something that stimulates the body to produce an antibody in this way is known as an ANTIGEN. Monoclonal antibodies are a specific type of antibody. Any given monoclonal antibody is made by a single clone of a B-lymphocyte, hence the name. This means that each antibody molecule is identical, and each one will interact with the same specific site on a given antigen.
For example, the monoclonal antibody drug INFLIXIMAB – a treatment for inflammatory joint and bowel diseases, and PSORIASIS – binds to a specific molecule associated with inflammation (tumour necrosis factor-alpha), blocking its action. Natalizumab – a drug for multiple sclerosis – binds to a molecule called a4ß1-integrin found on certain immune cells (leucocytes), and is thought to stop these cells causing inflammation of the central nervous system that leads to multiple sclerosis. Bevacizumab blocks the protein Vascular Endothelial Growth Factor A, which provokes the production of new blood vessels, which in turn are needed by cancer of the colon to grow. As well as use in the treatment of colon cancer, the drug is used in age-related macular degeneration, which condition results from overgrowth of blood vessels in the eye.
This group of drugs are expensive because of the research needed to bring them to market and the complexity of the manufacturing process. For example, the average annual cost per patient in the US for one of the top nine biologics is 200,000. Costs are equally astronomical in Europe so that all health systems are having to grapple with how to ‘ration’ these drugs at a time when patients and pressure groups are advocating loudly for their availability.