Comparison of the efficacy and safety of a proposed biosimilar MSB11456 with tocilizumab reference product in subjects with moderate-to-severe rheumatoid arthritis: results of a randomised double-blind study

OBJECTIVE

To evaluate the efficacy, immunogenicity and safety of the proposed biosimilar MSB11456 versus European Union (EU)-approved tocilizumab reference product in patients with rheumatoid arthritis (RA) in a multicentre, randomised, double-blind, multinational, parallel-group study (NCT04512001).

METHODS

Adult patients with moderate-to-severe active RA and inadequate clinical response to ≥1 disease-modifying antirheumatic drug (synthetic or biologic) receiving methotrexate were randomised to receive 24 weekly subcutaneous 162 mg injections of either MSB11456 or EU-approved tocilizumab. Equivalence between treatments was considered if the 95% CI (European Medicines Agency)/90% CI (US Food and Drug Administration) for the difference in mean change from baseline to week 24 in Disease Activity Score-28 Joint Count with erythrocyte sedimentation rate (DAS28-ESR) between treatments was entirely within prespecified equivalence intervals (-0.6 to 0.6 and -0.6 to 0.5, respectively). At week 24, patients were rerandomised to continued treatment or MSB11456. Secondary efficacy endpoints to week 52, and safety and immunogenicity to week 55 were also evaluated.

RESULTS

At week 24, the least squares mean difference in the change from baseline in DAS28-ESR between treatments was 0.01 (95% CI -0.19 to 0.22) in the 604 randomised patients. Similarity between treatments was shown for all other efficacy, safety and immunogenicity endpoints, including in patients who switched from EU-approved tocilizumab to MSB114466.

CONCLUSIONS

Therapeutic equivalence was demonstrated for efficacy endpoints, and safety and immunogenicity analyses support the similarity of the two treatments. The results of this study strengthen the evidence that the proposed biosimilar MSB11456 and EU-approved tocilizumab exert similar clinical effects.

Pharmacokinetics and tolerability of prefilled syringe and auto-injector presentations of MSB11456: results of a randomized, single-dose study in healthy adults

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.

Pharmacokinetics of a proposed tocilizumab biosimilar (MSB11456) versus US-licensed tocilizumab: results of a randomized, double-blind, single-intravenous dose study in healthy adults

BACKGROUND

Tocilizumab, a recombinant monoclonal immunoglobulin G, targets the interleukin-6 receptor. MSB11456 is a proposed tocilizumab biosimilar.

OBJECTIVES

To assess pharmacokinetic equivalence of intravenous MSB11456 to US-licensed tocilizumab.

RESEARCH DESIGN AND METHODS

In this double-blind, parallel-group, single-dose study, 128 healthy adults were randomized to a single one-hour 8 mg/kg IV infusion of either MSB11456 or US-licensed tocilizumab. Blood samples were collected pre-dose and at regular intervals up to day 48 post-dose. The primary endpoint pharmacokinetic parameter was analyzed using analysis of variance (ANOVA) model on the natural logarithm of the endpoint (AUC_0-last), with treatment as a fixed effect. Immunogenicity and safety data were summarized descriptively.

RESULTS

Subjects received either MSB11456 (N = 62) or US-licensed tocilizumab (N = 66). Pharmacokinetic bioequivalence, defined as 90% confidence intervals for the geometric least squares mean ratio entirely contained within the 80.00% to 125.00% equivalence limits, was demonstrated between MSB11456 and US-licensed tocilizumab for the primary and secondary pharmacokinetic endpoints. Anti-drug antibody responses, frequency of neutralizing antibodies against tocilizumab, and safety profiles showed no notable between-treatment differences. Safety was comparable between treatments.

CONCLUSIONS

Pharmacokinetic similarity of MSB11456 and US-licensed tocilizumab was demonstrated, with comparable immunogenicity and safety profiles, supporting MSB11455 as a biosimilar to US-licensed tocilizumab. The trial is registered at EudraCT, number 2019-003484-22.

