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Janković SM, Janković SV. Anti-calcitonin Gene-Related Peptide Monoclonal Antibodies in Migraine: Focus on Clinical Pharmacokinetics. Eur J Drug Metab Pharmacokinet 2024; 49:277-293. [PMID: 38461486 DOI: 10.1007/s13318-024-00885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
The calcitonin gene-related peptide transmission was the target for recent development of drugs that effectively prevent attacks of both episodic and chronic migraine. The aim of this narrative review was to offer deeper insight into pharmacokinetics of monoclonal antibodies approved for prevention of migraine attacks. For this narrative review, relevant literature was searched for in MEDLINE and Google Scholar databases, covering periods 1966-2023 and 2006-2023, respectively. The ClinicalTrials.gov database was also searched for relevant clinical studies whose results had not been published previously in medical journals, covering the period 2000-2023. The monoclonal antibodies from this group are distributed mainly in the plasma and part of the extracellular space; they are neither metabolized in the liver nor excreted via the kidneys. The elimination of galcanezumab, eptinezumab and fremanezumab takes place only by a non-specific linear process via the reticuloendothelial system in the liver, while erenumab is eliminated by a non-specific process and by a specific, saturable process because of binding to receptors located on the cell membrane. Since the elimination processes do not have a large capacity, the half-life is about 2 weeks for erenumab and about 4 weeks for other monoclonal antibodies. Variability in the pharmacokinetics of these monoclonal antibodies is small in different subpopulations, and body weight is the only parameter to consider when choosing the dose of these drugs.
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Affiliation(s)
- Slobodan M Janković
- Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića Street, 69, 34000, Kragujevac, Serbia.
| | - Snežana V Janković
- Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića Street, 69, 34000, Kragujevac, Serbia
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Zhao M, Kaiser E, Cucchiara B, Zuflacht J. Reversible Cerebral Vasoconstriction Syndrome Exacerbation After Calcitonin Gene-Related Peptide Inhibitor Administration. Neurohospitalist 2023; 13:415-418. [PMID: 37701251 PMCID: PMC10494831 DOI: 10.1177/19418744231173832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a non-inflammatory vasculopathy. While most patients have good clinical outcomes, RCVS can be associated with severe brain injury from ischemic stroke, subarachnoid, and intracerebral hemorrhage. Purpose: A number of vasoactive medications have been implicated in RCVS, including triptans, amphetamines, antidepressants, and decongestants. Given the role of CGRP in modulating cerebral vasodilation, the possibility of CGRP inhibitors contributing to RCVS has been raised. Research Design: Case report at the University of Pennsylvania. Study Sample: Patient at the University of Pennsylvania. Results: We report a patient with RCVS in which severe exacerbation resulting in multifocal ischemic stroke occurred following administration of the calcitonin gene-related peptide (CGRP) inhibitor fremanezumab. Conclusions: It is unclear whether fremanezumab played a role in this patient's case, but CGRP-inhibitor use should be considered as a potential precipiating factor.
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Affiliation(s)
- Megan Zhao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric Kaiser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Brett Cucchiara
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonah Zuflacht
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Tomaszewska-Kiecana M, Dryja A, Ullmann M, Petit-Frere C, Illes A, Dagres C, Monnet J. Pharmacokinetics and tolerability of prefilled syringe and auto-injector presentations of MSB11456: results of a randomized, single-dose study in healthy adults. Expert Rev Clin Immunol 2023; 19:447-455. [PMID: 36789991 DOI: 10.1080/1744666x.2023.2174970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Tocilizumab is a monoclonal immunoglobulin G interleukin-6 receptor antagonist. MSB11456 is a proposed tocilizumab biosimilar. OBJECTIVE To determine the pharmacokinetic equivalence of a single subcutaneous injection of MSB11456, when delivered via autoinjector (AI) and prefilled syringe (PFS), in healthy adult subjects. RESEARCH DESIGN AND METHODS In this randomized, open-label, single fixed-dose, crossover study, 91 subjects received subcutaneous administration of tocilizumab 162 mg via AI and PFS presentations. The primary endpoint pharmacokinetic parameters were analyzed using analysis of variance. Safety data were summarized descriptively. RESULTS There were no differences in pharmacokinetic parameters between presentations, and safety parameters were comparable. The 90% confidence intervals for the geometric least squares mean ratios of all primary pharmacokinetic parameters were contained within the predefined 80.00% to 125.00% bioequivalence limits, indicating pharmacokinetic equivalence between the AI and PFS. CONCLUSIONS MSB11456 administration via AI was bioequivalent to administration via PFS. MSB11456 can be administered by AI or PFS, increasing the available range of self-injection devices. TRIAL REGISTRATION The trial is registered at EudraCT, number 2020-003419-86.
