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Gerhardt A, Dörfel S, Schulz H, Schlag R, Vornholz L, Nejad-Asgari S, Welslau M. Outcomes with ibrutinib in patients with chronic lymphocytic leukaemia: Results from the German multicentre REALITY study. Eur J Haematol 2024; 112:927-937. [PMID: 38342972 DOI: 10.1111/ejh.14186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES To assess treatment adherence, effectiveness and safety outcomes of patients with chronic lymphocytic leukaemia (CLL) receiving ibrutinib in a real-world setting. METHODS Patients enrolled in REALITY were ≥18 years with a confirmed diagnosis of CLL and were receiving ibrutinib as a first-line (1L), 2L or ≥3L therapy. Treatment retention, adherence, progression-free survival (PFS), overall survival (OS) and time to next therapy were assessed at 1 and 2 years overall, by typology and by cytogenetic subgroups. PFS and OS were analysed using Kaplan-Meier methods. RESULTS Exactly 302 patients were enrolled across 57 sites in Germany, from January 2017 to July 2021. One-year retention rates were 69.9% overall (primary endpoint), 77.9% for 1L patients, and 77.6%/78.8% for high-risk patients with del17p/TP53. At 2 years, PFS/OS rates were 77.8%/90.7% overall (1L, 82.7%/90.4%), and were consistent across cytogenetic subgroups. PFS rates were higher for 1L versus ≥3L patients. Patients with the low-acceptance/low-control typology at baseline were less likely to retain treatment at 1 year versus the high-acceptance/high-control typology. No new safety signals were observed. CONCLUSIONS The REALITY study provides further evidence of the effectiveness and safety of ibrutinib in patients with CLL in a real-world setting, particularly in earlier treatment lines.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Adenine/analogs & derivatives
- Piperidines/therapeutic use
- Male
- Female
- Aged
- Middle Aged
- Germany/epidemiology
- Aged, 80 and over
- Treatment Outcome
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/administration & dosage
- Adult
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Affiliation(s)
- Anke Gerhardt
- Schwerpunktpraxis für Hämatologie und Onkologie Potsdam, Potsdam, Germany
| | | | - Holger Schulz
- Praxis Internistischer Onkologie und Hämatologie, Frechen, Germany
| | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis Würzburg, Würzburg, Germany
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Martin DA, Telliez JB, Pleasic-Williams S, Zhang Y, Tierney B, Blatnik M, Gale JD, Banfield C, Zhou Y, Lejeune A, Zwillich SH, Stevens E, Tiwari N, Kieras E, Karanam A. Target Occupancy and Functional Inhibition of JAK3 and TEC Family Kinases by Ritlecitinib in Healthy Adults: An Open-Label, Phase 1 Study. J Clin Pharmacol 2024; 64:67-79. [PMID: 37691236 DOI: 10.1002/jcph.2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
Ritlecitinib is a small molecule in clinical development that covalently and irreversibly inhibits Janus kinase 3 (JAK3) and the TEC family of kinases (BTK, BMX, ITK, TXK, and TEC). This phase 1, open-label, parallel-group study assessed target occupancy and functional effects of ritlecitinib on JAK3 and TEC family kinases in healthy participants aged 18-60 years who received 50 or 200 mg single doses of ritlecitinib on day 1. Blood samples to assess ritlecitinib pharmacokinetics, target occupancy, and pharmacodynamics were collected over 48 hours. Target occupancy was assessed using mass spectroscopy. Functional inhibition of JAK3-dependent signaling was measured by the inhibition of the phosphorylation of its downstream target signal transducer and activator of transcription 5 (pSTAT5), following activation by interleukin 15 (IL-15). The functional inhibition of Bruton's tyrosine kinase (BTK)-dependent signaling was measured by the reduction in the upregulation of cluster of differentiation 69 (CD69), an early marker of B-cell activation, following treatment with anti-immunoglobulin D. Eight participants received one 50 mg ritlecitinib dose and 8 participants received one 200 mg dose. Ritlecitinib plasma exposure increased in an approximately dose-proportional manner from 50 to 200 mg. The maximal median JAK3 target occupancy was 72% for 50 mg and 64% for 200 mg. Ritlecitinib 50 mg had >94% maximal target occupancy of all TEC kinases, except BMX (87%), and 200 mg had >97% for all TEC kinases. For BTK and TEC, ritlecitinib maintained high target occupancy throughout a period of 48 hours. Ritlecitinib reduced pSTAT5 levels following IL-15- and BTK-dependent signaling in a dose-dependent manner. These target occupancy and functional assays demonstrate the dual inhibition of the JAK3- and BTK-dependent pathways by ritlecitinib. Further studies are needed to understand the contribution to clinical effects of inhibiting these pathways.
