1
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Jensen MA, Dafoe ML, Wilhelmy J, Cervantes L, Okumu AN, Kipp L, Nemat-Gorgani M, Davis RW. Catalytic Antibodies May Contribute to Demyelination in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Biochemistry 2024; 63:9-18. [PMID: 38011893 PMCID: PMC10765373 DOI: 10.1021/acs.biochem.3c00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
Here we report preliminary data demonstrating that some patients with myalgic encephalomyelitis/chronic fatiguesyndrome (ME/CFS) may have catalytic autoantibodies that cause the breakdown of myelin basic protein (MBP). We propose that these MBP-degradative antibodies are important to the pathophysiology of ME/CFS, particularly in the occurrence of white matter disease/demyelination. This is supported by magnetic resonance imagining studies that show these findings in patients with ME/CFS and could explain symptoms of nerve pain and muscle weakness. In this work, we performed a series of experiments on patient plasma samples where we isolated and characterized substrate-specific antibodies that digest MBP. We also tested glatiramer acetate (copaxone), an FDA approved immunomodulator to treat multiple sclerosis, and found that it inhibits ME/CFS antibody digestion of MBP. Furthermore, we found that aprotinin, which is a specific serine protease inhibitor, specifically prevents breakdown of MBP while the other classes of protease inhibitors had no effect. This coincides with the published literature describing catalytic antibodies as having serine protease-like activity. Postpandemic research has also provided several reports of demyelination in COVID-19. Because COVID-19 has been described as a trigger for ME/CFS, demyelination could play a bigger role in patient symptoms for those recently diagnosed with ME/CFS. Therefore, by studying proteolytic antibodies in ME/CFS, their target substrates, and inhibitors, a new mechanism of action could lead to better treatment and a possible cure for the disease.
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Affiliation(s)
- Michael Anthony Jensen
- Stanford
Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, California 94304, United States
| | - Miranda Lee Dafoe
- Stanford
Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, California 94304, United States
| | - Julie Wilhelmy
- Stanford
Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, California 94304, United States
| | - Layla Cervantes
- Stanford
Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, California 94304, United States
| | - Anna N Okumu
- Stanford
Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, California 94304, United States
| | - Lucas Kipp
- Department
of Neurology and Neurological Sciences, Stanford University, Palo Alto, California 94304, United States
| | - Mohsen Nemat-Gorgani
- Stanford
Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, California 94304, United States
| | - Ronald Wayne Davis
- Stanford
Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, California 94304, United States
- Department
of Genetics, Stanford University, Palo Alto, California 94304, United States
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2
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Mirabella M, Annovazzi P, Brownlee W, Cohen JA, Kleinschnitz C, Wolf C. Treatment Challenges in Multiple Sclerosis – A Continued Role for Glatiramer Acetate? Front Neurol 2022; 13:844873. [PMID: 35493825 PMCID: PMC9051342 DOI: 10.3389/fneur.2022.844873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Earlier diagnosis, access to disease-modifying therapies (DMTs), and improved supportive care have favorably altered the disease course of multiple sclerosis (MS), leading to an improvement in long-term outcomes for people with MS (PwMS). This success has changed the medical characteristics of the population seen in MS clinics. Comorbidities and the accompanying polypharmacy, immune senescence, and the growing number of approved DMTs make selecting the optimal agent for an individual patient more challenging. Glatiramer acetate (GA), a moderately effective DMT, interacts only minimally with comorbidities, other medications, or immune senescence. We describe here several populations in which GA may represent a useful treatment option to overcome challenges due to advanced age or comorbidities (e.g., hepatic or renal disease, cancer). Further, we weigh GA's potential merits in other settings where PwMS and their neurologists must base treatment decisions on factors other than selecting the most effective DMT, e.g., family planning, conception and pregnancy, or the need for vaccination.
