Monoclonal antibodies in inflammatory disease of the muscle and peripheral nervous system

Introduction: A significant group of neuromuscular diseases are of autoimmune origin, but the classic immunomodulatory drugs are not often effective. For this reason, there is a need to find new more effective treatments that will lead to better control of these conditions, particularly those that are usually more resistant. In the last few years, the use of monoclonal antibodies against specific antigens of lymphocyte populations or against pro-inflammatory molecules has seen a great expansion, and has been demonstrated to be a useful alternative in autoimmune diseases. An intensive search was made in Medline using the Keywords neuromuscular, myopathy, neuropathy, myasthenia, Lambert-Eaton, monoclonal antibody, rituximab, alemtuzumab, and anti-TNF-alpha. Development: Clinical trials performed to evaluate the efficacy of monoclonal antibodies in neuromuscular disease are very limited and of reduced size. Thus, the experience in this field is basically limited to anecdotal cases or short series of patients on open-label treatment. The published data are encouraging, with favourable responses having been observed in patients resistant to classic treatments and in diseases that do not normally respond to the usual immunosuppressant drugs. On the other hand, it has been observed that anti-INF-alpha antibodies may trigger the appearance of autoimmune neuromuscular diseases. Conclusions: Monoclonal antibodies could be an effective alternative treatment in autoimmune neuromuscular diseases, but the favourable responses observed need to be confirmed by means of controlled clinical trials with a sufficient number of patients. (C) 2010 Sociedad Espanola de Neurologia. Published by Elsevier Espana, Si. All rights reserved.