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Zhu L, Shi R, Zhao T, Ye Y, Tang J, Hu Y, Peng P, Wang D, Chong C, Xu G, Leung S, Yuan W. A randomized, controlled single, and multiple ascending dose trial of the safety, pharmacokinetics and pharmacodynamics of SN1011 in healthy subjects. Clin Transl Sci 2023; 16:1982-1996. [PMID: 37551782 PMCID: PMC10582678 DOI: 10.1111/cts.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
The purpose of this study was to investigate the safety, tolerability, pharmacokinetics, and pharmacodynamics of SN1011, a novel Bruton tyrosine kinase (BTK) inhibitor, and food effects in healthy subjects. In this phase I trial, subjects received single ascending doses (SADs) of SN1011 (100 to 800 mg), multiple ascending doses (MADs) of SN1011 (200 to 600 mg), or placebo q.d. Additionally, 12 subjects randomly received a single dose of SN1011 600 mg under fasting states and then fed states, vice versa. Safety was assessed per Common Terminology Criteria for Adverse Events version 5.0. Pharmacokinetic parameters were calculated by noncompartmental analysis and BTK receptor occupancy in peripheral blood monocytes was determined. Seventy-one healthy subjects were dosed in five SAD cohorts, three MAD cohorts, and one food effect cohort, with 57 receiving SN1011 and 14 receiving placebo. No serious adverse events (AEs) were reported. There was no correlation between AE occurrences and SN1011 exposure. The three most frequent AEs with SN1011 were increased blood triglycerides, decreased neutrophil count, and decreased leucocyte count. SN1011 exhibited a dose-proportional increase in maximum plasma concentration and area under the time concentration curve following single and multiple dose administrations, with an accumulation ratio of 1.5 to 2.2 after multiple dose administrations. No difference in SN1011 exposure was observed between fed states. BTK receptor occupancy remained above 83% over 24 h after single administration and remained above 80% for the MAD groups for 10 days of continuous q.d. administration. SN1011 was well-tolerated and safe after single or multiple exposures to healthy subjects, supporting further clinical development of SN1011 for treatment of autoimmune diseases.
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Affiliation(s)
- Leilei Zhu
- Clinical Research CenterShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Rong Shi
- Surgery Intensive Care UnitShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Tongfang Zhao
- Clinical Research CenterShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yujie Ye
- Clinical Research CenterShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jie Tang
- Clinical Research CenterShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yihui Hu
- Clinical Research CenterShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Peng Peng
- Clinical Research CenterShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Dong Wang
- SinoMab Bioscience LimitedHong KongChina
- MediNexus Pharma (Suzhou) LimitedSuzhouChina
| | - Clement Chong
- SinoMab Bioscience LimitedHong KongChina
- MediNexus Pharma (Suzhou) LimitedSuzhouChina
| | - Guolin Xu
- SinoMab Bioscience LimitedHong KongChina
- MediNexus Pharma (Suzhou) LimitedSuzhouChina
| | - Shui‐on Leung
- SinoMab Bioscience LimitedHong KongChina
- MediNexus Pharma (Suzhou) LimitedSuzhouChina
| | - Wei’an Yuan
- Clinical Research CenterShuguang Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
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4
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Alsadhan A, Chen J, Gaglione EM, Underbayev C, Tuma PL, Tian X, Freeman LA, Baskar S, Nierman P, Soto S, Itsara A, Ahn IE, Sun C, Bibikova E, Hartmann TN, Mhibik M, Wiestner A. CD49d Expression Identifies a Biologically Distinct Subtype of Chronic Lymphocytic Leukemia with Inferior Progression-Free Survival on BTK Inhibitor Therapy. Clin Cancer Res 2023; 29:3612-3621. [PMID: 37227160 PMCID: PMC10524232 DOI: 10.1158/1078-0432.ccr-22-3217] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/14/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To determine the role of CD49d for response to Bruton's tyrosine kinase inhibitors (BTKi) in patients with chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS In patients treated with acalabrutinib (n = 48), CD49d expression, VLA-4 integrin activation, and tumor transcriptomes of CLL cells were assessed. Clinical responses to BTKis were investigated in acalabrutinib- (n = 48; NCT02337829) and ibrutinib-treated (n = 73; NCT01500733) patients. RESULTS In patients treated with acalabrutinib, treatment-induced lymphocytosis was comparable for both subgroups but resolved more rapidly for CD49d+ cases. Acalabrutinib inhibited constitutive VLA-4 activation but was insufficient to block BCR and CXCR4-mediated inside-out activation. Transcriptomes of CD49d+ and CD49d- cases were compared using RNA sequencing at baseline and at 1 and 6 months on treatment. Gene set enrichment analysis revealed increased constitutive NF-κB and JAK-STAT signaling, enhanced survival, adhesion, and migratory capacity in CD49d+ over CD49d- CLL that was maintained during therapy. In the combined cohorts of 121 BTKi-treated patients, 48 (39.7%) progressed on treatment with BTK and/or PLCG2 mutations detected in 87% of CLL progressions. Consistent with a recent report, homogeneous and bimodal CD49d-positive cases (the latter having concurrent CD49d+ and CD49d- CLL subpopulations, irrespective of the traditional 30% cutoff value) had a shorter time to progression of 6.6 years, whereas 90% of cases homogenously CD49d- were estimated progression-free at 8 years (P = 0.0004). CONCLUSIONS CD49d/VLA-4 emerges as a microenvironmental factor that contributes to BTKi resistance in CLL. The prognostic value of CD49d is improved by considering bimodal CD49d expression. See related commentary by Tissino et al., p. 3560.