Pharmacokinetics and pharmacodynamics of a proposed tocilizumab biosimilar MSB11456 versus both the US-licensed and EU-approved products: a randomized, double-blind trial

BACKGROUND

Tocilizumab is a recombinant humanized monoclonal immunoglobulin G1 antibody against the interleukin-6 receptor (IL-6R). MSB11456 is a proposed tocilizumab biosimilar.

OBJECTIVES

To assess the pharmacokinetic and pharmacodynamic similarity of MSB11456 to both US-licensed and EU-approved tocilizumab.

METHODS

Healthy adult volunteers (N=685) received a single 162 mg subcutaneous injection of MSB11456, US-licensed tocilizumab, or EU-approved tocilizumab in this randomized, double-blind, parallel-group study. Blood samples were taken predose and for up to 48 days postdose. Primary endpoint pharmacokinetic parameters were analyzed using analysis of covariance. Secondary pharmacodynamic measures included serum-soluble IL-6R and serum C-reactive protein. Safety data were analyzed descriptively.

RESULTS

Pharmacokinetic equivalence (with all corresponding 90% confidence intervals for the geometric least squares mean ratios within the predefined 80.00% to 125.00% equivalence margin) was demonstrated between MSB11456 and both US-licensed and EU-approved tocilizumab, as well as between the reference products. Pharmacodynamic analyses demonstrated similarity of MSB11456 and both US-licensed and EU-approved tocilizumab, as well as between the reference products. Safety, tolerability and immunogenicity were comparable between treatments.

CONCLUSION

: Pharmacokinetic and pharmacodynamic similarity of MSB11456, US-licensed tocilizumab, and EU-approved tocilizumab were demonstrated, and the three products had comparable immunogenicity and safety, supporting MSB11456 as a biosimilar to tocilizumab.

AB0195 PHARMACOKINETIC AND PHARMACODYNAMIC EVALUATION OF A PROPOSED BIOSIMILAR MSB11456 VERSUS BOTH THE US-LICENSED AND EU-APPROVED TOCILIZUMAB: RESULTS OF A RANDOMIZED, DOUBLE-BLIND, PARALLEL-GROUP, SINGLE-DOSE TRIAL IN HEALTHY ADULTS

Background:

Tocilizumab, a biologic disease-modifying antirheumatic drug, is a recombinant humanized monoclonal immunoglobulin G1 antibody against the interleukin-6 receptor (IL-6R). MSB11456 is a proposed biosimilar to the US-licensed tocilizumab and EU-approved tocilizumab. Prior to initiation of its clinical development program, MSB11456 was considered highly similar to the reference products based on extensive in vitro pharmacological testing and functional activity assays.

Objectives:

This double-blind, parallel-group phase I study (NCT03282851) assessed the pharmacokinetic (PK) and pharmacodynamic (PD) equivalence of MSB11456 to US-licensed and EU-approved tocilizumab and provided data on the similarity of safety profiles and immunogenicity of MSB11456 and the reference products in healthy adult subjects.

Methods:

Healthy adult volunteers were randomized to receive a single 162 mg subcutaneous injection of MSB11456, US-licensed tocilizumab, or EU-approved tocilizumab. Samples for PK/PD and immunogenicity analysis were taken predose, up to 29 days postdose, and at the end of study visit (day 48). Primary endpoint PK parameters were natural log transformed and analyzed using analysis of covariance (ANCOVA) methods; results were then transformed back to the original scale. Secondary PD analysis measured serum soluble IL-6R and serum C reactive protein (sCRP) parameters, and data were analyzed using a method similar to that for PK data. Safety data were collected throughout the study and analyzed descriptively.

