Other biologicals used in transplantation
Some of the drugs listed in Table 1 are used in very short courses in organ transplantation. According to definition (FDA https://www.fda.gov/files/drugs/published/Biological-Product-Definitions.pdf), anti-thymocyte globulin preparations (ATG) are biological drugs although not designed and produced like current biologicals. In the US immunosuppressive protocols frequently include ATG for induction therapy, while in most of Europe the specific IL-2R antagonist basiliximab is preferred. In these regimens only one or two doses are given, leaving limited space for personalized dosing except if one would try to individualize the initial dose more than current practice. In steroid resistant rejections ATG is an important treatment option. To reverse the rejection repeated doses will often be required, and in this setting the dosing intervals are adjusted based in part on the absolute CD3 cell counts –which may be considered a form of pharmacodynamics monitoring [29].
Imlifidase is an enzyme which rapidly degrades and depletes IgG from circulation. This drug is approved for desensitization in highly sensitized patients awaiting kidney transplantation. It is also in trials for treatment of ABMR [30]. For desensitization a single dose is recommended pretransplant while a small study also explored the use of one repetition [31]. Dosage is BW adjusted, otherwise no further personalization has been discussed. Of specific note is that several other mAbs may be degraded by imlifidase if administered concurrently.