Herding cats: predicting immunogenicity from heterogeneous clinical trials data

Antibodies represent the largest and fastest growing class of biologic therapeutics, yet forecasting their clinical performance, particularly immunogenicity, remains a major hurdle in drug development. Despite hundreds of antibody-based drugs progressing through clinical pipelines, systematic integration of their clinical outcomes has been limited by fragmented and heterogeneous data. Here, we present the Therapeutic Antibody Database, a comprehensive and curated resource that links therapeutic antibodies to clinical trial outcomes, with a dedicated focus on immunogenicity. Our dataset is sourced from approximately 11,500 anti-drug antibody (ADA) measurements across diverse molecules and indications, offering an unprecedented view into the clinical manifestation of immune responses to biologics. In order to evaluate the main drivers of ADA, we evaluate gathered immunogenicity incidence and prevalence data against various therapeutic descriptors which includes sequence, structure and contextual features related to therapeutics. We find that most tools have very poor performance, and we pinpoint the causes of it, demonstrating the need for systems immunology approaches incorporating clinical metadata beyond biochemical properties of the molecules alone.