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Affiliation(s)
- Massimiliano Mirabella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica, Rome, Italy
- *Correspondence: Massimiliano Mirabella ; orcid.org/0000-0002-7783-114X
| | - Pietro Annovazzi
- MS Center, ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Wallace Brownlee
- Queen Square MS Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey A. Cohen
- Department of Neurology, Mellen Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States
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3
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Giovannoni G, Brex PA, Dhiraj D, Fullarton J, Freddi M, Rodgers-Gray B, Schmierer K. Glatiramer acetate as a clinically and cost-effective treatment of relapsing multiple sclerosis over 10 years of use within the National Health Service: Final results from the UK Risk Sharing Scheme. Mult Scler J Exp Transl Clin 2019; 5:2055217319893103. [PMID: 31839981 PMCID: PMC6896140 DOI: 10.1177/2055217319893103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The UK Risk Sharing Scheme (RSS) provided information on the effect of first-line multiple sclerosis (MS) disease-modifying treatments on long-term disability. Objective The aim is to provide results specific to glatiramer acetate (GA; Copaxone®) from the final 10-year analysis of the RSS. Methods A Markov model was used to assess clinical effectiveness measured as Expanded Disability Status Scale (EDSS) progression and utility loss. Untreated patients from the British Columbia MS cohort (1980-1995) were used as a 'virtual comparator' group. A separate Markov model assessed cost-effectiveness, based on a 50-year time horizon (with a 50% treatment waning effect imposed at 10 years) and using NHS list price (£513.95 per 28 days). Results were expressed in quality-adjusted life years (QALYs). Results In total, 755 patients with relapsing-remitting MS (RRMS) received GA, with a mean follow-up of 7.1 (standard deviation 1.3) years. EDSS progression was reduced by 23% (progression ratio 76.7, 95% confidence interval [CI] 69.0-84.3) and utility loss by 39% (progression ratio 61.0, 95% CI 52.7-69.3) compared with no treatment. There was no persistent waning in GA treatment effect over time (EDSS: p = 0.093; utilities: p = 0.119). The cost per QALY was £17,841. Conclusion GA had a beneficial effect on long-term disability and was a cost-effective treatment for RRMS.
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Affiliation(s)
- G Giovannoni
- Blizard Institute, Barts, and The London School of Medicine and Dentistry, Queen Mary University London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, UK
| | - P A Brex
- King's College Hospital NHS Foundation Trust, UK
| | | | | | | | | | - K Schmierer
- Blizard Institute, Barts, and The London School of Medicine and Dentistry, Queen Mary University London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, UK
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4
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Borchard G, Crommelin D. Equivalence of glatiramer acetate products: challenges in assessing pharmaceutical equivalence and critical clinical performance attributes. Expert Opin Drug Deliv 2017; 15:247-259. [DOI: 10.1080/17425247.2018.1418322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Borchard
- School of Pharmaceutical Sciences Geneva-Lausanne (EPGL), University of Geneva, University of Lausanne, Geneva, Switzerland
| | - D.J.A Crommelin
- Department Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, UIPS, Utrecht, The Netherlands
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5
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Bell C, Anderson J, Ganguly T, Prescott J, Capila I, Lansing JC, Sachleben R, Iyer M, Fier I, Roach J, Storey K, Miller P, Hall S, Kantor D, Greenberg BM, Nair K, Glajch J. Development of Glatopa® (Glatiramer Acetate): The First FDA-Approved Generic Disease-Modifying Therapy for Relapsing Forms of Multiple Sclerosis. J Pharm Pract 2017. [PMID: 28847230 DOI: 10.1177/0897190017725984.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The multiple sclerosis (MS) treatment landscape in the United States has changed dramatically over the past decade. While many disease-modifying therapies (DMTs) have been approved by the US Food and Drug Administration (FDA) for the treatment of relapsing forms of MS, DMT costs continue to rise. The availability of generics and biosimilars in the MS-treatment landscape is unlikely to have a major impact on clinical benefit. However, their availability will provide alternative treatment options and potentially lower costs through competition, thus increasing the affordability of and access to these drugs. In April 2015, the first generic version of the complex drug glatiramer acetate (Glatopa® 20 mg/mL) injection was approved in the United States as a fully substitutable generic for all approved indications of the 20 mg/mL branded glatiramer acetate (Copaxone®) dosage form. Despite glatiramer acetate's complex nature-being a chemically synthesized (ie, nonbiologic) mixture of peptides-the approval occurred without conducting any clinical trials. Rather, extensive structural and functional characterization was performed to demonstrate therapeutic equivalence to the innovator drug. The approval of Glatopa signifies an important milestone in the US MS-treatment landscape, with the hope that the introduction of generic DMTs and eventually biosimilar DMTs will lead to future improvements in the affordability and access of these much-needed treatments for MS.
