The monoclonals: What have we learned and where are we going?

Since the approval of the first biologic for the treatment of allergic and immunologic diseases in 2003, the era of monoclonal antibodies has expanded. In this review, we explore technological updates that have improved the utility of monoclonal antibodies for the management of allergic and respiratory diseases. These improvements include the development of fully, vs previously partially, humanized monoclonal antibodies; the approval of biosimilars; the utility of mutations in the Fc portion of monoclonal antibodies that allow for a longer duration of action with an extended half-life; the development of bispecific and trispecific monoclonal antibodies and nanobodies; antibody-drug conjugates; and novel approaches to degrade proteins that are critical in the pathogenesis of these diseases. Emerging monoclonals will target IgE, mast cells, and other innovative targets through these various strategies. The current monoclonal antibodies have been invaluable in helping to understand disease pathogenesis, provide better therapies, and identify novel targets. The next generation should provide safer, longer-lasting, and more effective options. However, better biomarkers and outcomes data are still needed to more effectively match the best approach for each patient.