Abstract
Therapeutic monoclonal antibodies (mAbs) are currently being approved for marketing in Europe and the United States, as well as other countries, on a regular basis. As more mAbs become available to physicians and patients, keeping track of the number, types, production cell lines, antigenic targets, and dates and locations of approvals has become challenging. Data are presented here for 34 mAbs that were approved in either Europe or the United States (US) as of March 2012, and nimotuzumab, which is marketed outside Europe and the US. Of the 34 mAbs, 28 (abciximab, rituximab, basiliximab, palivizumab, infliximab, trastuzumab, alemtuzumab, adalimumab, tositumomab-I131, cetuximab, ibrituximab tiuxetan, omalizumab, bevacizumab, natalizumab, ranibizumab, panitumumab, eculizumab, certolizumab pegol, golimumab, canakinumab, catumaxomab, ustekinumab, tocilizumab, ofatumumab, denosumab, belimumab, ipilimumab, brentuximab) are currently marketed in Europe or the US. Data for six therapeutic mAbs (muromonab-CD3, nebacumab, edrecolomab, daclizumab, gemtuzumab ozogamicin, efalizumab) that were approved but have been withdrawn or discontinued from marketing in Europe or the US are also included.
Of the 28 mAbs currently marketed in the European Union or the US, 26 are marketed in Europe and 27 are marketed in the US, with 25 marketed in both regions (Table 1). Catumaxomab is approved in Europe but not the US; tositumomab-I131 is marketed in the US but not Europe. Brentuximab vedotin was approved in the US in 2011 and, as of March 2012, a marketing application for the mAb is undergoing review by the European Medicines Agency.1 Of the 28 mAbs that are marketed in one or the other region, 43% (12/28) are produced in Chinese hamster ovary (CHO) cells, 25% (7/28) are produced in SP2/0 cells,2 18% (5/28) are produced in NS0 cells,3 and 7% (2/28) are produced in hybridomas. The remaining two products (ranibizumab, certolizumab pegol) are antigen-binding fragments (Fab) that are produced in E. coli. Humanized and human mAbs comprise 36% (10/28) and 32% (9/28) of the total, respectively, while 21% (6/28) are chimeric and 11% (3/28) are murine. Most (75%; 21/28) are canonical full-length mAbs. Of the 7 non-canonical mAbs, three (abciximab, ranibizumab, certolizumab pegol) are Fab, with one of these (certolizumab pegol) pegylated; two (tositumomab-I131, ibrituximab tiuxetan) are radiolabeled when administered to patients; one (brentuximab vedotin) is an antibody-drug conjugate (ADC); and one is bispecific (catumaxomab). Although 16 marketed mAbs target unique antigens, CD20 and tumor necrosis factor are each targeted by 4 mAbs, and epidermal growth factor receptor (EGFR) and vascular endothelial growth factor are each targeted by 2 mAbs. If approved, pertuzumab, which is undergoing regulatory review in Europe and the US as a treatment for breast cancer, would be one of 2 mAbs that target human epidermal growth factor receptor 2 on the market.
Table 1. Therapeutic monoclonal antibodies marketed or in review in the European Union or United States.