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Affiliation(s)
- Christine Bell
- 1 Analytical Development, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - James Anderson
- 2 Pharmaceutical Sciences, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Tanmoy Ganguly
- 3 Research and Development, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - James Prescott
- 4 Analytical Chemistry, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Ishan Capila
- 5 Research, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | | | - Richard Sachleben
- 6 Complex Generics Manufacturing, Technical Operations, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Mani Iyer
- 7 Chemical Development and Manufacturing, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Ian Fier
- 8 Program and Project Management, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - James Roach
- 9 Clinical Development and Regulatory Affairs, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Kristina Storey
- 10 Regulatory Affairs, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Paul Miller
- 11 Medical Affairs and Communications, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Steven Hall
- 12 Medical Affairs, Sandoz, Inc, a Novartis Division, Princeton, NJ, USA
| | - Daniel Kantor
- 13 Division of Neurology, Florida Atlantic University, Boca Raton, FL, USA
| | - Benjamin M Greenberg
- 14 Neurology and Neurotherapeutics, Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kavita Nair
- 15 Department of Clinical Pharmacy, University of Colorado School of Pharmacy, Aurora, CO, USA
| | - Joseph Glajch
- 1 Analytical Development, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
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6
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Bell C, Anderson J, Ganguly T, Prescott J, Capila I, Lansing JC, Sachleben R, Iyer M, Fier I, Roach J, Storey K, Miller P, Hall S, Kantor D, Greenberg BM, Nair K, Glajch J. Development of Glatopa® (Glatiramer Acetate): The First FDA-Approved Generic Disease-Modifying Therapy for Relapsing Forms of Multiple Sclerosis. J Pharm Pract 2017; 31:481-488. [PMID: 28847230 PMCID: PMC6144347 DOI: 10.1177/0897190017725984] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The multiple sclerosis (MS) treatment landscape in the United States has changed dramatically over the past decade. While many disease-modifying therapies (DMTs) have been approved by the US Food and Drug Administration (FDA) for the treatment of relapsing forms of MS, DMT costs continue to rise. The availability of generics and biosimilars in the MS-treatment landscape is unlikely to have a major impact on clinical benefit. However, their availability will provide alternative treatment options and potentially lower costs through competition, thus increasing the affordability of and access to these drugs. In April 2015, the first generic version of the complex drug glatiramer acetate (Glatopa® 20 mg/mL) injection was approved in the United States as a fully substitutable generic for all approved indications of the 20 mg/mL branded glatiramer acetate (Copaxone®) dosage form. Despite glatiramer acetate's complex nature-being a chemically synthesized (ie, nonbiologic) mixture of peptides-the approval occurred without conducting any clinical trials. Rather, extensive structural and functional characterization was performed to demonstrate therapeutic equivalence to the innovator drug. The approval of Glatopa signifies an important milestone in the US MS-treatment landscape, with the hope that the introduction of generic DMTs and eventually biosimilar DMTs will lead to future improvements in the affordability and access of these much-needed treatments for MS.
