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Zhang N, Zhang C, Zeng Z, Zhang J, Du S, Bao C, Wang Z. Preclinical Characterization of the Selective JAK1 Inhibitor LW402 for Treatment of Rheumatoid Arthritis. J Inflamm Res 2021; 14:2133-2147. [PMID: 34054304 PMCID: PMC8153205 DOI: 10.2147/jir.s301076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Research on JAK family members as therapeutic targets for autoimmune diseases has brought tofacitinib and baricitinib into clinical for the treatment of rheumatoid arthritis and other autoimmune diseases. Despite the potent efficacy of these first-generation JAK inhibitors, their broad-spectrum JAK inhibition and adverse events warrant development of a JAK1-specific inhibitor to improve their safety profile. METHODS In this study, we characterized a JAK1-specific inhibitor, LW402, on biochemical and human whole-blood assays. We further evaluated the therapeutic efficacy of LW402 in a rat adjuvant-induced arthritis (rAIA) model and a mouse collagen-induced arthritis (mCIA) model. The safety of LW402 was evaluated in both SpragueDawley rats and cynomolgus monkeys. RESULTS LW402 exhibited potent nanomolar activity against JAK1 and showed a 45-fold selectivity for inhibition of JAK1- over JAK2-dependent signaling induced by either IL6 or GM-CSF in human whole-blood assays. In the rAIA model, oral dosing of LW402 resulted in a dose-dependent improvement in disease symptoms, including reduction in paw swelling, marked reduction in the inflammatory-cell infiltration to synovial tissue, and protection of articular cartilage and bone from damage. The therapeutic efficacy of LW402 correlated well with the plasma exposure of LW402 and the extent of pSTAT3 inhibition in white blood cells. LW402 also effectively eased disease symptoms in the mCIA model. Toxicity studies in the Sprague Dawley rats and cynomolgus monkeys established a ≥5x therapeutic window for LW402 as drug exposures of toxicity study NOAEL dose and pharmacology study ED50 dose were compared. CONCLUSION We developed a novel JAK1-specific inhibitor LW402 with potent efficacy in rAIA and mCIA models. We established a good safety profile for LW402 in toxicity studies, and the overall superiority of LW402 should translated well to the clinical setting for the treatment of RA and other autoimmune diseases.
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Affiliation(s)
- Ning Zhang
- Longwood Biopharmaceuticals, Shanghai, People’s Republic of China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Zhihong Zeng
- Longwood Biopharmaceuticals, Shanghai, People’s Republic of China
| | - Jiyong Zhang
- Longwood Biopharmaceuticals, Shanghai, People’s Republic of China
| | - Shengnan Du
- Longwood Biopharmaceuticals, Shanghai, People’s Republic of China
| | - Chunde Bao
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Zhe Wang
- Longwood Biopharmaceuticals, Shanghai, People’s Republic of China
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Abstract
PURPOSE OF REVIEW The aim of this study was to describe risks of systemic lupus erythematosus (SLE) in pregnancy and the importance of preconception counselling, medication optimization and close surveillance. RECENT FINDINGS Advances in care for pregnant patients with SLE have led to improved obstetric outcomes, but maternal and foetal risks continue to be elevated. Conception during periods of disease quiescence and continuation of most medications decrease adverse pregnancy outcomes. Hydroxychloroquine (HCQ) appears protective against flares in pregnancy, neonatal congenital heart block and preterm birth. SUMMARY SLE in pregnancy confers increased maternal and foetal risks, including disease flares, preeclampsia, preterm birth, foetal growth restriction, neonatal lupus erythematosus (NLE) and congenital heart block. Disease control on an effective medication regimen mitigates many of these risks, but pregnancy in women with SLE remains a high-risk condition requiring multidisciplinary care and an individualized approach to each patient.
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Keystone EC, Genovese MC, Schlichting DE, de la Torre I, Beattie SD, Rooney TP, Taylor PC. Safety and Efficacy of Baricitinib Through 128 Weeks in an Open-label, Longterm Extension Study in Patients with Rheumatoid Arthritis. J Rheumatol 2017; 45:14-21. [DOI: 10.3899/jrheum.161161] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 12/30/2022]
Abstract
Objective.To assess the safety and efficacy of baricitinib in patients with rheumatoid arthritis (RA) up to 128 weeks in a phase IIb study (NCT01185353).Methods.After a 24-week blinded period, eligible patients entered an initial 52-week open-label extension (OLE); patients receiving 8 mg once daily (QD) continued with that dose and all others received 4 mg QD. Doses could be escalated to 8 mg QD at 28 or 32 weeks at investigator discretion when ≥ 6 tender and ≥ 6 swollen joints were present. Patients completing the first OLE were eligible to enter a second 52-week OLE and receive 4 mg QD regardless of previous dose.Results.In the 4-mg (n = 108) and 8-mg (n = 93) groups, treatment-emergent adverse events (AE) occurred in 63% and 67%, serious AE in 16% and 13%, infections in 35% and 40%, and serious infections in 5% and 3% of patients, respectively. Exposure-adjusted incidence rates for AE for all baricitinib groups in the second OLE were similar to or lower than rates observed in the first OLE. No opportunistic infections, tuberculosis cases, or lymphomas were observed through 128 weeks; 1 death occurred during the first OLE. Among all patients in both OLE, the proportions who achieved disease improvement at Week 24 were similar or increased at weeks 76 and 128.Conclusion.In a phase IIb study in RA, the safety and tolerability profile of baricitinib, up to 128 weeks, remained consistent with earlier observations, without unexpected late signals. Clinical improvements seen in the 24-week blinded period were maintained during the OLE.
