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Nolain P, Djebli N, Brunet A, Fabre D, Khier S. Combined Semi-mechanistic Target-Mediated Drug Disposition and Pharmacokinetic-Pharmacodynamic Models of Alirocumab, PCSK9, and Low-Density Lipoprotein Cholesterol in a Pooled Analysis of Randomized Phase I/II/III Studies. Eur J Drug Metab Pharmacokinet 2022; 47:789-802. [PMID: 35974290 DOI: 10.1007/s13318-022-00787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Alirocumab is a cholesterol-lowering monoclonal antibody targeting proprotein convertase subtilisin kexin type 9 (PCSK9) indicated in the prevention of cardiovascular risk and exhibiting target-mediated drug disposition (TMDD). The aim of this work was to develop an integrated pharmacokinetic-pharmacodynamic model to describe the interaction of alirocumab with PCSK9 and its impact on the evolution of low-density lipoprotein cholesterol (LDL-C) levels and explore labeling specification for subpopulations. METHODS Using data collected from nine phase I/II/III clinical studies (n = 527, subcutaneous or intravenous administration), a TMDD model considering the quasi-steady-state approximation was developed to characterize the interaction dynamics of alirocumab and PCSK9, combined with an indirect pharmacodynamic model describing the inhibition of LDL-C by PCSK9 in a one-step approach using nonlinear-mixed effects modeling. A "full fixed effects modeling" strategy was implemented to quantify parameter-covariate relationships. RESULTS The model captures the interaction between alirocumab and its target PCSK9 and how this mechanism drives LDL-C depletion, with an estimation of the associated between-subject variability of model parameters and the quantification of clinically relevant parameter-covariate relationships. Co-administration of statins was found to increase the central volume of distribution of alirocumab by 1.75-fold (5.6 L versus 3.2 L) and allow for a 14% greater maximum lipid-lowering effect (88% versus 74%), highlighting the synergy of action between anti-PCSK9 therapeutic antibodies and statins toward lowering LDL-C plasma levels. Baseline levels of PCSK9 were found to be related to the amplitude of LDL-C variations by increasing the concentration of free PCSK9 necessary to reach half its capacity of inhibition of LDL-C degradation. CONCLUSION The maximum effect of alirocumab is achieved when free PCSK9 concentration is close to zero, as seen mostly after 150 mg every 2 weeks (Q2W) or 300 mg every 4 weeks (Q4W), indicating that there would be no additional clinical benefit of increasing the dose higher than these recommended dosing regimens.
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Affiliation(s)
- Patrick Nolain
- Pharmacokinetics-Pharmacodynamics and Metabolism, Translational Medicine and Early Development, Sanofi R&D, Montpellier, France
| | - Nassim Djebli
- Pharmacokinetics-Pharmacodynamics and Metabolism, Translational Medicine and Early Development, Sanofi R&D, Montpellier, France
| | - Aurélie Brunet
- Pharmacokinetics-Pharmacodynamics and Metabolism, Translational Medicine and Early Development, Sanofi R&D, Montpellier, France
| | - David Fabre
- Pharmacokinetics-Pharmacodynamics and Metabolism, Translational Medicine and Early Development, Sanofi R&D, Montpellier, France
| | - Sonia Khier
- Pharmacokinetics and Pharmacometrics Department, School of Pharmacy, UFR Pharmacie, Montpellier University, 15 Avenue Charles Flahault, 34000, Montpellier, France. .,Probabilities and Statistics Department, Institut Montpelliérain Alexander Grothendieck (IMAG), CNRS UMR 5149, Montpellier University, Montpellier, France.
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Xu C, Rafique A, Potocky T, Paccaly A, Nolain P, Lu Q, Iglesias-Rodriguez M, St John G, Nivens MC, Kanamaluru V, Fairhurst J, Ishii T, Maldonado R, Choy E, Emery P. Differential Binding of Sarilumab and Tocilizumab to IL-6Rα and Effects of Receptor Occupancy on Clinical Parameters. J Clin Pharmacol 2021; 61:714-724. [PMID: 33314148 DOI: 10.1002/jcph.1795] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/27/2020] [Indexed: 01/21/2023]
Abstract
We evaluated interleukin-6 (IL-6) receptor-α subunit (IL-6Rα) signaling inhibition with sarilumab and tocilizumab, the association between IL-6Rα receptor occupancy (RO) and C-reactive protein (CRP), and the potential clinical relevance of any differences. For this, we measured IL-6Rα binding and signaling inhibition with sarilumab and tocilizumab in vitro, simulated soluble IL-6Rα RO over time for approved sarilumab subcutaneous (SC) and tocilizumab intravenous (IV) and SC doses, and assessed associations between calculated RO and CRP reduction, 28-joint Disease Activity Score based on CRP, and 20%/50%/70% improvement in American College of Rheumatology responses from clinical data. Sarilumab binds IL-6Rα in vitro with 15- to 22-fold higher affinity than tocilizumab, and inhibits IL-6-mediated classical and trans signaling via membrane-bound and soluble IL-6Rα. Sarilumab 200 and 150 mg SC every 2 weeks achieved >90% RO after first and second doses, respectively, maintained throughout the treatment period. At steady-state trough, RO was greater with sarilumab 200 mg (98%) and 150 mg SC every 2 weeks (94%), and tocilizumab 162 mg SC weekly (>99%) and 8 mg/kg IV every 4 weeks (99%), vs tocilizumab 162 mg SC every 2 weeks (84%) and 4 mg/kg IV every 4 weeks (60%). Higher RO was associated with greater CRP reduction and 28-joint Disease Activity Score based on CRP reduction, and more sarilumab patients achieving 20%/50%/70% improvement in American College of Rheumatology responses. The greatest reduction in CRP levels was observed with sarilumab (both doses) and tocilizumab 8 mg/kg IV every 4 weeks (reductions proportionally smaller with 4 mg/kg IV every 4 weeks). Higher IL-6Rα binding affinity translated into higher RO with sarilumab vs tocilizumab 4 mg/kg every 4 weeks or 162 mg every 2 weeks; tocilizumab required the higher dose or increased frequency to maintain the same degree of RO and CRP reduction. Higher RO was associated with clinical parameter improvements.
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Affiliation(s)
- Christine Xu
- Translational Medicine and Early Development, Sanofi, Bridgewater, New Jersey, USA
| | - Ashique Rafique
- Therapeutic Proteins, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Terra Potocky
- Bioassay Development, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Anne Paccaly
- Immunology, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Patrick Nolain
- Research and Development, Sanofi-Aventis, Montpellier, France
| | - Qiang Lu
- Modeling and Simulation, Pharmacokinetics, Dynamics, and Metabolism, Sanofi, Bridgewater, New Jersey, USA
| | | | - Gregory St John
- Immunology and Inflammation, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Michael C Nivens
- Strategic Program Direction, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Vanaja Kanamaluru
- Pharmacokinetics, Dynamics, and Metabolism, Sanofi, Bridgewater, New Jersey, USA
| | - Jeanette Fairhurst
- Therapeutic Proteins, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Tomonori Ishii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rafael Maldonado
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Ernest Choy
- Department of Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Paul Emery
- Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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