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Affiliation(s)
- Anfal Alsadhan
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Catholic University of America, DC, 20064, USA
- College of applied medical sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jonathan Chen
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Erika M. Gaglione
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Chingiz Underbayev
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | | | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lita A. Freeman
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sivasubramanian Baskar
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Pia Nierman
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Susan Soto
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Andy Itsara
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Inhye E. Ahn
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Clare Sun
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | | | - Tanja Nicole Hartmann
- Department of Medicine I, Medical Center-University, Faculty of Medicine of Freiburg, Freiburg, Germany
| | - Maissa Mhibik
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
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5
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Ibrahim EIK, Karlsson MO, Friberg LE. Assessment of ibrutinib scheduling on leukocyte, lymph node size and blood pressure dynamics in chronic lymphocytic leukemia through pharmacokinetic-pharmacodynamic models. CPT Pharmacometrics Syst Pharmacol 2023; 12:1305-1318. [PMID: 37452622 PMCID: PMC10508536 DOI: 10.1002/psp4.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/13/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Ibrutinib is a Bruton tyrosine kinase (Btk) inhibitor for treating chronic lymphocytic leukemia (CLL). It has also been associated with hypertension. The optimal dosing schedule for mitigating this adverse effect is currently under discussion. A quantification of relationships between systemic ibrutinib exposure and efficacy (i.e., leukocyte count and sum of the product of perpendicular diameters [SPD] of lymph nodes) and hypertension toxicity (i.e., blood pressure), and their association with overall survival is needed. Here, we present a semi-mechanistic pharmacokinetic-pharmacodynamic modeling framework to characterize such relationships and facilitate dose optimization. Data from a phase Ib/II study were used, including ibrutinib plasma concentrations to derive daily 0-24-h area under the concentration-time curve, leukocyte count, SPD, survival, and blood pressure measurements. A nonlinear mixed effects modeling approach was applied, considering ibrutinib's pharmacological action and CLL cell dynamics. The final framework included (i) an integrated model for SPD and leukocytes consisting of four CLL cell subpopulations with ibrutinib inhibiting phosphorylated Btk production, (ii) a turnover model in which ibrutinib stimulates an increase in blood pressure, and (iii) a competing risk model for dropout and death. Simulations predicted that the approved dosing schedule had a slightly higher efficacy (24-month, progression-free survival [PFS] 98%) than de-escalation schedules (24-month, average PFS ≈ 97%); the latter had, on average, ≈20% lower proportions of patients with hypertension. The developed modeling framework offers an improved understanding of the relationships among ibrutinib exposure, efficacy and toxicity biomarkers. This framework can serve as a platform to assess dosing schedules in a biologically plausible manner.
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6
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Gomez EB, Ebata K, Randeria HS, Rosendahl MS, Cedervall EP, Morales TH, Hanson LM, Brown NE, Gong X, Stephens J, Wu W, Lippincott I, Ku KS, Walgren RA, Abada PB, Ballard JA, Allerston CK, Brandhuber BJ. Preclinical characterization of pirtobrutinib, a highly selective, noncovalent (reversible) BTK inhibitor. Blood 2023; 142:62-72. [PMID: 36796019 PMCID: PMC10651869 DOI: 10.1182/blood.2022018674] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Bruton tyrosine kinase (BTK), a nonreceptor tyrosine kinase, is a major therapeutic target for B-cell-driven malignancies. However, approved covalent BTK inhibitors (cBTKis) are associated with treatment limitations because of off-target side effects, suboptimal oral pharmacology, and development of resistance mutations (eg, C481) that prevent inhibitor binding. Here, we describe the preclinical profile of pirtobrutinib, a potent, highly selective, noncovalent (reversible) BTK inhibitor. Pirtobrutinib binds BTK with an extensive network of interactions to BTK and water molecules in the adenosine triphosphate binding region and shows no direct interaction with C481. Consequently, pirtobrutinib inhibits both BTK and BTK C481 substitution mutants in enzymatic and cell-based assays with similar potencies. In differential scanning fluorimetry studies, BTK bound to pirtobrutinib exhibited a higher melting temperature than cBTKi-bound BTK. Pirtobrutinib, but not cBTKis, prevented Y551 phosphorylation in the activation loop. These data suggest that pirtobrutinib uniquely stabilizes BTK in a closed, inactive conformation. Pirtobrutinib inhibits BTK signaling and cell proliferation in multiple B-cell lymphoma cell lines, and significantly inhibits tumor growth in human lymphoma xenografts in vivo. Enzymatic profiling showed that pirtobrutinib was highly selective for BTK in >98% of the human kinome, and in follow-up cellular studies pirtobrutinib retained >100-fold selectivity over other tested kinases. Collectively, these findings suggest that pirtobrutinib represents a novel BTK inhibitor with improved selectivity and unique pharmacologic, biophysical, and structural attributes with the potential to treat B-cell-driven cancers with improved precision and tolerability. Pirtobrutinib is being tested in phase 3 clinical studies for a variety of B-cell malignancies.
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7
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Martino EA, Bruzzese A, Vigna E, Iaccino E, Mendicino F, Lucia E, Olivito V, Filippelli G, Neri A, Morabito F, Gentile M. Acalabrutinib in chronic lymphocytic leukemia. Expert Opin Pharmacother 2023; 24:545-549. [PMID: 36943916 DOI: 10.1080/14656566.2023.2194486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
| | | | - Ernesto Vigna
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Enrico Iaccino
- Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Italy
| | | | - Eugenio Lucia
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | | | - Antonino Neri
- Scientific Directorate IRCCS of Reggio Emilia, I-42123 Reggio Emilia, Emilia-Romagna, Italy
| | | | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
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8
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Tichenor MS, Wiener JJM, Rao NL, Bacani GM, Wei J, Pooley Deckhut C, Barbay JK, Kreutter KD, Chang L, Clancy KW, Murrey HE, Wang W, Ahn K, Huber M, Rex E, Coe KJ, Wu J, Rui H, Sepassi K, Gaudiano M, Bekkers M, Cornelissen I, Packman K, Seierstad M, Xiouras C, Bembenek SD, Alexander R, Milligan C, Balasubramanian S, Lebsack AD, Venable JD, Philippar U, Edwards JP, Hirst G. Discovery of JNJ-64264681: A Potent and Selective Covalent Inhibitor of Bruton’s Tyrosine Kinase. J Med Chem 2022; 65:14326-14336. [DOI: 10.1021/acs.jmedchem.2c01026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark S. Tichenor
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - John J. M. Wiener
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Navin L. Rao
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Genesis M. Bacani
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Jianmei Wei
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Charlotte Pooley Deckhut
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - J. Kent Barbay
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Kevin D. Kreutter
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Leon Chang
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Kathleen W. Clancy
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Heather E. Murrey
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Weixue Wang
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Kay Ahn
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Michael Huber
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Elizabeth Rex
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Kevin J. Coe
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Jiejun Wu
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Haopeng Rui
- Janssen Research & Development, 4560 Jinke Road, Pudong New Area, Shanghai 201319, P. R. China
| | - Kia Sepassi
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Marcello Gaudiano
- Janssen Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - Mariette Bekkers
- Janssen Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - Ivo Cornelissen
- Janssen Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - Kathryn Packman
- Janssen Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - Mark Seierstad
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Christos Xiouras
- Janssen Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - Scott D. Bembenek
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Richard Alexander
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Cynthia Milligan
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Sriram Balasubramanian
- Janssen Research & Development, LLC, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Alec D. Lebsack
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Jennifer D. Venable
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Ulrike Philippar
- Janssen Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - James P. Edwards
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Gavin Hirst
- Janssen Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121-1126, United States
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9
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Sharma S, Pepin X, Burri H, Zheng L, Kuptsova-Clarkson N, de Jong A, Yu T, MacArthur HL, Majewski M, Byrd JC, Furman RR, Ware JA, Mann J, Ramies D, Munugalavadla V, Sheridan L, Tomkinson H. Bioequivalence and Relative Bioavailability Studies to Assess a New Acalabrutinib Formulation That Enables Coadministration With Proton-Pump Inhibitors. Clin Pharmacol Drug Dev 2022; 11:1294-1307. [PMID: 36029150 DOI: 10.1002/cpdd.1153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023]
Abstract
Acalabrutinib is a Bruton tyrosine kinase (BTK) inhibitor approved to treat adults with chronic lymphocytic leukemia, small lymphocytic lymphoma, or previously treated mantle cell lymphoma. As the bioavailability of the acalabrutinib capsule (AC) depends on gastric pH for solubility and is impaired by acid-suppressing therapies, coadministration with proton-pump inhibitors (PPIs) is not recommended. Three studies in healthy subjects (N = 30, N = 66, N = 20) evaluated the pharmacokinetics (PKs), pharmacodynamics (PDs), safety, and tolerability of acalabrutinib maleate tablet (AT) formulated with pH-independent release. Subjects were administered AT or AC (orally, fasted state), AT in a fed state, or AT in the presence of a PPI, and AT or AC via nasogastric (NG) route. Acalabrutinib exposures (geometric mean [% coefficient of variation, CV]) were comparable for AT versus AC (AUCinf 567.8 ng h/mL [36.9] vs 572.2 ng h/mL [38.2], Cmax 537.2 ng/mL [42.6] vs 535.7 ng/mL [58.4], respectively); similar results were observed for acalabrutinib's active metabolite (ACP-5862) and for AT-NG versus AC-NG. The geometric mean Cmax for acalabrutinib was lower when AT was administered in the fed versus the fasted state (Cmax 255.6 ng/mL [%CV, 46.5] vs 504.9 ng/mL [49.9]); AUCs were similar. For AT + PPI, geometric mean Cmax was lower (371.9 ng/mL [%CV, 81.4] vs 504.9 ng/mL [49.9]) and AUCinf was higher (AUCinf 694.1 ng h/mL [39.7] vs 559.5 ng h/mL [34.6]) than AT alone. AT and AC were similar in BTK occupancy. Most adverse events were mild with no new safety concerns. Acalabrutinib formulations were comparable and AT could be coadministered with PPIs, food, or via NG tube without affecting the PKs or PDs.
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Affiliation(s)
| | - Xavier Pepin
- New Modalities and Parenteral Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, England, UK
| | - Harini Burri
- AstraZeneca, South San Francisco, California, USA
| | | | | | | | - Ting Yu
- AstraZeneca, South San Francisco, California, USA
| | | | | | - John C Byrd
- Department of Internal Medicine and University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Richard R Furman
- New York-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | | | - James Mann
- Oral Product Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, England, UK
| | - David Ramies
- AstraZeneca, South San Francisco, California, USA
| | | | - Louise Sheridan
- Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, England, UK
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10
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Joshi D, Bahekar R, Soman S, Jadav P, Patel D, Goswami A, Pethani J, Kumar J, Patel J, Sundar R, Goswami P, Goshdastidar K, Patel H, Patel A, Bandyopadhyay D, Chattarjee A, Sharma M, Jain M, Desai R. Design, Synthesis and Biological Evaluation of Novel Pyrazolo-pyrimidin-amines as Potent and Selective BTK Inhibitors. Bioorg Chem 2022; 130:106238. [DOI: 10.1016/j.bioorg.2022.106238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 11/15/2022]
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11
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Bruton's Kinase Inhibitors for the Treatment of Immunological Diseases: Current Status and Perspectives. J Clin Med 2022; 11:jcm11102807. [PMID: 35628931 PMCID: PMC9145705 DOI: 10.3390/jcm11102807] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
The use of Bruton’s tyrosine kinase (BTK) inhibitors has changed the management of patients with B-cell lymphoid malignancies. BTK is an important molecule that interconnects B-cell antigen receptor (BCR) signaling. BTK inhibitors (BTKis) are classified into three categories, namely covalent irreversible inhibitors, covalent reversible inhibitors, and non-covalent reversible inhibitors. Ibrutinib is the first covalent, irreversible BTK inhibitor approved in 2013 as a breakthrough therapy for chronic lymphocytic leukemia patients. Subsequently, two other covalent, irreversible, second-generation BTKis, acalabrutinib and zanubrutinib, have been developed for lymphoid malignancies to reduce the ibrutinib-mediated adverse effects. More recently, irreversible and reversible BTKis have been under development for immune-mediated diseases, including autoimmune hemolytic anemia, immune thrombocytopenia, multiple sclerosis, pemphigus vulgaris, atopic dermatitis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s disease, and chronic spontaneous urticaria, among others. This review article summarizes the preclinical and clinical evidence supporting the role of BTKis in various autoimmune, allergic, and inflammatory conditions.
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12
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Robak T, Witkowska M, Smolewski P. The Role of Bruton's Kinase Inhibitors in Chronic Lymphocytic Leukemia: Current Status and Future Directions. Cancers (Basel) 2022; 14:771. [PMID: 35159041 PMCID: PMC8833747 DOI: 10.3390/cancers14030771] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 12/20/2022] Open
Abstract
The use of Bruton's tyrosine kinase (BTK) inhibitors has changed the management and clinical history of patients with chronic lymphocytic leukemia (CLL). BTK is a critical molecule that interconnects B-cell antigen receptor (BCR) signaling. BTKis are classified into two categories: irreversible (covalent) inhibitors and reversible (non-covalent) inhibitors. Ibrutinib was the first irreversible BTK inhibitor approved by the U.S. Food and Drug Administration in 2013 as a breakthrough therapy in CLL patients. Subsequently, several studies have evaluated the efficacy and safety of new agents with reduced toxicity when compared with ibrutinib. Two other irreversible, second-generation BTK inhibitors, acalabrutinib and zanubrutinib, were developed to reduce ibrutinib-mediated adverse effects. Additionally, new reversible BTK inhibitors are currently under development in early-phase studies to improve their activity and to diminish adverse effects. This review summarizes the pharmacology, clinical efficacy, safety, dosing, and drug-drug interactions associated with the treatment of CLL with BTK inhibitors and examines their further implications.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, 93-510 Lodz, Poland
| | - Magda Witkowska
- Department of Experimental Hematology, Medical University of Lodz, 93-510 Lodz, Poland; (M.W.); (P.S.)
| | - Piotr Smolewski
- Department of Experimental Hematology, Medical University of Lodz, 93-510 Lodz, Poland; (M.W.); (P.S.)
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13
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Ringheim GE, Wampole M, Oberoi K. Bruton's Tyrosine Kinase (BTK) Inhibitors and Autoimmune Diseases: Making Sense of BTK Inhibitor Specificity Profiles and Recent Clinical Trial Successes and Failures. Front Immunol 2021; 12:662223. [PMID: 34803999 PMCID: PMC8595937 DOI: 10.3389/fimmu.2021.662223] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Clinical development of BTK kinase inhibitors for treating autoimmune diseases has lagged behind development of these drugs for treating cancers, due in part from concerns over the lack of selectivity and associated toxicity profiles of first generation drug candidates when used in the long term treatment of immune mediated diseases. Second generation BTK inhibitors have made great strides in limiting off-target activities for distantly related kinases, though they have had variable success at limiting cross-reactivity within the more closely related TEC family of kinases. We investigated the BTK specificity and toxicity profiles, drug properties, disease associated signaling pathways, clinical indications, and trial successes and failures for the 13 BTK inhibitor drug candidates tested in phase 2 or higher clinical trials representing 7 autoimmune and 2 inflammatory immune-mediated diseases. We focused on rheumatoid arthritis (RA), multiple sclerosis (MS), and systemic lupus erythematosus (SLE) where the majority of BTK nonclinical and clinical studies have been reported, with additional information for pemphigus vulgaris (PV), Sjogren’s disease (SJ), chronic spontaneous urticaria (CSU), graft versus host disease (GVHD), and asthma included where available. While improved BTK selectivity versus kinases outside the TEC family improved clinical toxicity profiles, less profile distinction was evident within the TEC family. Analysis of genetic associations of RA, MS, and SLE biomarkers with TEC family members revealed that BTK and TEC family members may not be drivers of disease. They are, however, mediators of signaling pathways associated with the pathophysiology of autoimmune diseases. BTK in particular may be associated with B cell and myeloid differentiation as well as autoantibody development implicated in immune mediated diseases. Successes in the clinic for treating RA, MS, PV, ITP, and GVHD, but not for SLE and SJ support the concept that BTK plays an important role in mediating pathogenic processes amenable to therapeutic intervention, depending on the disease. Based on the data collected in this study, we propose that current compound characteristics of BTK inhibitor drug candidates for the treatment of autoimmune diseases have achieved the selectivity, safety, and coverage requirements necessary to deliver therapeutic benefit.
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Affiliation(s)
- Garth E Ringheim
- Clinical Pharmacology and Translational Medicine, Eisai Inc, Woodcliff Lake, NJ, United States
| | | | - Kinsi Oberoi
- Science Group, Clarivate, Philadelphia, PA, United States
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14
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Wu W, Jia L, Zhang Y, Zhao J, Dong Y, Qiang Y. Exploration of the prognostic signature reflecting tumor microenvironment of lung adenocarcinoma based on immunologically relevant genes. Bioengineered 2021; 12:7417-7431. [PMID: 34612148 PMCID: PMC8806418 DOI: 10.1080/21655979.2021.1974779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Lung adenocarcinoma (LUAD) represents the major histological type of lung cancer with high mortality globally. Due to the heterogeneous nature, the same treatment strategy to various patients may result in different therapeutic responses. Hence, we aimed to elaborate an effective signature for predicting patient survival outcomes. The TCGA-LUAD cohort from the TCGA portal was used as a training dataset. The GSE26939 and GSE68465 cohorts from the GEO database were taken as validation datasets. All immunologically relevant genes were extracted from the ImmPort. The ESTIMATE algorithm was employed to explore LUAD microenvironment in the training dataset. Further, the DEGs were picked out based on the immune-associated genes reflecting different statuses in the immune context of TME. Univariate/multivariate Cox regression was performed to determine six prognosis- specific genes (PIK3CG, BTK, VEGFD, INHA, INSL4, and PTPRC) and established a risk predictive signature. The time-dependent ROC indicated that AUC values were all greater than 0.70 at 1-, 3-, and 5- year intervals. Corresponding RiskScore of each LUAD patient was calculated from the signature, and they were stratified into the high- and low-risk groups by the median value of RiskScore. K-M curves and Log-rank test demonstrated significant survival differences between the two groups (P < 0.05). Similar results were exhibited in the validation datasets. The RiskScore was incredibly relevant to clinicopathological factors like gender, AJCC stage, and T stage. Also, it can mirror the distribution state of 15 kinds of TIICs and have some predictive value for the sensitivity of therapeutic drugs.
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Affiliation(s)
- Wei Wu
- Department of Physiology, Shanxi Medical University, Taiyuan, China.,Key Laboratory of Cellular Physiology, (Shanxi Medical University), Ministry of Education, Taiyuan, China.,Key Laboratory of Cellular Physiology, Shanxi Province, Taiyuan, China
| | - Liye Jia
- College of Information and Computer, Taiyuan University of Technology, Taiyuan,China
| | - Yanan Zhang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan,China
| | - Juanjuan Zhao
- College of Information and Computer, Taiyuan University of Technology, Taiyuan,China
| | - Yunyun Dong
- School of Software, Taiyuan University of Technology, Taiyuan, China
| | - Yan Qiang
- Department of Physiology, Shanxi Medical University, Taiyuan, China
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15
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Tam CS, Ou YC, Trotman J, Opat S. Clinical pharmacology and PK/PD translation of the second-generation Bruton's tyrosine kinase inhibitor, zanubrutinib. Expert Rev Clin Pharmacol 2021; 14:1329-1344. [PMID: 34491123 DOI: 10.1080/17512433.2021.1978288] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: Bruton's tyrosine kinase (BTK) inhibitors have revolutionized the treatment of B-cell lymphomas. Zanubrutinib was designed to achieve improved therapeutic concentrations and minimize off-target activities putatively accounting, in part, for the adverse effects seen with other BTK inhibitors.Areas covered: This drug profile covers zanubrutinib clinical pharmacology and the translation of pharmacokinetics (PK) and pharmacodynamics (PD) to clinical efficacy and safety profiles, by highlighting key differences between zanubrutinib and other BTK inhibitors. We discuss PK, sustained BTK occupancy, and potential factors affecting PK of zanubrutinib, including food effects, hepatic impairment, and drug-drug interactions. These data, along with exposure-response analyses, were used to support the recommended dose of 320 mg, either once daily or as 160 mg twice daily. Translation of PK/PD attributes into clinical effects was demonstrated in a randomized, phase 3 head-to-head study comparing it with ibrutinib in patients with Waldenström macroglobulinemia.Expert opinion: Among the approved BTK inhibitors, zanubrutinib is less prone to PK modulation by intrinsic and extrinsic factors, leading to more consistent, sustained therapeutic exposures and improved dosing convenience. Zanubrutinib PK/PD has translated into durable responses and improved safety, representing an important new treatment option for patients who benefit from BTK therapy.
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Affiliation(s)
- Constantine S Tam
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Haematology, St Vincent's Hospital, Fitzroy, VIC, Australia.,Department of Haematology, University of Melbourne, Parkville, VIC, Australia.,Department of Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ying C Ou
- Sr. Director, Clinical Pharmacology, BeiGene USA Inc., San Mateo, CA, USA
| | - Judith Trotman
- Department of Haematology, Concord Repatriation Hospital, Concord, NSW, Australia.,Department of Haematology, The University of Sydney, Concord, NSW, Australia
| | - Stephen Opat
- Director, Clinical Haematology, Monash Health, Clayton, VIC, Australia.,Director, Clinical Haematology, Monash University, Clayton, VIC, Australia
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16
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Ou YC, Tang Z, Novotny W, Cohen A, Wang K, Liu L, Gao Y, Sahasranaman S. Rationale for once-daily or twice-daily dosing of zanubrutinib in patients with mantle cell lymphoma. Leuk Lymphoma 2021; 62:2612-2624. [PMID: 34159878 DOI: 10.1080/10428194.2021.1929961] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This report summarizes a totality-of-evidence approach supporting recommendation of a 320-mg total daily dose, either as 160-mg twice daily (BID) or 320-mg once daily (QD) for zanubrutinib in patients with mantle cell lymphoma. Data were derived from a phase 2 study in patients receiving 160-mg BID and a phase 1/2 study with similar response rates observed with 160-mg BID or 320-mg QD. Given the limited number of patients in the QD dose group, population pharmacokinetics and exposure-response analyses were employed to bridge the two regimens. The analyses showed that similar plasma exposure and BTK inhibition were achieved, and differences in trough concentration and maximum plasma concentration between the two regimens are unlikely to have a meaningful impact on efficacy and safety endpoints. The totality of data, including pharmacokinetic, pharmacodynamic, safety, efficacy, and exposure-response analyses, provided support for the recommended 320-mg total daily dose for the approved indication.
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Affiliation(s)
- Ying C Ou
- BeiGene USA, Inc, San Mateo, CA, USA
| | | | | | | | - Kun Wang
- Shanghai Qiangshi Information Technology Co., Ltd, Shanghai, China
| | - Lucy Liu
- Shanghai Qiangshi Information Technology Co., Ltd, Shanghai, China
| | - Yuying Gao
- Shanghai Qiangshi Information Technology Co., Ltd, Shanghai, China
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17
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Tichenor MS, Wiener JJM, Rao NL, Pooley Deckhut C, Barbay JK, Kreutter KD, Bacani GM, Wei J, Chang L, Murrey HE, Wang W, Ahn K, Huber M, Rex E, Coe KJ, Wu J, Seierstad M, Bembenek SD, Leonard KA, Lebsack AD, Venable JD, Edwards JP. Discovery of a Potent and Selective Covalent Inhibitor of Bruton's Tyrosine Kinase with Oral Anti-Inflammatory Activity. ACS Med Chem Lett 2021; 12:782-790. [PMID: 34055226 DOI: 10.1021/acsmedchemlett.1c00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022] Open
Abstract
Bruton's tyrosine kinase (BTK) is a cytoplasmic tyrosine kinase that plays a critical role in the activation of B cells, macrophages, and osteoclasts. Given the key role of these cell types in the pathology of autoimmune disorders, BTK inhibitors have the potential to improve treatment outcomes in multiple diseases. Herein, we report the discovery and characterization of a novel potent and selective covalent 4-oxo-4,5-dihydro-3H-1-thia-3,5,8-triazaacenaphthylene-2-carboxamide BTK inhibitor chemotype. Compound 27 irreversibly inhibits BTK by targeting a noncatalytic cysteine residue (Cys481) for covalent bond formation. Compound 27 is characterized by selectivity for BTK, potent in vivo BTK occupancy that is sustained after it is cleared from systemic circulation, and dose-dependent efficacy at reducing joint inflammation in a rat collagen-induced arthritis model.
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Affiliation(s)
- Mark S. Tichenor
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - John J. M. Wiener
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Navin L. Rao
- Janssen Research & Development, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Charlotte Pooley Deckhut
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - J. Kent Barbay
- Janssen Research & Development, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Kevin D. Kreutter
- Janssen Research & Development, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Genesis M. Bacani
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Jianmei Wei
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Leon Chang
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Heather E. Murrey
- Janssen Research & Development, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Weixue Wang
- Janssen Research & Development, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Kay Ahn
- Janssen Research & Development, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Michael Huber
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Elizabeth Rex
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Kevin J. Coe
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - JieJun Wu
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Mark Seierstad
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Scott D. Bembenek
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Kristi A. Leonard
- Janssen Research & Development, 1400 McKean Road, Spring House, Pennsylvania 19477-0776, United States
| | - Alec D. Lebsack
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - Jennifer D. Venable
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
| | - James P. Edwards
- Janssen Research & Development, 3210 Merryfield Row, San Diego, California 92121-1126, United States
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