Thursday, 3 January 2013

Neutralizing anti-interferon-beta antibodies or NABs

#MSBlog: Are you on interferon-beta? Have you been  tested for NABs?

Creeke & Farrell. Clinical testing for neutralizing antibodies to interferon-β in multiple sclerosis. Ther Adv Neurol Disord. 2013 Jan;6(1):3-17. doi: 10.1177/1756285612469264.

Biopharmaceuticals are drugs which are based on naturally occurring proteins.. Immunogenicity of these agents has been commonly described and refers to a specific antidrug antibody response. Such immunogenicity represents a major factor impairing the efficacy of biopharmaceuticals due to biopharmaceutical neutralization. Indeed, clinical experience has shown that induction of antidrug antibodies is associated with a loss of response to biopharmaceuticals and also with hypersensitivity reactions. The first disease-specific agent licensed to treat MS was interferon-β (IFNβ). In its various preparations, it remains the most commonly used first-line agent. The occurrence of antidrug antibodies has been extensively researched in MS, particularly in relation to IFNβ. However, much controversy remains regarding the significance of these antibodies and incorporation of testing into clinical practice. Between 2% and 45% of people treated with IFNβ will develop neutralizing antibodies, and this is dependent on the specific drug and dosing regimen. The aim of this review is to discuss the use of IFNβ in MS, the biological and clinical relevance of anti-IFNβ antibodies (binding and neutralizing antibodies), the incorporation of testing in clinical practice and ongoing research in the field.

"This review raises the issue of neutralising antibodies to interferon beta or NABs yet again. Some of you may say not again. However,  this is a serious issue and needs to be taken seriously. If you are on interferon beta you should have yourself tested to see if you are NAB positive. MSers who are NAB positive do much worse than those who are NAB negative. NABs not only stop interferon -beta from working they probably neutralise the activity of your own interferon beta with potential long-term consequences. This is why we have a study underway to try and get rid of NABs."

"We are interested to know how common NABs testing is amongst readers of this blog, which is why we would appreciate you completing the following poll. If you have been on IFNbeta for 12 months or longer you should ask your neurologist whether or not he/she thinks a NABs test is necessary."


CoI: Paul Creeke and Rachel Farrell work at Barts and UCL; i.e. they are members of MS@UCLP

5 comments:

  1. Re getting rid of nabs.
    How much longer will the study go on?
    Will it allow people to get back on interferon?
    Will the same method work for nabs to drugs other than interferon?

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  2. Well, I answered the poll - but also thought my comment needed sharing. The last time I spoke to my NHS neuro about NABs was in 2005 - 5 years after starting Rebif. He said that no way was he going to authorise a test and refused to tell me the symptoms of NABs. I gave up trying to talk to him about this.
    The brilliant MS nurse at York told me that a course of steroids could wipe out NABs, but of course, first I'd need a test. Bloody vicious circle and also - that neuro department only gave steroids with unbearable symptoms - pain, contortions due to spasms etc.
    What's the point of debating NABs when the neuro you are assigned to won't even tell you the symptoms.
    I've been on Rebif for 12 years and never once had a NABs test.

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    Replies
    1. The NAB test costs the NHS £120. To have it done privately costs £136, I know we shouldn't have to but if you're prepared to pay you could go via your GP and get it done privately. By-pass the consultant & you could find out for yourself.
      (the reluctance to do the test by neuro's & even their reaction when you've got NABs ie ignore the result & carry on with a treatment that costs £0000's HAS to be related to the benefits THEY get from the pharma companies Eg all expenses paid trips to conferences all over the world, wining & dining etc etc. Of course they're not going to want to uncover how many people AREN'T benefitting from IFN-beta - most of them woulld starve to death when the pharma cos. stop 'courting' them as the prescriptions fall!)

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    2. Anon 7.18 is cynical. There are other reasons why doctors dont bother about NABS - some are actially ignorant, some feel that NABS dont reduce the effectiveness all that much and it's better to stay on treatment

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    3. I note Prof G and his team run tests for NABs:

      http://www.nab-bio.com/

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