To monitor for immunogenicity, or the appearance of anti-drug antibodies, we have implemented a reflexive testing approach that aligns with American Gastroenterology Association (AGA) guidelines. This approach first measures the biologic concentration within a patient’s specimen. Then, if necessary, an additional test is performed to assess the presence of antibodies to a specific drug that the patient has been receiving. The information from these tests helps healthcare providers determine if patients are experiencing a loss of response to a specific therapy.
Biologics management Test menu
Clinically significant antibodies to biologic therapies are found in patients with very low trough concentrations in their serum. Therefore, a reflexive approach, which performs testing only when it is clinically relevant, benefits patients and reduces costs for the ordering institution. When concentration results are below a specified level, testing for antibodies to the specific drug will be performed at an additional charge.
Key testing
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Many patients may have flare-ups of their disease, or they may stop responding to treatment. In these situations, the clinician may choose to increase the dose administered or recommend more frequent injections. One cause of decreased response to treatment is the appearance of anti-drug antibodies or “immunogenicity.”
For newer therapies such as ustekinumab that do not yet have well-established therapeutic thresholds and optimal concentrations associated with good outcomes, we offer testing that performs both quantitation and antibody testing on all specimens. We also offer this approach for infliximab and adalimumab therapies.
The panel approach may be considered if there is a known justification for performing both quantitation and anti-drug antibody reactivity. We offer a comprehensive menu of biologic testing for providers to order the right test for the patient at the right time. Offering a reflex test in addition to the panel provides versatility for physicians responding to patients’ needs. Furthermore, the panel will assist with proactive monitoring, which plays a significant role in helping some patients, such as the pediatric population, to manage IBD early in the treatment course.
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Maria Alice Willrich, Ph.D., and Melissa Snyder, Ph.D., explain how Mayo Clinic Laboratories' unique risankizumab panel measures levels of both that drug and its antibodies in patients' blood. The results can better guide the management of patients with inflammatory bowel disease.
Maria Willrich, Ph.D., and Melissa Snyder, Ph.D., describe Mayo Clinic Laboratories' panel for proactive therapeutic drug monitoring of patients with inflammatory bowel disease. The panel expands options for clinicians assessing patients' response to infliximab and adalimumab.
Our risankizumab panel includes two tests for patients who are prescribed this drug for conditions including psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. The first test is a mass spectrometry-based assay to measure the concentration of the drug in patient serum. It’s an IgG kappa monoclonal antibody therapy that measures the signature light chain mass of risankizumab. The second is an antibody test that identifies the presence of anti-drug antibodies against the therapeutic monoclonal risankizumab. The antibody test is performed by a bridging immunoassay that is run on a chemiluminescence platform.
Key testing
Highlights
Maria Alice Willrich, Ph.D., and Melissa Snyder, Ph.D., explain how Mayo Clinic Laboratories' unique risankizumab panel measures levels of both that drug and its antibodies in patients' blood. The results can better guide the management of patients with inflammatory bowel disease.
We offer a mass spectrometry-based test to measure risankizumab concentrations in patients who are prescribed this drug for conditions including psoriasis, psoriatic arthritis, and Crohn's disease. This stand-alone test will help physicians identify loss of response to the therapy in patients, allowing the physician to increase or discontinue therapy as needed.
Key testing
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Maria Alice Willrich, Ph.D., explains how Mayo Clinic Laboratories' new assay provides therapeutic drug monitoring of risankizumab, or RISA. Test results help guide care for patients with plaque psoriasis, psoriatic arthritis, and Crohn's disease.