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Wang Y, Diep JK, Yu RZ, Hurh E, Karwatowska-Prokopczuk E, Schneider E, Henry S, Bhanot S, Geary RS. Assessment of the Effect of Organ Impairment on the Pharmacokinetics of 2'-MOE and Phosphorothioate Modified Antisense Oligonucleotides. J Clin Pharmacol 2023; 63:21-28. [PMID: 35801818 DOI: 10.1002/jcph.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/01/2022] [Indexed: 12/15/2022]
Abstract
The pharmacokinetics (PK) of 2'-O-methoxyethyl and phosphorothioate antisense oligonucleotides (ASOs), with or without N-acetyl galactosamine conjugation, have been well characterized following subcutaneous or intravenous drug administration. However, the effect of organ impairment on ASO PK, primarily hepatic or renal impairment, has not yet been reported. ASOs distribute extensively to the liver and kidneys, where they are metabolized slowly by endo- and exonucleases, with minimal renal excretion as parent drug (<1%-3%). This short review evaluated the effect of organ impairment on ASO PK using 3 case studies: (1) a phase 1 renal impairment study evaluating a N-acetyl galactosamine-conjugated ASO in healthy study participants and study participants with moderate renal impairment, (2) a phase 2 study evaluating an unconjugated ASO in patients with end-stage renal disease; and (3) a phase 3 study evaluating an unconjugated ASO, which included patients with mild hepatic or renal impairment. Results showed that patients with end-stage renal disease had a mild increase (≈34%) in total plasma exposure, whereas mild or moderate renal impairment showed no effect on plasma PK. The effect of hepatic impairment on ASO PK could not be fully evaluated due to lack of data in moderate and severe hepatic impairment study participants. Nonetheless, available data suggest that mild hepatic impairment had no effect on ASO exposure.
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Affiliation(s)
- Yanfeng Wang
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - John K Diep
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Rosie Z Yu
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Eunju Hurh
- Akcea Therapeutics, Inc., Boston, Massachusetts, USA
| | | | | | - Scott Henry
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Sanjay Bhanot
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
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Chambergo-Michilot D, Alur A, Kulkarni S, Agarwala A. Mipomersen in Familial Hypercholesterolemia: An Update on Health-Related Quality of Life and Patient-Reported Outcomes. Vasc Health Risk Manag 2022; 18:73-80. [PMID: 35221690 PMCID: PMC8880726 DOI: 10.2147/vhrm.s191965] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/01/2022] [Indexed: 12/22/2022] Open
Affiliation(s)
- Diego Chambergo-Michilot
- Universidad Científica del Sur, Lima, Peru
- Department of Cardiology Research, Torres de Salud National Research Center, Lima, Peru
| | - Anish Alur
- Ridge High School, Basking Ridge, NJ, USA
| | - Saneel Kulkarni
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anandita Agarwala
- Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA
- Correspondence: Anandita Agarwala, Division of Cardiology, Center for Cardiovascular Disease Prevention, Baylor Scott & White Heart Hospital Baylor Plano, 1100 Allied Dr, Plano, TX, 75093, USA, Tel +1 469 814 3278, Email
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Watts LM, Karwatowska-Prokopczuk E, Hurh E, Alexander VJ, Balogh K, O'Dea L, Geary RS, Tsimikas S. Treatment with Volanesorsen, a 2'-O-Methoxyethyl-Modified Antisense Oligonucleotide Targeting APOC3 mRNA, Does Not Affect the QTc Interval in Healthy Volunteers. Nucleic Acid Ther 2020; 30:198-206. [PMID: 32589506 PMCID: PMC7415887 DOI: 10.1089/nat.2019.0837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to assess the effect of volanesorsen on the corrected QT (QTc) interval. This thorough QT study enrolled 52 healthy male and female subjects who were randomized at a single site in a four-way crossover study. Subjects were randomly assigned to 1 of 12 treatment sequences and crossed over into four treatment periods over the course of which each subject was to receive a single therapeutic dose of volanesorsen as a 300 mg subcutaneous (SC) injection, a single supratherapeutic dose of volanesorsen as 300 mg intravenous (IV) infusion, a single oral (PO) dose of moxifloxacin (positive control), and placebo dose. The study demonstrated that volanesorsen 300 mg SC and 300 mg IV did not have a clinically relevant effect on ΔΔQTcF exceeding 10 ms. The largest mean effect at any postdose time point was 3.0 ms (90% confidence interval [CI]: 0.8–5.2) after SC dosing and 1.8 ms (90% CI −0.4 to 4.0) after IV dosing. Volanesorsen, at the studied therapeutic and supratherapeutic doses, does not have a clinically meaningful effect on the QTc.
