3
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Yap DYH, Hai J, Lee PCH, Zhou X, Lee M, Zhang Y, Wang M, Chen X. Safety, tolerability, pharmacokinetics, and pharmacodynamics of HBM9161, a novel FcRn inhibitor, in a phase I study for healthy Chinese volunteers. Clin Transl Sci 2021; 14:1769-1779. [PMID: 33742786 PMCID: PMC8504844 DOI: 10.1111/cts.13019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 02/03/2023] Open
Abstract
Blockade of the binding between neonatal Fc receptor and IgG-Fc reduces circulating IgG, and thus emerges as a potential therapy for IgG-mediated autoimmune conditions. This was a double blind, randomized, single ascending dose study to evaluate the safety, pharmacokinetics, and pharmacodynamics of HBM9161 (a fully humanized Fc receptor monoclonal antibody) in healthy Chinese volunteers. Subjects were randomized to receive a single s.c. dose of HBM9161 or placebo in a 3:1 ratio in 3 dosing cohorts (340 mg, 510 mg, or 680 mg, respectively), and then followed up for 85 days. Study end points included incidence of adverse event (AE), serum drug concentration, IgG and its subclasses, and anti-drug antibodies (ADAs). Twenty-four subjects were randomized. Dose-dependent reduction of total IgG occurred rapidly from baseline to reach nadir at day 11, then recovered steadily from day 11 to day 85. The mean maximum percentage reductions from baseline total IgG were 21.0 ± 9.3%, 39.8 ± 5.13%, and 41.2 ± 10.4% for subjects receiving HBM9161 340 mg, 510 mg, and 680 mg, respectively. The exposure of HBM9161 (areas under the curve [AUCs] and peak plasma concentration [Cmax ]) increased in a more than dose-proportional manner at the dose examined. All reported AEs were mild in severity. The most reported AEs in the HBM9161 groups were influenza-like illness and rash. Two subjects developed ADA during the study period. A single s.c. dose of HBM9161 results in sustained and dose-dependent IgG reduction, and was well-tolerated at a dose up to 680 mg in Chinese subjects. The data warrant further investigation of its effects in IgG-mediated autoimmune disorders.
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Affiliation(s)
- Desmond Y. H. Yap
- Phase I Clinical Trials CentreThe University of Hong KongHong KongHong Kong
- Division of NephrologyDepartment of MedicineThe University of Hong KongHong KongHong Kong
| | - Jojo Hai
- Phase I Clinical Trials CentreThe University of Hong KongHong KongHong Kong
- Division of CardiologyDepartment of MedicineThe University of Hong KongHong KongHong Kong
| | - Paul C. H. Lee
- Phase I Clinical Trials CentreThe University of Hong KongHong KongHong Kong
- Division of Endocrinology and MetabolismDepartment of MedicineThe University of Hong KongHong KongHong Kong
| | | | | | - Yu Zhang
- Harbour Biomed, Inc.ShanghaiChina
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4
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Lambros MB, Seed G, Sumanasuriya S, Gil V, Crespo M, Fontes M, Chandler R, Mehra N, Fowler G, Ebbs B, Flohr P, Miranda S, Yuan W, Mackay A, Ferreira A, Pereira R, Bertan C, Figueiredo I, Riisnaes R, Rodrigues DN, Sharp A, Goodall J, Boysen G, Carreira S, Bianchini D, Rescigno P, Zafeiriou Z, Hunt J, Moloney D, Hamilton L, Neves RP, Swennenhuis J, Andree K, Stoecklein NH, Terstappen LWMM, de Bono JS. Single-Cell Analyses of Prostate Cancer Liquid Biopsies Acquired by Apheresis. Clin Cancer Res 2018; 24:5635-5644. [PMID: 30093450 DOI: 10.1158/1078-0432.ccr-18-0862] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/01/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
Purpose: Circulating tumor cells (CTCs) have clinical relevance, but their study has been limited by their low frequency.Experimental Design: We evaluated liquid biopsies by apheresis to increase CTC yield from patients suffering from metastatic prostate cancer, allow precise gene copy-number calls, and study disease heterogeneity.Results: Apheresis was well tolerated and allowed the separation of large numbers of CTCs; the average CTC yield from 7.5 mL of peripheral blood was 167 CTCs, whereas the average CTC yield per apheresis (mean volume: 59.5 mL) was 12,546 CTCs. Purified single CTCs could be isolated from apheresis product by FACS sorting; copy-number aberration (CNA) profiles of 185 single CTCs from 14 patients revealed the genomic landscape of lethal prostate cancer and identified complex intrapatient, intercell, genomic heterogeneity missed on bulk biopsy analyses.Conclusions: Apheresis facilitated the capture of large numbers of CTCs noninvasively with minimal morbidity and allowed the deconvolution of intrapatient heterogeneity and clonal evolution. Clin Cancer Res; 24(22); 5635-44. ©2018 AACR.
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Affiliation(s)
- Maryou B Lambros
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - George Seed
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Semini Sumanasuriya
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Veronica Gil
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Mariane Fontes
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rob Chandler
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Niven Mehra
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gemma Fowler
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Berni Ebbs
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Penny Flohr
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Susana Miranda
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Wei Yuan
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Alan Mackay
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer, Research, London, United Kingdom
| | - Ana Ferreira
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Rita Pereira
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Claudia Bertan
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Ines Figueiredo
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Daniel Nava Rodrigues
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Adam Sharp
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jane Goodall
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Gunther Boysen
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Suzanne Carreira
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Diletta Bianchini
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pasquale Rescigno
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Zafeiris Zafeiriou
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joanne Hunt
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Deirdre Moloney
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lucy Hamilton
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rui P Neves
- Department of General, Visceral and Pediatric Surgery, University Hospital of the, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Joost Swennenhuis
- Department of Medical Cell BioPhysics, University of Twente, Enschede, the Netherlands
| | - Kiki Andree
- Department of Medical Cell BioPhysics, University of Twente, Enschede, the Netherlands
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital of the, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Leon W M M Terstappen
- Department of Medical Cell BioPhysics, University of Twente, Enschede, the Netherlands
| | - Johann S de Bono
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom.
