Anti-lymphocyte monoclonal antibodies (under construction)

The anti-lymphocyte monoclonal antibodies suppress lymphocyte activity. All such agents must be administered under the supervision of an experienced specialist, in a setting with immediate access to full resuscitation facilities.

Alemtuzumab is a CAMPATH-1 (CD52) antigen inhibitor. It is primarily used for the treatment of relapsing-remitting multiple sclerosis. Alemtuzumab can also be used in B-cell chronic lymphocytic leukemia (CLL) therapy and in transplant indications, but access for these indications is controlled through a patient access programme.

Basiliximab acts as a functional IL-2 receptor antagonist, inhibiting IL-2-mediated activation of T lymphocytes. It is for prophylaxis of acute rejection in allogeneic renal transplantation. It is used alongside cyclosporin and corticosteroid-containing immunosuppression regimens.

Belimumab suppresses B-cell mediated immunity and the autoimmune response by binding to circulating soluble TNFSF13B (BLyS). IN the UK belimumab can be prescribed as adjunctive therapy for patients with active, autoantibody-positive systemic lupus erythematosus (SLE), in particular for those patienst whose disease is unresponsive to standard therapy.

Natalizumab binds to the α₄-subunit of α₄β₁ and α₄β₇ integrins on leukocyte cell surfaces. This action inhibits leukocyte adhesion to the counter-receptor vascular cell adhesion molecule-1 (VCAM-1), thereby inhibiting leukocyte migration to inflamed tissue and reducing active inflammation. IN the UK natalizumab is licensed to treat relapsing-remitting multiple sclerosis despite treatment with interferon beta or glatiramer acetate, or rapidly evolving severe relapsing-remitting multiple sclerosis. In the US it may also be used to treat moderate to severe treatment-resistant Crohn's disease in adults.

Obinutuzumab is an anti-CD20 monoclonal approved for the treatment of chronic lymphocytic leukemia (CLL) and rituximab-relapsed follicular lymphoma (FL) (in the US, in combination with bendamustine, followed by obinutuzumab monotherapy).

Ofatumumab is another anti-CD20 monoclonal approved for certain cases of CLL e.g. CLL refractory to fludarabine and alemtuzumab, or treatment-naive patients who are not eligible for fludarabine based therapy.

Rituximab also targets CD20 on B-cells. It is used to treat CD20-positive non-Hodgkins lymphoma, chronic lymphocytic leukemia, and DMARDTHF inhibitor-resistant sever active rheumatoid arthritis.

Vedolizumab binds specifically to the α₄β₇ integrin, expressed on gut homing T helper lymphocytes. This action reduces gastrointestinal inflammation. Used to treat adult patients with moderate to severe ulcerative colitis or moderate to severe Crohn‘s disease.