Results:

685 subjects were randomized and treated. Results of the primary PK analysis demonstrated bioequivalence between MSB11456 and both US-licensed and EU-approved tocilizumab, as well as between the reference products, since all corresponding 90% confidence intervals (CIs) for the geometric least squares mean (LSM) ratios were within the predefined 80.00% to 125.00% equivalence margin (Table 1). PD analyses also demonstrated equivalence of MSB11456 and both US-licensed and EU-approved tocilizumab, as well as between the reference products. Safety, tolerability and immunogenicity were also comparable between treatments. The incidence of tocilizumab-specific neutralizing antibodies was low (<3% for all three products).

Conclusion:

PK and PD equivalence of MSB11456, US-licensed tocilizumab, and EU-approved tocilizumab were demonstrated with comparable immunogenicity, safety, and tolerability for the three products. This study adds to the totality of evidence in support of MSB11456 as a proposed biosimilar to tocilizumab.

Table 1.

Results of primary PK analysis

ParameterTreatmentnRatio of geometric LSMs (%)90% CI of ratioMSB11456 vs US-licensed tocilizumabAUC0–∞MSB11456194106.1696.80, 116.43US-licensed tocilizumab190AUC0–tMSB11456230104.1593.58, 115.90US-licensed tocilizumab226CmaxMSB11456230104.4595.05, 114.77US-licensed tocilizumab226MSB11456 vs EU-tocilizumabAUC0–∞MSB11456194104.0394.96, 113.96EU-approved tocilizumab200AUC0–tMSB1145623094.7885.15, 105.50EU-approved tocilizumab224CmaxMSB1145623094.8386.28, 104.22EU-approved tocilizumab224US-licensed vs EU-approved tocilizumabAUC0–∞US-licensed tocilizumab19097.9989.40, 107.41EU-approved tocilizumab200AUC0–tUS-licensed tocilizumab22691.0181.71, 101.36EU-approved tocilizumab224CmaxUS-licensed tocilizumab22690.7982.57, 99.84EU-approved tocilizumab224

AUC, area under the serum concentration-time curve (µg·h/mL); AUC0–∞, AUC from time zero to infinity; AUC0–t, AUC from time zero to the time of the last quantifiable concentration; Cmax, maximum concentration (µg/mL)

Acknowledgements:

Medical writing support was provided by Caroline Spencer and Dr Sue Chambers (Rx Communications, Mold, UK), funded by Fresenius Kabi SwissBioSim.

Disclosure of Interests:

Christian Schwabe: None declared, Chris Wynne: None declared, Andras Illes Employee of: Fresenius Kabi SwissBioSim, Martin Ullmann Employee of: Fresenius Kabi SwissBioSim, Emmanuelle Vincent Employee of: Fresenius Kabi SwissBioSim, Vishal Ghori Employee of: Fresenius Kabi SwissBioSim, Corinne Petit-Frere Employee of: Biosimilars, Fresenius Kabi SwissBioSim, Anne-Sophie Racault Employee of: Fresenius Kabi SwissBioSim, Isabelle Morin Employee of: Former employee of Fresenius Kabi SwissBioSim

Interleukin-9 potentiates the interleukin-4-induced IgE and IgG1 release from murine B lymphocytes

Interleukin-9 (IL-9) is a mouse T-cell-derived cytokine that supports the growth of mucosal type mast cells suggesting its role in the regulation of type I hypersensitivity reactions. Therefore the possible effect of IL-9 on the in vitro regulation of IL-4-induced IgE and IgG1 releases in the mouse was investigated. In this report, we present evidence that IL-9 potentiated IL-4-induced IgE and IgG1 releases from lipopolysaccharide (LPS)-primed murine B lymphocytes, whereas IL-9 alone was ineffective. The potentiating effect of IL-9 is specific for IgE and IgG1 since no effect on IgM production was observed. This potentiating effect was neither related to an enhanced cell viability, nor to an alteration of the IL-4-induced expression of class II antigens by murine B cells. Besides the fact that IL-9 increased the number of IgG1-secreting cells, this cytokine might also enhance immunoglobulin release on a cell basis. Taken together, these data suggest that IL-9 plays an in vitro regulatory role in antibody synthesis, probably via a direct action on murine B lymphocytes.