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Understanding and Managing Pregnancy in Patients with Lupus. Autoimmune Dis 2015; 2015:943490. [PMID: 26246905 PMCID: PMC4515284 DOI: 10.1155/2015/943490] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/31/2015] [Indexed: 12/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6–12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies.
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Van Rompaey L, Galien R, van der Aar EM, Clement-Lacroix P, Nelles L, Smets B, Lepescheux L, Christophe T, Conrath K, Vandeghinste N, Vayssiere B, De Vos S, Fletcher S, Brys R, van 't Klooster G, Feyen JHM, Menet C. Preclinical characterization of GLPG0634, a selective inhibitor of JAK1, for the treatment of inflammatory diseases. THE JOURNAL OF IMMUNOLOGY 2013; 191:3568-77. [PMID: 24006460 DOI: 10.4049/jimmunol.1201348] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The JAKs receive continued interest as therapeutic targets for autoimmune, inflammatory, and oncological diseases. JAKs play critical roles in the development and biology of the hematopoietic system, as evidenced by mouse and human genetics. JAK1 is critical for the signal transduction of many type I and type II inflammatory cytokine receptors. In a search for JAK small molecule inhibitors, GLPG0634 was identified as a lead compound belonging to a novel class of JAK inhibitors. It displayed a JAK1/JAK2 inhibitor profile in biochemical assays, but subsequent studies in cellular and whole blood assays revealed a selectivity of ∼30-fold for JAK1- over JAK2-dependent signaling. GLPG0634 dose-dependently inhibited Th1 and Th2 differentiation and to a lesser extent the differentiation of Th17 cells in vitro. GLPG0634 was well exposed in rodents upon oral dosing, and exposure levels correlated with repression of Mx2 expression in leukocytes. Oral dosing of GLPG0634 in a therapeutic set-up in a collagen-induced arthritis model in rodents resulted in a significant dose-dependent reduction of the disease progression. Paw swelling, bone and cartilage degradation, and levels of inflammatory cytokines were reduced by GLPG0634 treatment. Efficacy of GLPG0634 in the collagen-induced arthritis models was comparable to the results obtained with etanercept. In conclusion, the JAK1 selective inhibitor GLPG0634 is a promising novel therapeutic with potential for oral treatment of rheumatoid arthritis and possibly other immune-inflammatory diseases.
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Affiliation(s)
- Luc Van Rompaey
- Departement of In Vitro Pharmacology, Galapagos NV, 2800 Mechelen, Belgium
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Ruffatti A, Milanesi O, Chiandetti L, Cerutti A, Gervasi MT, De Silvestro G, Pengo V, Punzi L. A combination therapy to treat second-degree anti-Ro/La-related congenital heart block. A strategy to avoid stable third-degree heart block? Lupus 2011; 21:666-71. [DOI: 10.1177/0961203311430969] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While mainly based on the use of fluorinated steroids, there is no standard management of anti-Ro/La-related congenital heart block (CHB). This is a report concerning two consecutive cases of anti-Ro/La-related second-degree block treated with betamethasone (4 mg/day), weekly plasmapheresis, and intravenous immunoglobulins (IVIGs; 1 g/kg) administered every 15 days, a therapy that was begun shortly after CHB was detected and continued until delivery. The newborns were also treated with IVIG (1 g/kg) soon after birth and continued fortnightly until the anti-Ro/La antibody levels became undetectable. In both cases second-degree AV block reverted to a stable sinus rhythm with a first-degree atrioventricular (AV) block. Moreover, there was no recurrence of CHB when therapy was suspended, as confirmed by a 29 month and an eight month follow-up, respectively.
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Affiliation(s)
- A Ruffatti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - O Milanesi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - L Chiandetti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - A Cerutti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - MT Gervasi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - G De Silvestro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - V Pengo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - L Punzi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy; 2Department of Paediatrics, University of Padua, Padua, Italy; 3Obstetrics and Gynaecology Unit, Hospital of Padua, Padua, Italy; 4Blood Transfusion Unit, Hospital of Padua, Padua, Italy; and 5Cardiology Unit, Department of Cardio-thoracic and Vascular Sciences, University of Padua, Padua, Italy
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