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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5
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Ulrichts P, Guglietta A, Dreier T, van Bragt T, Hanssens V, Hofman E, Vankerckhoven B, Verheesen P, Ongenae N, Lykhopiy V, Enriquez FJ, Cho J, Ober RJ, Ward ES, de Haard H, Leupin N. Neonatal Fc receptor antagonist efgartigimod safely and sustainably reduces IgGs in humans. J Clin Invest 2018; 128:4372-4386. [PMID: 30040076 DOI: 10.1172/jci97911] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 07/03/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Intravenous Ig (IVIg), plasma exchange, and immunoadsorption are frequently used in the management of severe autoimmune diseases mediated by pathogenic IgG autoantibodies. These approaches modulating IgG levels can, however, be associated with some severe adverse reactions and a substantial burden to patients. Targeting the neonatal Fc receptor (FcRn) presents an innovative and potentially more effective, safer, and more convenient alternative for clearing pathogenic IgGs. METHODS A randomized, double-blind, placebo-controlled first-in-human study was conducted in 62 healthy volunteers to explore single and multiple ascending intravenous doses of the FcRn antagonist efgartigimod. The study objectives were to assess safety, tolerability, pharmacokinetics, pharmacodynamics, and immunogenicity. The findings of this study were compared with the pharmacodynamics profile elicited by efgartigimod in cynomolgus monkeys. RESULTS Efgartigimod treatment resulted in a rapid and specific clearance of serum IgG levels in both cynomolgus monkeys and healthy volunteers. In humans, single administration of efgartigimod reduced IgG levels up to 50%, while multiple dosing further lowered IgGs on average by 75% of baseline levels. Approximately 8 weeks following the last administration, IgG levels returned to baseline. Efgartigimod did not alter the homeostasis of albumin or Igs other than IgG, and no serious adverse events related to efgartigimod infusion were observed. CONCLUSION Antagonizing FcRn using efgartigimod is safe and results in a specific, profound, and sustained reduction of serum IgG levels. These results warrant further evaluation of this therapeutic approach in IgG-driven autoimmune diseases. TRIAL REGISTRATION Clinicaltrials.gov NCT03457649. FUNDING argenx BVBA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - JunHaeng Cho
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center, College Station, Texas, USA
| | - Raimund J Ober
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center, College Station, Texas, USA.,Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - E Sally Ward
- Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center, College Station, Texas, USA.,Department of Microbial Pathogenesis and Immunology, Texas A&M University Health Science Center, Bryan, Texas, USA
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6
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Soyuöz A, Karadağ Ö, Karaağaç T, Kılıç L, Bilgen ŞA, Özcebe Oİ. Therapeutic plasma exchange for refractory SLE: A comparison of outcomes between different sub-phenotypes. Eur J Rheumatol 2017; 5:32-36. [PMID: 29657872 DOI: 10.5152/eurjrheum.2017.17088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Therapeutic plasma exchange (TPE) offers an alternative therapeutic modality for patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS). However, there is conflicting evidence regarding its efficacy in different sub-phenotypes. This study aimed to investigate the main clinical characteristics and outcomes of patients with different phenotypes of SLE and APS treated with TPE at a tertiary care center. Methods The database of the Blood and Apheresis Unit between 2001 and 2013 was screened for patients with SLE and primary APS. SLE disease activity index (SELENA-SLEDAI), the indications for treatment, complications, and outcomes were obtained from a review of medical records and phone calls. A total of 24 patients (SLE: 20, APS: 4) were recruited for the study. Results Mean ages of SLE (M/F: 1/19) and primary APS (PAPS) patients (M/F: 2/2) were 32.4±12.89 and 52.0±10.7 years, respectively. The main indications for TPE were hematologic, neurologic, and pulmonary involvement and APS-related symptoms. TPE was preferred in eight patients because of leucopenia and co-infection. SLEDAI was significantly decreased after TPE (16.7±8.3 before vs. 8.8±3.1 after, p=0.001). Both primary APS and SLE-related catastrophic APS (CAPS) patients had completely responded to TPE. The success rate of TPE in patients with thrombocytopenia was lower than patients with hemolytic anemia. The median (IQR 25%-75%) number of TPE sessions was 6.5 (5-10.5). In total, five patients experienced TPE-related major adverse events (catheter infections in three patients, bleeding in one patient, and hypotension in one patient). The median (IQR 25%-75%) follow-up time was 33.5 (6.75-81.25) months. In total, four patients died during follow up, of which three died during the period of TPE administration. Conclusion Our data suggest that CAPS and other APS-related problems respond well to the TPE treatment. TPE should be kept in mind for the treatment of patients with other features of SLE, especially those resistant to other agents and in the presence of leucopenia.
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Affiliation(s)
- Aynur Soyuöz
- Division of Haemotology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ömer Karadağ
- Division of Haemotology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tülay Karaağaç
- Blood and Apheresis Unit of Hacettepe University School of Medicine Hospital, Ankara, Turkey
| | - Levent Kılıç
- Division of Haemotology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Şule Apraş Bilgen
- Division of Haemotology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Osman İlhami Özcebe
- Division of Haemotology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.,Blood and Apheresis Unit of Hacettepe University School of Medicine Hospital, Ankara, Turkey
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