International non-proprietary name (Trade name) | Manufacturing cell line | Type | Target | First EU (US) approval year |
---|---|---|---|---|
Abciximab (Reopro®) |
Sp2/0 |
Chimeric IgG1κ Fab |
GPIIb/IIIa |
1995# (1994) |
Rituximab (MabThera®, Rituxan®) |
CHO |
Chimeric IgG1κ |
CD20 |
1998 (1997) |
Basiliximab (Simulect®) |
Sp2/0 |
Chimeric IgG1κ |
IL2R |
1998 (1998) |
Palivizumab (Synagis®) |
NS0 |
Humanized IgG1κ |
RSV |
1999 (1998) |
Infliximab (Remicade®) |
Sp2/0 |
Chimeric IgG1κ |
TNF |
1999 (1998) |
Trastuzumab (Herceptin®) |
CHO |
Humanized IgG1κ |
HER2 |
2000 (1998) |
Alemtuzumab (MabCampath, Campath-1H®) |
CHO |
Humanized IgG1κ |
CD52 |
2001 (2001) |
Adalimumab (Humira®) |
CHO |
Human IgG1κ |
TNF |
2003 (2002) |
Tositumomab-I131 (Bexxar®) |
Hybridoma |
Murine IgG2aλ |
CD20 |
NA (2003) |
Cetuximab (Erbitux®) |
Sp2/0 |
Chimeric IgG1κ |
EGFR |
2004 (2004) |
Ibritumomab tiuxetan (Zevalin®) |
CHO |
Murine IgG1κ |
CD20 |
2004 (2002) |
Omalizumab (Xolair®) |
CHO |
Humanized IgG1κ |
IgE |
2005 (2003) |
Bevacizumab (Avastin®) |
CHO |
Humanized IgG1κ |
VEGF |
2005 (2004) |
Natalizumab (Tysabri®) |
NS0 |
Humanized IgG4κ |
α4-integrin |
2006 (2004) |
Ranibizumab (Lucentis®) |
E. coli |
Humanized IgG1κ Fab |
VEGF |
2007 (2006) |
Panitumumab (Vectibix®) |
CHO |
Human IgG2κ |
EGFR |
2007 (2006) |
Eculizumab (Soliris®) |
NS0 |
Humanized IgG2/4κ |
C5 |
2007 (2007) |
Certolizumab pegol (Cimzia®) |
E. coli |
Humanized IgG1κ Fab, pegylated |
TNF |
2009 (2008) |
Golimumab (Simponi®) |
Sp2/0 |
Human IgG1κ |
TNF |
2009 (2009) |
Canakinumab (Ilaris®) |
Sp2/0 |
Human IgG1κ |
IL1b |
2009 (2009) |
Catumaxomab (Removab®) |
Hybrid hybridoma |
Rat IgG2b/mouse IgG2a bispecific |
EpCAM/CD3 |
2009 (NA) |
Ustekinumab (Stelara®) |
Sp2/0 |
Human IgG1κ |
IL12/23 |
2009 (2009) |
Tocilizumab (RoActemra, Actemra®) |
CHO |
Humanized IgG1κ |
IL6R |
2009 (2010) |
Ofatumumab (Arzerra®) |
NS0 |
Human IgG1κ |
CD20 |
2010 (2009) |
Denosumab (Prolia®) |
CHO |
Human IgG2λ |
RANK-L |
2010 (2010) |
Belimumab (Benlysta®) |
NS0 |
Human IgG1κ |
BLyS |
2011 (2011) |
Raxibacumab (Pending) |
NS0** |
Human IgG1κ |
B. anthrasis PA |
NA (In review) |
Ipilimumab (Yervoy®) |
CHO |
Human IgG1κ |
CTLA-4 |
2011 (2011) |
Brentuximab vedotin (Adcentris®) |
CHO |
Chimeric IgG1κ; conjugated to monomethyl auristatin E |
CD30 |
In review (2011) |
Pertuzumab (Pending) | CHO | Humanized IgG1κ | HER2 | In review (in review) |
As of March 10, 2012. #Country-specific approval; approved under concertation procedure **Product manufactured for Phase 1 study in humans. Abbreviations: BLyS, B lymphocyte stimulator; C5, complement 5; CD, cluster of differentiation; CHO, Chinese hamster ovary; CTLA-4, cytotoxic T lymphocyte antigen 4; EGFR, epidermal growth factor receptor; EpCAM, epithelial cell adhesion molecule; Fab, antigen-binding fragment; GP glycoprotein; IL, interleukin; NA, not approved; PA, protective antigen; RANK-L, receptor activator of NFκb ligand; RSV, respiratory syncytial virus; TNF, tumor necrosis factor; VEGF, vascular endothelial growth factor. Sources: European Medicines Agency public assessment reports, United States Food and Drug Administration (drugs@fda), the international ImMunoGeneTics information system® (www.imgt.org/mAb-DB/index).
In addition to the 28 mAbs currently marketed, six mAbs were approved in at least one country of Europe or in the US, but were subsequently withdrawn or discontinued from marketing for various reasons (Table 2). First approved in the US in 1986, muromonab-CD3 (Orthoclone OKT3®) was a murine IgG2a used to treat acute kidney allograft rejection; however, manufacturing was discontinued in 2010 due to the availability of other treatments with similar efficacy and fewer side effects, and declining sales.4,5 Nebacumab (Centoxin®), a human IgM, was approved in The Netherlands, Britain, Germany and France during 1991 as a treatment for Gram-negative sepsis,6 but the product was subsequently withdrawn for safety, efficacy and commercial reasons.7 The murine anti-epithelial cell adhesion molecule (EpCAM) edrecolomab (Panorex®) was approved in Germany in 1995 as an adjuvant treatment for colon cancer, but subsequently withdrawn because of the product’s lack of efficacy.8 Daclizumab was first approved in 1997 for prophylaxis of acute organ rejection in patients receiving renal transplants, but the product was voluntarily withdrawn from the market in Europe effective January 1, 20099 and discontinued for the US market because of the availability of alternative therapy and the diminished market demand.10 The first ADC to be approved, gemtuzumab ozogamicin was marketed in the US for a decade before being voluntarily withdrawn in 2010. The product was approved under the accelerated approval mechanism as a treatment for acute myeloid leukemia (AML), but was withdrawn when a confirmatory clinical trial and post-approval use did not show evidence of clinical benefit in AML patients.11 Efalizumab (Raptiva®) was approved in the US and Europe in 2003 and 2004, respectively, as a treatment for adults with moderate to severe plaque psoriasis, but the product was voluntarily withdrawn from both markets in 2009 because of the risk of side effects, including progressive multifocal leukoencephalopathy.12,13
Table 2. Therapeutic monoclonal antibodies withdrawn or discontinued from marketing in the European Union or United States.
International proprietary name (Trade name) | Manufacturing cell line |
Type | Target | First EU (US) approval year |
---|---|---|---|---|
Muromonab-CD3 (Orthoclone OKT3®) |
Hybridoma |
Murine IgG2a |
CD3 |
1986* (1986) |
Nebacumab (Centoxin®) |
Hybridoma |
Human IgM |
Endotoxin |
1991*(NA) |
Edrecolomab (Panorex®) |
Hybridoma |
Murine IgG2a |
EpCAM |
1995*(NA) |
Daclizumab (Zenapax®) |
NS0 |
Humanized IgG1κ |
IL2R |
1999 (1997) |
Gemtuzumab ozogamicin (Mylotarg®) |
NS0 |
Humanized IgG4κ |
CD33 |
NA (2000) |
Efalizumab (Raptiva®) | CHO | Humanized IgG1κ | CD11a | 2004 (2003) |
Note: Information current as of March 10, 2012. *European country-specific approval. Abbreviations: CD, cluster of differentiation; CHO, Chinese hamster ovary; EpCAM, epithelial cell adhesion molecule; IL, interleukin; NA, not approved. Sources: European Medicines Agency public assessment reports, United States Food and Drug Administration (drugs@fda), the international ImMunoGeneTics information system® (www.imgt.org/mAb-DB/index).
The European Union and the US are not necessarily the first or only markets for therapeutic mAbs (Table 3). Nimotuzumab, a humanized mAb that targets EGFR, was developed at the Center of Molecular Immunology in Cuba. The mAb is marketed in over 20 countries, including Brazil, India and China, as a treatment for head and neck cancer or glioma, but it is not approved in the EU, US or Japan.14 Mogamulizumab is a defucosylated humanized anti-CC chemokine receptor 4 (CCR4) antibody developed by Kyowa Hakko Kirin Co Ltd.15 The mAb is undergoing regulatory review in Japan as a treatment for adult T-cell leukemia-lymphoma and peripheral T-cell lymphoma.
Table 3. Therapeutic monoclonal antibodies marketed or in review outside the European Union or United States.
International proprietary name (Trade name) | Manufacturing cell line |
Type | Target | First approval year |
---|---|---|---|---|
Nimotuzumab (TheraCIM®, BIOMAB-EGFR®) |
NS0 |
Humanized IgG1κ |
EGFR |
1999 |
Mogamulizumab | [Not found] | Humanized IgG1κ | CCR4 | In review in Japan |
Note: Information current as of March 10, 2012. Abbreviations: CCR, chemokine receptor; EGFR, epidermal growth factor receptor.
The 35 marketed mAbs, most of which are canonical full-length IgG1, paved the way for the next generation of antibody-based therapeutics such as ADCs, bispecific antibodies, engineered antibodies, and antibody fragments or domains. The commercial pipeline includes ~350 mAbs now being evaluated in clinical studies around the world as treatments for many indications, including cancer, immunological disorders and infectious diseases.16 The compendium of marketed therapeutic antibodies may thus be substantially larger in the future.
Acknowledgments
The author thanks Marjorie Shapiro and Mike Clark for providing detailed descriptions and references for the Sp2/0 and NS0 cell lines.
Footnotes
Previously published online: www.landesbioscience.com/journals/mabs/article/19931
References
- 1.European Medicines Agency. Applications for new human medicines under evaluation by the Committee for Medicinal Products for Human Use. March 2012. www.ema.europa.eu/docs/en_GB/document_library/Report/2012/03/WC500123528.pdf
- 2.Shulman M, Wilde CD, Köhler G. A better cell line for making hybridomas secreting specific antibodies. Nature. 1978;276:269–70. doi: 10.1038/276269a0. [DOI] [PubMed] [Google Scholar]
- 3.Clark MR, Milstein C. Expression of spleen cell immunoglobulin phenotype in hybrids with myeloma cell lines. Somatic Cell Genet. 1981;7:657–66. doi: 10.1007/BF01538755. [DOI] [PubMed] [Google Scholar]
- 4.Mahmud N, Klipa D, Ahsan N. Antibody immunosuppressive therapy in solid-organ transplant: Part I. MAbs. 2010;2:148–56. doi: 10.4161/mabs.2.2.11159. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Janssen-Cilag. Orthoclone®OKT3 muromonab-CD3 – Worldwide discontinuation [press release], January 4, 2010. www.cochrane-renal.org/docs/Newsletter_October_2010.pdf
- 6.Rosenberg LT. Delaying approval of a critical drug: safety, efficacy, economics, compassion. J Med Humanit. 1994;15:243–50. doi: 10.1007/BF02273711. [DOI] [PubMed] [Google Scholar]
- 7.Marks L. The birth pangs of monoclonal antibody therapeutics: the failure and legacy of Centoxin. MAbs. 2012;4 doi: 10.4161/mabs.19909. In press. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Punt CJ, Nagy A, Douillard JY, Figer A, Skovsgaard T, Monson J, et al. Edrecolomab alone or in combination with fluorouracil and folinic acid in the adjuvant treatment of stage III colon cancer: a randomised study. Lancet. 2002;360:671–7. doi: 10.1016/S0140-6736(02)09836-7. [DOI] [PubMed] [Google Scholar]
- 9.European Medicines Agency public statement on Zenapax (daclizumab): withdrawal of the marketing application in the Europe Union, January 16, 2009. www.ema.europa.eu/docs/en_GB/document_library/Public_statement/2009/11/WC500011995.pdf
- 10.Roche letter to healthcare professionals, September 2009. www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM194907.pdf
- 11.United States Food and Drug Administration. Pfizer voluntarily withdraws cancer treatment Mylotarg from U.S. market, June 21, 2010. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm216448.htm
- 12.European Medicines Agency public statement on Raptiva (efalizumab): withdrawal of the marketing application in the Europe Union, August 3, 2009. www.ema.europa.eu/docs/en_GB/document_library/Public_statement/2009/11/WC500009129.pdf
- 13.United States Food and Drug Administration statement on the voluntary withdrawal of Raptiva from the U.S. market, April 8, 2009. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm149561.htm
- 14.Ramakrishnan MS, Eswaraiah A, Crombet T, Piedra P, Saurez G, Iyer H, et al. Nimotuzumab, a promising therapeutic monoclonal for treatment of tumors of epithelial origin. MAbs. 2009;1:41–8. doi: 10.4161/mabs.1.1.7509. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Yamamoto K, Utsunomiya A, Tobinai K, Tsukasaki K, Uike N, Uozumi K, et al. Phase I study of KW-0761, a defucosylated humanized anti-CCR4 antibody, in relapsed patients with adult T-cell leukemia-lymphoma and peripheral T-cell lymphoma. J Clin Oncol. 2010;28:1591–8. doi: 10.1200/JCO.2009.25.3575. [DOI] [PubMed] [Google Scholar]
- 16.Reichert JM. Which are the antibodies to watch in 2012? MAbs. 2012;4:1–3. doi: 10.4161/mabs.4.1.18719. [DOI] [PMC free article] [PubMed] [Google Scholar]