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Affiliation(s)
- Lynnetta M Watts
- Clinical Development, Ionis Pharmaceutical, Inc, Carlsbad, California, USA
| | | | - Eunju Hurh
- Clinical Development, Akcea Therapeutic, Boston, Massachusetts, USA
| | | | - Kristin Balogh
- Clinical Development, Ionis Pharmaceutical, Inc, Carlsbad, California, USA
| | - Louis O'Dea
- Clinical Development, Akcea Therapeutic, Boston, Massachusetts, USA
| | - Richard S Geary
- Clinical Development, Ionis Pharmaceutical, Inc, Carlsbad, California, USA
| | - Sotirios Tsimikas
- Clinical Development, Ionis Pharmaceutical, Inc, Carlsbad, California, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
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Wang Y, Yu RZ, Henry S, Geary RS. Pharmacokinetics and Clinical Pharmacology Considerations of GalNAc 3-Conjugated Antisense Oligonucleotides. Expert Opin Drug Metab Toxicol 2019; 15:475-485. [PMID: 31144994 DOI: 10.1080/17425255.2019.1621838] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Triantennary N-acetyl galactosamine (GalNAc3) - conjugated antisense oligonucleotides (ASOs) have demonstrated improved hepatocyte uptake and pharmacologic activity over their parent unconjugated ASOs in animals and humans. Areas covered: In this review, the ADME (absorption, distribution, metabolism, and excretion) characteristics of GalNAc3-conjugated ASOs in animals and in humans are summarized, and their clinical relevance is evaluated from the clinical pharmacology perspectives. Expert opinion: ASOs distribute to tissues via receptor-mediated processes, and conjugation to a ligand specific to certain cell types can improve target tissue delivery. GalNAc3-conjugation represents a good example on this regard and has demonstrated ideal characteristics of a prodrug to target delivery of ASOs to hepatocytes via the asialoglycoprotein receptor (ASGPR). The improved potency and safety margin permit more flexible dosing (e.g. monthly or less frequently if needed) taking full advantage of the long half-life of the parent ASO in humans. However, while still speculative, it should be noted that ASGPR-mediated uptake could become nonlinear with dose and factors that impact ASGPR expression or compete with ASGPR-mediated uptake could potentially affect the uptake of GalNAc3-conjugated ASOs, further studies are warranted.
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Affiliation(s)
- Yanfeng Wang
- a Ionis Pharmaceuticals, Inc , Carlsbad , CA , USA
| | - Rosie Z Yu
- a Ionis Pharmaceuticals, Inc , Carlsbad , CA , USA
| | - Scott Henry
- a Ionis Pharmaceuticals, Inc , Carlsbad , CA , USA
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Abstract
The therapeutic pathways that modulate transcription mechanisms currently include gene knockdown and splicing modulation. However, additional mechanisms may come into play as more understanding of molecular biology and disease etiology emerge. Building on advances in chemistry and delivery technology, oligonucleotide therapeutics is emerging as an established, validated class of drugs that can modulate a multitude of genetic targets. These targets include over 10,000 proteins in the human genome that have hitherto been considered undruggable by small molecules and protein therapeutics. The approval of five oligonucleotides within the last 2 years elicited unprecedented excitement in the field. However, there are remaining challenges to overcome and significant room for future innovation to fully realize the potential of oligonucleotide therapeutics. In this review, we focus on the translational strategies encompassing preclinical evaluation and clinical development in the context of approved oligonucleotide therapeutics. Translational approaches with respect to pharmacology, pharmacokinetics, cardiac safety evaluation, and dose selection that are specific to this class of drugs are reviewed with examples. The mechanism of action, chemical evolution, and intracellular delivery of oligonucleotide therapies are only briefly reviewed to provide a general background for this class of drugs.
