Getting the Dose Right in Drug Development for Rare Diseases: Barriers and Enablers

Confirmation of Fixed Quarterly Riliprubart Regimen in Patients with Cold Agglutinin Disease Using Population PK/PD and Exposure-Response Analyses

Riliprubart is a second-generation, humanized immunoglobulin G4 that inhibits only the activated form of the C1s component of the proximal classical complement pathway. The clinical studies of riliprubart conducted thus far for the treatment of cold agglutinin disease (CAD), a rare autoimmune disease, include a Phase 1 first-in-human study in healthy participants and a Phase 1b single-dose study in 12 adult CAD patients. The objective of this study was to derive a riliprubart dosing regimen for CAD patients using model-informed drug development (MIDD) approaches utilizing available clinical data. A virtual population consisting of 1,000 CAD patients was created by sampling with replacement of the body weight distribution of CAD patients from a clinical database. The 3.5 g IV quarterly (q12w) riliprubart regimen with an additional 3.5 g IV dose on Day 29 is predicted to have a greater than threefold safety margin and >90% efficacy. The observed riliprubart concentration-time profiles from 9 CAD patients were consistently within the popPK simulated 90% prediction interval. Based on the totality of the efficacy, safety, and PK/PD data observed under clinical evaluation, the proposed dose regimen demonstrated suitability for CAD patients.

Unlocking the Mysteries of Rare Disease Drug Development: A Beginner's Guide for Clinical Pharmacologists

Clinical pharmacologists face unique challenges when developing drugs for rare diseases. These conditions are characterized by small patient populations, diverse disease progression patterns, and a limited understanding of underlying pathophysiology. This tutorial serves as a comprehensive guide, offering practical insights and strategies to navigate its complexities. In this tutorial, we outline global regulatory incentives and resources available to support rare disease research, describe some considerations for designing a clinical development plan for rare diseases, and we highlight the role of biomarkers, real-world data, and modeling and simulations to navigate rare disease challenges. By leveraging these tools and understanding regulatory pathways, clinical pharmacologists can significantly contribute to advancing therapeutic options for rare diseases.

Synthetic data generation: a privacy-preserving approach to accelerate rare disease research

Rare disease research faces significant challenges due to limited patient data, strict privacy regulations, and the need for diverse datasets to develop accurate AI-driven diagnostics and treatments. Synthetic data-artificially generated datasets that mimic patient data while preserving privacy-offer a promising solution to these issues. This article explores how synthetic data can bridge data gaps, enabling the training of AI models, simulating clinical trials, and facilitating cross-border collaborations in rare disease research. We examine case studies where synthetic data successfully replicated patient characteristics, and supported predictive modelling and ensured compliance with regulations like GDPR and HIPAA. While acknowledging current limitations, we discuss synthetic data's potential to revolutionise rare disease research by enhancing data availability and privacy file enabling more efficient and effective research efforts in diagnosing, treating, and managing rare diseases globally.

Citrate-Assisted Regulation of Protein Stability and Secretability from Synthetic Amyloids

The mammalian endocrine system uses functional amyloids as dynamic depots to store and release protein hormones into the bloodstream. Such depots, acting as secretory granules within the microscale, are formed in specialized cells by the coordination between the ionic, divalent form of zinc (Zn2+) and the imidazole ring from accessible His residues. The reversibility of such cross-linking events allows for the release of monomeric or oligomeric forms of the functional protein for biological activity. In vitro, and mimicking such a natural coordination process, synthetic amyloidal granules with secretory properties can be fabricated using selected therapeutic proteins as building blocks. Then, these microparticles act as delivery systems for endocrine-like, sustained protein release, with proven applicability in vaccinology, cancer therapy, regenerative medicine, and as antimicrobial agents. While the temporal profile in which the protein is leaked from the material might be highly relevant to clinically oriented applications, the fine control of such parameters remains unclear. We have explored here how the kinetics of protein release can be regulated by intervening in the storage formulation of the granules, through the concentration of citrate not only as a buffer component and protein stabilizer but also as a chelating agent. The citrate-assisted, time-prolonged regulatable release of proteins, in their functional form, opens a spectrum of possibilities to adjust the preparation of synthetic secretory granules to specific clinical needs.

Pharmacogenomics and rare diseases: optimizing drug development and personalized therapeutics

Pharmacogenomics (PGx) is an evolving field that integrates genetic information into clinical decision-making to optimize drug therapy and minimize adverse drug reactions (ADRs). Its application in rare disease (RD) drug development is promising, given the genetic basis of many RDs and the need for precision medicine approaches. Despite significant advancements, challenges persist in developing effective therapies for RDs due to small patient populations, genetic heterogeneity, and limited surrogate biomarkers. The Orphan Drug Act in the U.S. has incentivized RD drug development. However, the traditional drug approval process is constrained by logistical and economic challenges, necessitating innovative PGx-driven strategies. Identifying genetic biomarkers in the early drug development stages can optimize dose selection, enhance therapeutic efficacy, and reduce ADRs. Case studies such as eliglustat for Gaucher disease and ivacaftor for cystic fibrosis demonstrate the efficacy of PGx-guided treatment strategies. Integrating PGx into global drug development requires the harmonization of regulatory policies and increased diversity in genetic research. Artificial intelligence (AI) tools further enhance genetic analysis, disease prediction, and clinical decision-making. Modernizing drug labeling with PGx information is critical to ensuring safe and effective drug use. Collectively, PGx offers transformative potential in RD therapeutics by facilitating personalized medicine approaches and addressing unmet medical needs.

Highlights of Precision Medicine, Genetics, Epigenetics and Artificial Intelligence in Pompe Disease

Pompe disease is a neuromuscular disorder caused by a deficiency of the enzyme acid alpha-glucosidase (GAA), which leads to lysosomal glycogen accumulation and progressive development of muscle weakness. Two distinct isoforms have been identified. In the infantile form, the weakness is often severe and leads to motor difficulties from the first few months of life. In adult patients, the progression is slower but can still lead to significant loss of mobility. The current inherent difficulties of the disease lie in both early diagnosis and the use of biomarkers. Given that this is a multifactorial disease, a number of components may exert an influence on the disease process; from the degree of pre-ERT (enzyme replacement therapy) muscle damage to the damaged autophagic system and the different pathways involved. What methodology should be employed to study the complex characteristics of Pompe disease? Our approach relies on the application of genetic and epigenetic knowledge, with a progression from proteomics to transcriptomics. It is also becoming increasingly evident that artificial intelligence is a significant area of interest. The objective of this study is to conduct a comprehensive review of the existing literature on the known data and complications associated with the disease in patients with disorders attributed to Pompe disease.