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Affiliation(s)
- Christine Bell
- 1 Analytical Development, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - James Anderson
- 2 Pharmaceutical Sciences, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Tanmoy Ganguly
- 3 Research and Development, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - James Prescott
- 4 Analytical Chemistry, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Ishan Capila
- 5 Research, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | | | - Richard Sachleben
- 6 Complex Generics Manufacturing, Technical Operations, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Mani Iyer
- 7 Chemical Development and Manufacturing, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Ian Fier
- 8 Program and Project Management, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - James Roach
- 9 Clinical Development and Regulatory Affairs, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Kristina Storey
- 10 Regulatory Affairs, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Paul Miller
- 11 Medical Affairs and Communications, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Steven Hall
- 12 Medical Affairs, Sandoz, Inc, a Novartis Division, Princeton, NJ, USA
| | - Daniel Kantor
- 13 Division of Neurology, Florida Atlantic University, Boca Raton, FL, USA
| | - Benjamin M Greenberg
- 14 Neurology and Neurotherapeutics, Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kavita Nair
- 15 Department of Clinical Pharmacy, University of Colorado School of Pharmacy, Aurora, CO, USA
| | - Joseph Glajch
- 1 Analytical Development, Momenta Pharmaceuticals, Inc, Cambridge, MA, USA
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7
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Annovazzi P, Bertolotto A, Brescia Morra V, Gasperini C, Montanari E, Navarra P, Patti F, Sormani MP, Ghezzi A. A Comprehensive Review on Copemyl ®. Neurol Ther 2017; 6:161-173. [PMID: 28762192 PMCID: PMC5700901 DOI: 10.1007/s40120-017-0079-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 01/17/2023] Open
Abstract
Economic sustainability is of paramount importance in the rapidly evolving therapeutic scenario of multiple sclerosis (MS). Glatiramoids are a class of drugs whose forefather, glatiramer acetate, has been used as a disease modifying drug (DMD) in patients with MS for over 20 years. Its patent expired in 2015; new versions of such drug are nowadays available on the market, potentially contributing to lowering prices and enhancing a better allocation of economic resources. In this review, we analyze the recommendations underlying the approval of both generic drugs and biosimilars by regulatory authorities, and we provide methodological tools to contextualize the design of studies on these new classes of drugs. We examine in more detail the preclinical and clinical data of Copemyl®, a new member of the glatiramoid class, focusing on its biological and immunological properties and illustrating randomized controlled trials that led to its authorization.
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Affiliation(s)
- Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy.
| | - Antonio Bertolotto
- Neurology and Multiple Sclerosis Regional Reference Center (CRESM), AOU San Luigi, Orbassano, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Departement of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Claudio Gasperini
- Multiple Sclerosis Center, S. Camillo-Forlanini Hospital Rome, Rome, Italy
| | | | - Pierluigi Navarra
- Institute of Pharmacology, Catholic University Medical School, Largo F. Vito 1, 00168, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced Technologies, GF Ingrassia, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
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8
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De Riccardis L, Ferramosca A, Danieli A, Trianni G, Zara V, De Robertis F, Maffia M. Metabolic response to glatiramer acetate therapy in multiple sclerosis patients. BBA CLINICAL 2016; 6:131-137. [PMID: 27785417 PMCID: PMC5079236 DOI: 10.1016/j.bbacli.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 12/15/2022]
Abstract
Glatiramer acetate (GA; Copaxone) is a random copolymer of glutamic acid, lysine, alanine, and tyrosine used for the treatment of patients with multiple sclerosis (MS). Its mechanism of action has not been already fully elucidated, but it seems that GA has an immune-modulatory effect and neuro-protective properties. Lymphocyte mitochondrial dysfunction underlines the onset of several autoimmune disorders. In MS first diagnosis patients, CD4+, the main T cell subset involved in the pathogenesis of MS, undergo a metabolic reprogramming that consist in the up-regulation of glycolysis and in the down-regulation of oxidative phosphorylation. Currently, no works exist about CD4+ T cell metabolism in response to GA treatment. In order to provide novel insight into the potential use of GA in MS treatment, blood samples were collected from 20 healthy controls (HCs) and from 20 RR MS patients prior and every 6 months during the 12 months of GA administration. GA treated patients' CD4+ T cells were compared with those from HCs analysing their mitochondrial activity through polarographic and enzymatic methods in association with their antioxidant status, through the analysis of SOD, GPx and CAT activities. Altogether, our findings suggest that GA is able to reduce CD4+ T lymphocytes' dysfunctions by increasing mitochondrial activity and their response to oxidative stress. GA is able to reduce CD4 + T cell's dysfunctions in MS patients; A CD4 + T cell metabolic response in GA treated patients is proposed; Metabolic response relies on changes in mitochondrial activity and in antioxidative status.
