Comprehensive guide to biological agents

Safety of biologics therapy. Brian A Baldo. Springer, 2016 (€109.99; 610 pp). ISBN 9783319304700

The skyrocketing number of biological agents available is partly due to their specific targeting ability and also because new indications continue to be discovered, spanning multiple medical disciplines. Biological agents differ from small molecular drugs in the durations of action and adverse effects, particularly with hypersensitivity, infusion reactions, infections and immunogenicity. There are available resources detailing safety in specific diseases, but as more biological agents are marketed for a greater disease range, it is essential to have a single resource such as Safety of biologics therapy, which covers comprehensively all biologicals for all conditions for various health professionals, without becoming quickly outdated.

Formerly heading the Molecular Immunology Unit at the Kolling Institute in Sydney, Brian Baldo’s field knowledge is undoubted; yet publishing this 600-page book is still no mean feat. It is an up-to-date reference covering early biologicals, such as human insulin, to the recently approved monoclonal antibody atezolizumab. It details — sometimes excessively so — each drug’s indications, adverse effects and immunogenicity reported by clinical trials and international drug regulators. However, unfortunately for Australian readers, the Therapeutic Goods Administration indications and Pharmaceutical Benefits Scheme approval status are not explicitly included.

The text contains sequential lists, either of adverse effects with specific drugs or of drugs with specific adverse effects (eg, “human mouse chimeras abciximab, basiliximab, brentuximab, cetuximab, infliximab, rituximab, siltuximab, and dinutuximab”), which makes the text difficult to follow occasionally. The book excels in explaining the known mechanisms of action and toxicity of these drugs, but it may be improved by offering potential theories for unknown mechanisms of toxicity. Detailed tables contain useful information but overflow onto subsequent pages, leading to cumbersome flicking between pages for abbreviations and footnotes. The key message — use these drugs with appropriate caution — is lost in the main text’s detail; the text could be simplified in future editions to highlight this better.

The best feature of the book is the chapter summaries. These are succinct and very readable — ideal for clinicians needing a quick reference, students requiring clear and precise details about the drug’s safety, or academics wanting a taste of the complexities that lie within the chapter’s text. Even for just these summaries, investment in this book is worthwhile.