Monoclonal antibodies

Overview

Monoclonal antibodies are synthetic proteins created in labs to replicate the natural antibodies found in our immune system. These antibodies play a crucial role in our immune response by identifying and attaching to foreign substances (antigens), thereby aiding in their elimination. Produced in laboratories, monoclonal antibodies are designed to activate and boost our immune system. The term “monoclonal” signifies that these antibodies are exact copies of a single antibody. Products often bear names ending in “mab,” indicating their monoclonal origin.

Reasons for undergoing the procedure

Monoclonal antibodies find application in various fields such as research, diagnosis, and therapy of diseases. They serve multiple purposes:

• Act as identification probes for materials in labs or as components of home testing kits, such as those for ovulation or pregnancy.
• Type blood and tissue for transplant purposes.
• Make a diagnosis.
• Treat medical conditions.

Types of diseases monoclonal antibodies treat

The following ailments have been treated with monoclonal antibodies:

• Cancer.
• Migraines.
• High cholesterol.
• Nervous system disorders.
• Organ transplant rejection.
• Infections, including COVID-19.
• Autoimmune and inflammatory conditions, such as allergies.
• Osteoporosis.
• Eye conditions.

Risks

Infusion reactions are frequent and can occur either during or shortly after monoclonal antibody treatment. These reactions happen when the immune system reacts strongly to the monoclonal antibodies. Common symptoms include rash, fever, chills, shortness of breath, sweating, changes in blood pressure, and increased heart rate. Adjusting the infusion rate or reducing the dose can help mitigate these reactions.

Less common but more severe risks are associated with unintended immune responses, such as acute anaphylaxis, Cytokine Release Syndrome (CRS), and serum sickness. Acute anaphylaxis is a severe allergic reaction that can be life-threatening. Serum sickness occurs when the immune system attacks the antiserum or blood product containing proteins used in treatment. CRS, also known as cytokine storm, can lead to organ damage.

The specific risks of monoclonal antibody therapy vary depending on the condition being treated. For instance, cancer treatments may trigger tumor lysis syndrome, which can result in kidney failure.

During the procedure

In most instances, monoclonal antibodies are administered Intravenously (IV), directly into a vein, commonly in an infusion center where multiple patients receive treatment simultaneously.

During your initial treatment, it’s advisable to have someone accompany you to familiarize yourself with the procedure and what to expect. Doctors closely monitor for any potential severe allergic reactions during this first session.

In some cases, a doctor may prescribe a monoclonal antibody administered subcutaneously (under the skin). Patients are typically instructed on self-administration, often in the abdomen or upper thigh.

Monoclonal antibodies can be administered in the following ways:

• Offered on their own as therapy. The term “bare monoclonal antibodies” refers to this.
• Converted into radioactive particles and administered as a combination medication. Conjugated, tagged, loaded, or labeled monoclonal antibodies are the names given to these.
• Changed to bind to two distinct antigens simultaneously and attack them. We refer to these as monoclonal antibodies that are bispecific.

Outcome

Infusion durations can vary depending on the treatment regimen. For example, monoclonal antibody therapy for COVID-19, authorized under Emergency Use Authorization, typically involves an hour for infusion followed by an additional hour of observation for potential reactions.

Your doctor may recommend having a trusted adult family member or friend accompany you for the first infusion as a precaution. This may not be necessary for subsequent treatments if you tolerate the infusion well. If you feel well after treatment, you may be able to resume normal activities such as work or school, though it’s essential to discuss specific guidelines with your doctor. Recommendations will be tailored based on your specific condition being treated and your overall health.