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Key Words
- CAT, catalase
- CD4+ T cells
- CNS, central nervous system
- CS, citrate synthase
- EAE, experimental autoimmune encephalomyelitis
- GPX, glutathione peroxidase
- GR, glutathione reductase
- Glycolysis
- HK, hexokinase
- MCT, mono-carboxylate transporters
- MS, Multiple Sclerosis
- Multiple sclerosis
- OXPHOS
- OXPHOS, oxidative phosphorylation
- Oxidative stress
- PBMC, peripheral blood mononuclear cell
- PFK, phosphofructokinase
- RCR, respiratory control ratio
- ROS, reactive oxygen species
- RRMS, Relapsing-Remitting Multiple Sclerosis
- SOD, superoxide dismutase
- Th, T helper
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Affiliation(s)
- Lidia De Riccardis
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Prov.le Lecce-Monteroni, Lecce, Italy
| | - Alessandra Ferramosca
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Prov.le Lecce-Monteroni, Lecce, Italy
| | - Antonio Danieli
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Prov.le Lecce-Monteroni, Lecce, Italy
| | - Giorgio Trianni
- Department of Neurology, "Vito Fazzi" Hospital, ASL-Lecce, Italy
| | - Vincenzo Zara
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Prov.le Lecce-Monteroni, Lecce, Italy
| | | | - Michele Maffia
- Department of Biological and Environmental Sciences and Technologies, University of Salento, via Prov.le Lecce-Monteroni, Lecce, Italy
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9
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Crommelin DJA, Broich K, Holloway C, Meesen B, Lizrova Preiningerova J, Prugnaud JL, Silva-Lima B. The regulator’s perspective: How should new therapies and follow-on products for MS be clinically evaluated in the future? Mult Scler 2016; 22:47-59. [DOI: 10.1177/1352458516650744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 11/16/2022]
Abstract
Background: Although there is still no cure for multiple sclerosis (MS), the introduction of several innovative drugs with modes of action different from that of the existing drug arsenal and the progress in monitoring disease progression by imaging and using biomarkers are currently causing a knowledge surge. This provides opportunities for improving patient disease management. New therapies are also under development and pose challenges to the regulatory bodies regarding the optimal design of clinical trials with more patient-focused clinical endpoints. Moreover, with the upcoming patent expiry of some of the key first-line MS treatments in Europe, regulatory bodies will also face the challenge of recommending marketing authorisation for generic and abridged versions based on appropriate requirements for demonstrating equality/similarity to the innovator’s product. Objective: The goal of this article is to improve the understanding of the relevant guidance documents of the European Medicines Agency (EMA) on clinical investigation of medicinal products and to highlight the issues that the agency will need to clarify regarding follow-on products of first-line MS treatments. Conclusion: Today, it is clear that close collaboration between patients, healthcare professionals, regulatory bodies and industry is crucial for developing new safe and effective drugs, which satisfy the needs of MS patients.
