title: Immunogenicity Assessment of Tumor Necrosis Factor Antagonists in the Clinical Laboratory.
abstract: Tumor necrosis factor (TNF) antagonists are increasingly used for the treatment of inflammatory and autoimmune diseases. Immunogenicity of these drugs poses therapeutic challenges such as therapeutic failure and adverse effects in a number of patients. Evaluation of clinical nonresponsiveness includes laboratory testing for drug concentrations and detecting the presence of antidrug antibodies.
  
  
  
  This review provides an overview of the immunogenicity of TNF antagonists and testing methodologies currently available for measuring antidrug antibody response, which decreases treatment efficacy and may result in therapeutic failure. This review summarizes methodologies such as binding assays, including ELISA and HPLC-based homogenous mobility shift assay, as well as functional cell-based assays such as reporter gene assay. Furthermore, based on the laboratory findings of testing for antidrug antibody response, as well as serum drug concentrations, an algorithm is provided for interpretation, based on the current available literature and guidelines, which may aid in determining optimal therapy after treatment failure.
  
  
  
  Laboratory testing methodologies for measuring serum concentrations of TNF inhibitors and antidrug antibodies are clinically available. These methods provide an evidence-based, personalized approach for the workup of patients showing treatment failure, which saves time and resources, and contributes to improved patient care.
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Eszter
authors.initials: E
authors.lastname: Lázár-Molnár
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT. julio.delgado@aruplab.com.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Delgado
mesh_terms: D000906:Antibodies / Q000097:blood / Q000276:immunology*; D018501:Antirheumatic Agents / Q000097:blood / Q000276:immunology / Q000494:pharmacology*; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology*; D002851:Chromatography, High Pressure Liquid; D064790:Clinical Laboratory Services; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000906:Antibodies; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha