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Journal Information
Vol. 151. Issue 4.
Pages 148-155 (August 2018)
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Vol. 151. Issue 4.
Pages 148-155 (August 2018)
Review
DOI: 10.1016/j.medcle.2018.06.002
Pharmacological interactions of monoclonal antibodies
Interacciones farmacológicas de los anticuerpos monoclonales
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José M. Serra López-Matencioa, Alberto Morell Baladróna, Santos Castañedab,
Corresponding author
scastas@gmail.com

Corresponding author.
a Servicio de Farmacia Hospitalaria, Hospital de la Princesa, IIS-Princesa, Madrid, Spain
b Servicio de Reumatología, Hospital de la Princesa, IIS-Princesa, Madrid, Spain
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Table 1. Monoclonal antibodies currently approved (EMA/FDA).
Table 2. Main differences in the RADME process between mAbs and chemical synthesis molecules.
Table 3. Enzyme superfamily involved in drug degradation.
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Abstract

The pharmacological interactions of biological agents are not well known. Because biologic agents are not metabolized by cytochrome P450 (CYP) enzymes and do not interact with cell membrane transporters, it is generally perceived that they are free from interactions with small molecule drugs. However, the clearance of biological agents varies depending on the modulation of the immune response or by either increasing or reducing the expression of target cells of the biological agents, which can occur through the action of multiple synthetic chemical agents. Furthermore, some biological agents may modify the metabolism of chemical drugs through their effects on the expression of P450 system enzymes. In this review, we will provide an outline of the pharmacokinetics properties and pharmacologic interactions of biological drugs, focusing on monoclonal antibodies, and how these can interact with chemical synthesis molecules. We believe knowledge of them is important for clinicians and affects multiple clinical specialties.

Keywords:
Adverse reactions
Biologics
Monoclonal antibodies
Pharmacodynamics
Pharmacological interactions
Resumen

Las interacciones farmacológicas de los agentes biológicos no son bien conocidas. Debido a que los fármacos biológicos no son metabolizados por las enzimas del citocromo P450 (CYP450) ni interaccionan con los transportadores transmembrana, existe la percepción de que estos no presentan interacciones medicamentosas con los fármacos de síntesis química. Sin embargo, el aclaramiento de los agentes biológicos puede variar en función de la respuesta inmune o si se modifica la expresión de sus células diana, lo cual puede ocurrir por la acción de muchos agentes químicos. Además, algunos biológicos son capaces de modular la expresión de las enzimas del sistema CYP450. En esta revisión, se proporciona una descripción de las propiedades farmacocinéticas y posibles interacciones de los fármacos biológicos, centrándonos en los anticuerpos monoclonales, y como estos pueden interaccionar con las moléculas de síntesis química. Creemos que su conocimiento es importante para los clínicos y afecta a varias especialidades médicas.

Palabras clave:
Interacciones farmacológicas
Farmacodinamia
Agentes biológicos
Anticuerpos monoclonales
Reacciones adversas

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