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MESH Headings
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacokinetics
- Clinical Trials as Topic
- Drug Approval
- Drug Delivery Systems/methods
- Drug Evaluation, Preclinical
- Gene Expression Regulation/drug effects
- Genetic Therapy/methods
- Humans
- Oligoribonucleotides, Antisense/administration & dosage
- Oligoribonucleotides, Antisense/genetics
- Oligoribonucleotides, Antisense/pharmacokinetics
- RNA Interference
- RNA Stability/drug effects
- RNA, Messenger/agonists
- RNA, Messenger/antagonists & inhibitors
- RNA, Messenger/genetics
- RNA, Small Interfering/administration & dosage
- RNA, Small Interfering/genetics
- RNA, Small Interfering/pharmacokinetics
- Transcription, Genetic/drug effects
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Affiliation(s)
- Wei Yin
- Quantitative Clinical PharmacologyTakeda Pharmaceutical Company LtdCambridgeMassachusettsUSA
| | - Mark Rogge
- Quantitative Clinical PharmacologyTakeda Pharmaceutical Company LtdCambridgeMassachusettsUSA
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MacLeod AR, Crooke ST. RNA Therapeutics in Oncology: Advances, Challenges, and Future Directions. J Clin Pharmacol 2018; 57 Suppl 10:S43-S59. [PMID: 28921648 DOI: 10.1002/jcph.957] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/08/2017] [Indexed: 12/18/2022]
Abstract
RNA-based therapeutic technologies represent a rapidly expanding class of therapeutic opportunities with the power to modulate cellular biology in ways never before possible. With RNA-targeted therapeutics, inhibitors of previously undruggable proteins, gene expression modulators, and even therapeutic proteins can be rationally designed based on sequence information alone, something that is not possible with other therapeutic modalities. The most advanced RNA therapeutic modalities are antisense oligonucleotides (ASOs) and small interfering RNAs. Particularly with ASOs, recent clinical data have demonstrated proof of mechanism and clinical benefit with these approaches across several nononcology disease areas by multiple routes of administration. In cancer, next-generation ASOs have recently demonstrated single-agent activity in patients with highly refractory cancers. Here we discuss advances in RNA therapeutics for the treatment of cancer and the challenges that remain to solidify these as mainstay therapeutic modalities to bridge the pharmacogenomic divide that remains in cancer drug discovery.
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Affiliation(s)
- A Robert MacLeod
- Vice President, Oncology Discovery, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | - Stanley T Crooke
- CEO and Chairman of the Board, Ionis Pharmaceuticals, Carlsbad, CA, USA
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Yu RZ, Gunawan R, Geary RS, Hughes SG, Henry SP, Wang Y. Lack of QT Prolongation for 2'-O-Methoxyethyl-Modified Antisense Oligonucleotides Based on Retrospective Exposure/Response Analysis of Ten Phase 1 Dose-Escalation Placebo-Controlled Studies in Healthy Subjects. Nucleic Acid Ther 2017; 27:285-294. [PMID: 28799823 PMCID: PMC5649121 DOI: 10.1089/nat.2017.0676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The potential of QT prolongation of ten 2′-O-methoxyethyl-modified (2′-MOE) antisense oligonucleotides (ASOs) was evaluated retrospectively via exposure/response (ER) analysis using data from Phase 1 clinical studies in healthy subjects. All Phase 1 studies were double-blind, placebo-controlled, single and multiple ascending dose studies designed to assess the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics of the ASOs in healthy subjects. The active doses in these studies ranged from 50 to 450 mg administered by subcutaneous (SC) injection in single and multiple ascending dose cohorts. Two of the ten studies also included 2-h intravenous (IV) infusions up to 600 mg. Electrocardiogram (ECG) measurements were performed at baseline and selected time points (including Tmax). The correlation between QTcF intervals corrected for baseline (ΔQTcF) and the mean time-matched placebo (ΔΔQTcF) with PK plasma exposure when available was evaluated using a linear mixed-effects approach. There was no evidence for QTc prolongation associated with increasing plasma concentrations in healthy subjects, including exposures with treatment up to 450 mg administered SC or 600 mg by IV infusions, and concentrations that are 4–20 times the Cmax of the therapeutic dose, as assessed by both ΔQTcF and ΔΔQTcF. The ER analysis of the relationship between drug plasma concentration and ΔΔQTcF showed that the slope of the regression line was close to zero, and the upper bound of the 90% confidence interval at twice the mean observed (or predicted) Cmax (2 × Cmax) of the clinical therapeutic dose (ie, the highest clinically relevant plasma concentration) was well below 10 ms for all 10 compounds evaluated. Therefore, no concentration-dependent effect on QT prolongation was observed for any one of the ten 2′-MOE ASOs evaluated in Phase 1 studies. These results confirmed that 2′-MOE ASOs, as a chemical class, do not cause QT prolongation at clinically relevant dose levels.