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Affiliation(s)
| | - Anna Dryja
- MTZ Clinical Research Sp Z O O, Warsaw, Poland
| | | | | | - Andras Illes
- Biosimilars, Fresenius Kabi SwissBioSim, Switzerland
| | | | - Joëlle Monnet
- Biosimilars, Fresenius Kabi SwissBioSim, Switzerland
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Hirata K, Takeshima T, Imai N, Igarashi H, Shiosakai M, Inage M, Sakurai F, Ning X, Nakai M, Koga N. A multicenter, open-label, phase 3 study to evaluate the safety of fremanezumab for migraine, subcutaneously self-administered with an auto-injection device at institutional sites and at home. Expert Opin Drug Saf 2023; 22:447-454. [PMID: 36578197 DOI: 10.1080/14740338.2023.2162038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fremanezumab is a humanized monoclonal antibody against calcitonin gene-related peptide for subcutaneous use to suppress migraine attacks. A phase 3 study was conducted to investigate the safety of autoinjector (AI)-assisted self-injection of fremanezumab 225 mg. RESEARCH DESIGN AND METHODS The multicenter, open-label study involving 71 patients with migraine was conducted between June 2020 and November 2020 at ten institutions in Japan. The study consisted of a 4-week (28-day) screening period and an 8-week (57-day) treatment period. According to the investigator's instructions, all patients successfully performed self-injection for 4 weeks at the institutional site and at home and maintained eDiaries of their headaches. The primary endpoint was safety of the drug based on treatment-emergent adverse events (TEAEs). RESULTS Treatment-emergent adverse events were more frequent after at-home injection than after at-site injection, but they were mainly injection site reactions and mostly mild. The safety profile was comparable, raising no concerns compared with what has been reported in previous studies. Both migraine days and headache days were decreased considerably. CONCLUSIONS Overall, AI-assisted, at-home self-injection of fremanezumab was found to be generally safe and well-tolerated. This injection strategy is considered clinically meaningful in view of improved utility of and adherence to the drug.
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Affiliation(s)
- Koichi Hirata
- Headache Center, Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Takao Takeshima
- Headache Center, Department of Neurology, Headache Center Tominaga Hospital, Osaka, Japan
| | - Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Hisaka Igarashi
- Headache Care Unit, Department of Internal Medicine, Fujitsu Clinic, Kanagawa, Japan
| | - Masako Shiosakai
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co Ltd, Tokyo, Japan
| | - Masanobu Inage
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co Ltd, Tokyo, Japan
| | - Fumi Sakurai
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co Ltd, Tokyo, Japan
| | - Xiaoping Ning
- Speciality Clinical Development, Teva Branded Pharmaceutical Products R&D, Inc, West Chester, PA, USA
| | - Masami Nakai
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Osaka, Japan
| | - Nobuyuki Koga
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Tokushima, Japan
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Patel R, Ghadge P, Nair PA, Kumar M, Adhikary L. A review of bridging clinical studies between different presentations of biological products approved by the United States Food and Drug Administration (US FDA). Expert Opin Biol Ther 2022; 22:1293-1310. [PMID: 35968654 DOI: 10.1080/14712598.2022.2113053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There is growing interest in the development of multiple presentations for biological products for subcutaneous (SC) injection for life cycle management and product differentiation. Bridging clinical studies are required to extrapolate the existing data package to new presentations. AREAS COVERED This review compiles information of bridging clinical studies conducted for biological products administered by the SC route and approved in more than one presentation by the United States Food and Drug Administration's Center for Drug Evaluation and Research up until 31 December 2021. Information regarding indication(s), presentation(s), approval pathways, approval timelines, and various aspects of bridging clinical studies was collected from published documents. EXPERT OPINION The type of bridging clinical study can depend on the extent of differences between presentations, existing data packages, and the stage of the product development. Design of a bridging clinical study should be based on the characteristics of a biological product and should be aimed at detecting the relevant differences between presentations. Single-dose comparative pharmacokinetics in normal healthy volunteers is the most common bridging clinical study design. Covariates like body weight and injection site should be considered during the design of these studies. The impact of the different user interfaces of presentations should also be considered.