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Affiliation(s)
- Daan JA Crommelin
- Department of Pharmaceutics, Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Sciences, Utrecht University, Utrecht, The Netherlands
| | - Karl Broich
- President and Head of the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Germany
| | - Chris Holloway
- European Regulatory Consultant, Chief Scientific Officer of ERA Consulting GmbH, Walsrode, Germany
| | - Bianca Meesen
- Managing Director at Ismar Healthcare, Lier, Belgium
| | - Jana Lizrova Preiningerova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jean-Louis Prugnaud
- Expert Involved in the Development of Recommendations Related to Drug Registrations, Paris, France
| | - Beatriz Silva-Lima
- iMed.ULisboa, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
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10
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Carrá A, Macías Islas MA, Tarulla A, Bichuetti DB, Finkelsztejn A, Fragoso YD, Árcega-Revilla R, Cárcamo Rodríguez C, Durán JC, Bonitto JG, León R, Oehninger Gatti C, Orozco G, Vizcarra Escobar D. Biological and nonbiological complex drugs for multiple sclerosis in Latin America: regulations and risk management. Expert Rev Neurother 2015; 15:597-600. [PMID: 25924772 DOI: 10.1586/14737175.2015.1042456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Biological drugs and nonbiological complex drugs with expired patents are followed by biosimilars and follow-on drugs that are supposedly similar and comparable with the reference product in terms of quality, safety and efficacy. Unlike simple molecules that can be copied and reproduced, biosimilars and follow-on complex drugs are heterogeneous and need specific regulations from health and pharmacovigilance agencies. A panel of 14 Latin American experts on multiple sclerosis from nine different countries met to discuss the recommendations regarding biosimilars and follow-on complex drugs for treating multiple sclerosis. Specific measures relating to manufacturing, therapeutic equivalence assessment and pharmacovigilance reports need to be implemented before commercialization. Physical, chemical, biological and immunogenic characterizations of the new product need to be available before clinical trials start. The new product must maintain the same immunogenicity as the original. Automatic substitution of biological and complex drugs poses unacceptable risks to the patient.
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Affiliation(s)
- Adriana Carrá
- Hospital Británico, Buenos Aires, Buenos Aires, Argentina
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11
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12
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Starossom SC, Veremeyko T, Dukhinova M, Yung AWY, Ponomarev ED. Glatiramer acetate (copaxone) modulates platelet activation and inhibits thrombin-induced calcium influx: possible role of copaxone in targeting platelets during autoimmune neuroinflammation. PLoS One 2014; 9:e96256. [PMID: 24788965 PMCID: PMC4008572 DOI: 10.1371/journal.pone.0096256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background Glatiramer acetate (GA, Copaxone, Copolymer-1) is an FDA approved drug for the treatment of MS and it is very effective in suppressing neuroinflammation in experimental autoimmune encephalitis (EAE), an animal model of MS. Although this drug was designed to inhibit pathogenic T cells, the exact mechanism of EAE/MS suppression by GA is still not well understood. Previously we presented evidence that platelets become activated and promote neuroinflammation in EAE, suggesting a possible pathogenic role of platelets in MS and EAE. We hypothesized that GA could inhibit neuroinflammation by affecting not only immune cells but also platelets. Methodology/Principal Findings We investigated the effect of GA on the activation of human platelets in vitro: calcium influx, platelet aggregation and expression of activation markers. Our results in human platelets were confirmed by in-vitro and in-vivo studies of modulation of functions of platelets in mouse model. We found that GA inhibited thrombin-induced calcium influx in human and mouse platelets. GA also decreased thrombin-induced CD31, CD62P, CD63, and active form of αIIbβ3 integrin surface expression and formation of platelet aggregates for both mouse and human platelets, and prolonged the bleeding time in mice by 2.7-fold. In addition, we found that GA decreased the extent of macrophage activation induced by co-culture of macrophages with platelets. Conclusions GA inhibited the activation of platelets, which suggests a new mechanism of GA action in suppression of EAE/MS by targeting platelets and possibly preventing their interaction with immune cells such as macrophages. Furthermore, the reduction in platelet activation by GA may have additional cardiovascular benefits to prevent thrombosis.