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Affiliation(s)
- Rosie Z Yu
- 1 Department of Pharmacokinetics and Clinical Pharmacology, Ionis Pharmaceuticals, Inc. , Carlsbad, California
| | - Rudy Gunawan
- 1 Department of Pharmacokinetics and Clinical Pharmacology, Ionis Pharmaceuticals, Inc. , Carlsbad, California
| | - Richard S Geary
- 2 Department of Clinical Development, Ionis Pharmaceuticals, Inc. , Carlsbad, California
| | - Steven G Hughes
- 2 Department of Clinical Development, Ionis Pharmaceuticals, Inc. , Carlsbad, California
| | - Scott P Henry
- 3 Department of Nonclinical Development, Ionis Pharmaceuticals, Inc. , Carlsbad, California
| | - Yanfeng Wang
- 1 Department of Pharmacokinetics and Clinical Pharmacology, Ionis Pharmaceuticals, Inc. , Carlsbad, California
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Abstract
Recent studies have led to a greater appreciation of the diverse roles RNAs play in maintaining normal cellular function and how they contribute to disease pathology, broadening the number of potential therapeutic targets. Antisense oligonucleotides are the most direct means to target RNA in a selective manner and have become an established platform technology for drug discovery. There are multiple molecular mechanisms by which antisense oligonucleotides can be used to modulate RNAs in cells, including promoting the degradation of the targeted RNA or modulating RNA function without degradation. Antisense drugs utilizing various antisense mechanisms are demonstrating therapeutic potential for the treatment of a broad variety of diseases. This review focuses on some of the advances that have taken place in translating antisense technology from the bench to the clinic.
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Affiliation(s)
| | | | - Nguyen Pham
- Ionis Pharmaceuticals, Carlsbad, California 92010;
| | - Eric Swayze
- Ionis Pharmaceuticals, Carlsbad, California 92010;
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Abstract
INTRODUCTION Anti-sense oligonucleotide (ASO) therapies are a new development in clinical pharmacology offering greater specificity compared to small molecule inhibitors and the ability to target intracellular process' not susceptible to antibody-based therapies. AREAS COVERED This article reviews the chemical biology of ASOs and related RNA therapeutics. It then reviews the data on their use to treat hyperlipidaemia. Data on mipomersen - an ASO to apolipoprotein B-100(apoB) licensed for treatment of homozygous familial hypercholesterolaemia (FH) is presented. Few effective therapies are available to reduce atehrogenic lipoprotein (a) levels. An ASO therapy to apolipoprotein(a) (ISIS Apo(a)Rx) specifically reduced lipoprotein (a) levels by up to 78%. Treatment options for patients with familial chylomicronaemia syndrome (lipoprotein lipase deficiency; LPLD) or lipodystrophies are highly limited and often inadequate. Volanesorsen, an ASO to apolipoprotein C-3, shows promise in the treatment of LPLD and severe hypertriglyceridaemia as it increases clearance of triglyceride-rich lipoproteins and can normalise triglycerides in these patients. EXPERT OPINION The uptake of the novel ASO therapies is likely to be limited to selected niche groups or orphan diseases. These will include homozygous FH, severe heterozygous FH for mipomersen; LPLD deficiency and lipodystrophy syndromes for volanesorsen and treatment of patients with high elevated Lp(a) levels.
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Affiliation(s)
- Anthony S Wierzbicki
- a Department of Metabolic Medicine/Chemical Pathology , Guy's and St Thomas' Hospitals , London , UK
| | - Adie Viljoen
- b Consultant in Metabolic Medicine/Chemical Pathology , Lister Hospital , Stevenage , UK
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Tylutki Z, Polak S, Wiśniowska B. Top-down, Bottom-up and Middle-out Strategies for Drug Cardiac Safety Assessment via Modeling and Simulations. ACTA ACUST UNITED AC 2016; 2:171-7. [PMID: 27429898 DOI: 10.1007/s40495-016-0060-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac safety is an issue causing early terminations at various stages of drug development. Efforts are put into the elimination of false negatives as well as false positives resulting from the current testing paradigm. In silico approaches offer mathematical system and data description from the ion current, through cardiomyocytes level, up to incorporation of inter-individual variability at the population level. The article aims to review three main modelling and simulation approaches, i.e. “top-down” which refers to models built on the observed data, “bottom-up”, which stands for a mechanistic description of human physiology, and “middle-out” which combines both strategies. Modelling and simulation is a well-established tool in the assessment of drug proarrhythmic potency with an impact on research and development as well as on regulatory decisions, and it is certainly here to stay. What is more, the shift to systems biology and physiology-based models makes the cardiac effect more predictable.
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