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Affiliation(s)
- Ronak Patel
- Research and Development, Intas Pharmaceuticals Limited (Biopharma Division), Ahmedabad, India
| | - Pravin Ghadge
- Commercial Development, Intas Pharmaceuticals Limited, Corporate House, Ahmedabad, India
| | - Pravin A Nair
- Research and Development, Intas Pharmaceuticals Limited (Biopharma Division), Ahmedabad, India
| | - Manish Kumar
- Research and Development, Intas Pharmaceuticals Limited (Biopharma Division), Ahmedabad, India
| | - Laxmi Adhikary
- Research and Development, Intas Pharmaceuticals Limited (Biopharma Division), Ahmedabad, India
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Fremanezumab autoinjector pen for the prevention of migraine. Ther Deliv 2021; 12:645-650. [PMID: 34392708 DOI: 10.4155/tde-2021-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ajovy (fremanezumab, Teva Pharmaceuticals, Israel) is a fully humanized monoclonal antibody that selectively binds both isoforms of the calcitonin gene-related peptide. Calcitonin gene-related peptide is a 37-amino acid neuropeptide involved in central and peripheral pathophysiological events in migraine. It is indicated for prophylaxis of migraine in adults who have at least four migraine days per month, and can be administered as a subcutaneous injection using an autoinjector device, with two dosing options: 225 mg once a month or 675 mg quarterly. In this article, I present data from Phase III clinical trials of fremanezumab in episodic and chronic migraine, in which fremanezumab demonstrated efficacy and had a favorable tolerability profile, with no serious treatment-related adverse events.
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Scaling Approaches for Pediatric Dose Selection: The Fremanezumab (AJOVY ®) Journey to Select a Phase 3 Dose Using Pharmacokinetic Data from a Phase 1 Study. Pharmaceutics 2021; 13:pharmaceutics13060785. [PMID: 34074002 PMCID: PMC8225049 DOI: 10.3390/pharmaceutics13060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
Fremanezumab, a fully humanized IgG2Δa/kappa monoclonal antibody, selectively targets the calcitonin-gene-related peptide (CGRP) and prevents it from binding to the CGRP receptor. The safety, tolerability, pharmacokinetics (PK), and efficacy of fremanezumab for treating migraines administered as a once monthly 225 mg dose or a once quarterly 675 mg dose have been well characterized in adults. The fremanezumab exposure and body weight relationship supported the use of the approved 225 mg monthly adult dose for pediatric patients weighing ≥45 kg. In the pediatric Phase 3 program, a 120 mg dose for patients weighing <45 kg was determined using the results of an open-label study and a population PK modeling and simulation strategy. A thorough evaluation was conducted to further characterize the population PK of fremanezumab and assess the predictive performance of the adult population PK model when applied to the Phase 1 pediatric data, the predictive performance of alternative pediatric population PK models, and the predictive performance of the selected pediatric population PK model via a noncompartmental-based approach. This latter comparison to noncompartmental results provided additional evidence that the pediatric population PK model predicts the observed data well and supports the 120 mg monthly dose in patients weighing <45 kg.
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