title: A Proposal to Redefine Clinical Immunogenicity Assessment.
abstract: With more than 100 therapeutic proteins (TP) approved since the first EMA guidance on immunogenicity in 2007, a vast amount of clinical experience with a variety of therapeutic proteins has been gained. This has provided data on anti-drug antibodies (ADA) and their observed clinical impact, or lack thereof. It has become evident that not all ADA responses are clinically relevant. The current "standard practice" is to test for ADA in all patients on every study. It is essential that we acknowledge the immunogenicity data gained from marketed TPs and that options for immunogenicity testing reflect this information. Improvements in bioanalytical support throughout the drug development process will eliminate extraneous, non-impactful practices. We propose that low-risk therapeutic proteins could be supported with an event-driven ("collect-and-hold") immunogenicity testing strategy throughout early phases of the clinical program. In the absence of an event, only pivotal studies (where ADA incidence and impact can be decisively assessed) would include default ADA testing. In keeping with the "standard practice," immunogenicity risk assessment must be an on-going and real-time evaluation. This approach has the potential to deliver meaningful, clinically relevant immunogenicity results while maintaining an emphasis on patient safety.
authors.affiliation: Medical Sciences-Clinical Immunology, Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, California, 91320, USA. dmytych@amgen.com.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Mytych
authors.affiliation: Medical Sciences-Clinical Immunology, Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, California, 91320, USA.
authors.forename: M Benjamin
authors.initials: MB
authors.lastname: Hock
authors.affiliation: Medical Sciences-Clinical Immunology, Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, California, 91320, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Kroenke
authors.affiliation: Merck, 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033, USA.
authors.forename: Vibha
authors.initials: V
authors.lastname: Jawa
authors.affiliation: Medical Sciences-Clinical Immunology, Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, California, 91320, USA.
authors.forename: Arunan
authors.initials: A
authors.lastname: Kaliyaperumal
authors.affiliation: Medical Sciences-Clinical Immunology, Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, California, 91320, USA.
authors.forename: Yanchen
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D002986:Clinical Trials as Topic; D004341:Drug Evaluation / Q000379:methods*; D006801:Humans; D007110:Immunity, Active; D011506:Proteins / Q000276:immunology / Q000627:therapeutic use*
chemical_list: D011506:Proteins
keywords: anti-drug antibodies (ADA); immunogenicity; impact analysis; risk assessment