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Affiliation(s)
- Sarah C. Starossom
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute for Medical Immunology and NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tatyana Veremeyko
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Marina Dukhinova
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Amanda W. Y. Yung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Eugene D. Ponomarev
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
- * E-mail:
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Johnson KP. Glatiramer acetate for treatment of relapsing–remitting multiple sclerosis. Expert Rev Neurother 2014; 12:371-84. [DOI: 10.1586/ern.12.25] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Messina S, Patti F. The pharmacokinetics of glatiramer acetate for multiple sclerosis treatment. Expert Opin Drug Metab Toxicol 2013; 9:1349-59. [PMID: 23795716 DOI: 10.1517/17425255.2013.811489] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a T-cell-mediated disease affecting the central nervous system (CNS), characterized by demyelination and axonal degeneration. INF-β1b was the first drug approved for MS patients in 1993. In 1996, glatiramer acetate (GA), a synthetic copolymer, was approved in the USA for the treatment of relapsing-remitting MS (RRMS) and clinically isolated syndrome (CIS). Although the immunological action of GA has been fully investigated, the exact mechanisms of action of GA are still not completely elucidated. Several in vitro studies on mice and human antigen-presenting cells (APCs) have shown that GA is able to bind to the major histocompatibility complex (MHC), on the surface of APCs, recognizing myelin basic protein (MBP). AREAS COVERED This review explores the pharmacological characteristics of GA, its mechanism of action and its pharmacokinetics properties. The article also provides information on the efficacy, tolerability and an overview of the most important clinical data on GA. EXPERT OPINION Despite the development of novel compounds, it is not surprising that GA is, to date, one of the most prescribed drugs for RRMS patients and CIS patients. The proven efficacy and the mild adverse events, makes GA a good therapeutic option in the early stage of the disease. This is particularly useful for patients who suffer flu-like symptoms from other RRMS therapies as an alternative.
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Affiliation(s)
- Silvia Messina
- Department G.F. Ingrassia, Section of Neurosciences, Università degli studi di Catania , Via S. Sofia, 78, Catania , Italy +0953782642 ; +0953782626 ;
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Shvarts GY, Ramenskaya GV. Analysis of reasons for the impossibility of creating Copaxone generics. Pharm Chem J 2013. [DOI: 10.1007/s11094-013-0864-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Complex Drugs and Biologics: Scientific and Regulatory Challenges for Follow-on Products. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/0092861512437759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ramot Y, Rosenstock M, Klinger E, Bursztyn D, Nyska A, Shinar DM. Comparative Long-Term Preclinical Safety Evaluation of Two Glatiramoid Compounds (Glatiramer Acetate, Copaxone®, and TV-5010, Protiramer) in Rats and Monkeys. Toxicol Pathol 2011; 40:40-54. [DOI: 10.1177/0192623311424169] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Glatiramer acetate (GA), the active ingredient in Copaxone®, is a complex mixture of polypeptides used for the treatment of relapsing remitting multiple sclerosis. Glatiramoids are related mixtures that may differ in some characteristics of the prototype molecule. Our aim is to describe the long-term toxicity studies with protiramer (TV-5010), a new glatiramoid, in comparison with similar studies conducted with GA. The toxicity of twice-weekly subcutaneous injections of protiramer to Sprague-Dawley rats (twenty-six weeks) and cynomolgus monkeys (fifty-two weeks) was compared with similar studies done with daily subcutaneous injections of GA. Daily treatment with GA was safe and well tolerated, without systemic effects or death. Protiramer administration was not as well tolerated as GA and led to dose- and time-related mortalities, probably mediated through severe injection-site lesions both in rats and in monkeys. Bridging fibrosis in the liver and severe progressive nephropathy were seen in rats. A dose-related increase in eosinophils was observed in monkeys. The protiramer toxicity studies show that minor variations in the manufacturing of glatiramoids may lead to significant toxic effects. It is therefore essential that the safety of any new glatiramoid be studied in long-term preclinical studies before exposing humans.
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Affiliation(s)
- Yuval Ramot
- Hadassah—Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ety Klinger
- Teva Pharmaceutical Industries, Ltd, Petach Tikva, Israel
| | - Dizza Bursztyn
- Teva Pharmaceutical Industries, Ltd, Petach Tikva, Israel
| | - Abraham Nyska
- Consultant in Toxicological Pathology, Timrat, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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