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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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Preparation, characterization and in-vivo efficacy study of glatiramer acetate (GA)-hydrogel-microparticles as novel drug delivery system for GA in RRMS. Sci Rep 2022; 12:22042. [PMID: 36543898 PMCID: PMC9772231 DOI: 10.1038/s41598-022-26640-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Relapsing Remitting Multiple Sclerosis is a chronic Central nervous system autoimmune disease. There is no absolute treatment for MS and the available remedies are called disease modifying therapies (DMTs). Glatiramer acetate (GA) is one of the FDA approved DMTs. Currently, injection-site problems and unfavorable daily injection are the most common milestones in administration of GA. So that, the design of improved drug delivery systems with sustained release profile seem necessary and helpful in order to minimize GA adverse effects and improve patients' compliance. In this study, we have manufactured a novel chitosan-PLGA (poly (lactic-co-glycolic acid)) hydrogel-microparticles containing GA by double emulsion method. Hydrogel-microparticles' properties including size, morphology and GA loading were investigated. In-vitro drug release was studied during 30 days. In vivo efficacy of GA-hydrogel-microparticles was evaluated in experimental autoimmune encephalomyelitis (EAE) as an established animal model for MS. Pathological studies were performed through H&E (Hematoxylin and Eosin) staining of brain, spine, liver, skin and kidney tissues. Luxol fast blue staining of brain tissue was also done. The obtained results were applied for safety and efficacy evaluations. GA loading and Entrapment efficiency (EE %) of 60% and 95% were achieved, respectively. In- vitro release studies confirms a sustained release profile for GA-hydrogel-microparticles. Mean clinical scores and mean body weights obtained from EAE animal model for GA-hydrogel-microparticles were compared to the outcomes achieved from conventional Iranian brand-generic injection solution of GA (Copamer®, 20 mg/ml). EAE outcomes and pathological studies confirm similar therapeutic efficacy with longer dosing intervals possibility, improved safety through decreased adverse effects and elimination of site injection reactions for GA-hydrogel-microparticles. Further studies on pharmacokinetic and pharmacodynamics in human volunteers are still required to thoroughly examine different aspects of this newly developed GA- hydrogel-microparticles.
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Jan Z, Mollazadeh S, Abnous K, Taghdisi SM, Danesh A, Ramezani M, Alibolandi M. Targeted Delivery Platforms for the Treatment of Multiple Sclerosis. Mol Pharm 2022; 19:1952-1976. [PMID: 35501974 DOI: 10.1021/acs.molpharmaceut.1c00892] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Multiple sclerosis (MS) is a neurodegenerative condition of the central nervous system (CNS) that presents with varying levels of disability in patients, displaying the significance of timely and effective management of this complication. Though several treatments have been developed to protect nerves, comprehensive improvement of MS is still considered an essential bottleneck. Therefore, the development of innovative treatment methods for MS is one of the core research areas. In this regard, nanoscale platforms can offer practical and ideal approaches to the diagnosis and treatment of various diseases, especially immunological disorders such as MS, to improve the effectiveness of conventional therapies. It should be noted that there is significant progress in the development of neuroprotective strategies through the implementation of various nanoparticles, monoclonal antibodies, peptides, and aptamers. In this study, we summarize different particle systems as well as targeted therapies, such as antibodies, peptides, nucleic acids, and engineered cells for the treatment of MS, and discuss their potential in the treatment of MS in the preclinical and clinical stages. Future advances in targeted delivery of medical supplies may offer new strategies for complete recovery as well as practical treatment of progressive forms of MS.
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Affiliation(s)
- Zeinab Jan
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Science, 7GJP+VPQ Mashhad, Iran
| | - Samaneh Mollazadeh
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, F82C+G8V Bojnurd, Iran
| | - Khalil Abnous
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, 7GJP+VPQ Mashhad, Iran
| | - Seyed Mohammad Taghdisi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, 7GJP+VPQ Mashhad, Iran
| | - Abolghasem Danesh
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Science, 7GJP+VPQ Mashhad, Iran
| | - Mohammad Ramezani
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, 7GJP+VPQ Mashhad, Iran
| | - Mona Alibolandi
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, 7GJP+VPQ Mashhad, Iran
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Song Z, Khaw YM, Pacheco LA, Tseng KY, Tan Z, Cai K, Ponnusamy E, Cheng J, Inoue M. Induction of a higher-ordered architecture in glatiramer acetate improves its biological efficiency in an animal model of multiple sclerosis. Biomater Sci 2020; 8:5271-5281. [PMID: 32744547 DOI: 10.1039/d0bm00957a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Glatiramer acetate (GA), a linear random copolypeptide, is a first-line treatment for multiple sclerosis (MS). A major concern, however, is that GA treatment is associated with adverse effects and poor patient adherence due to the need for frequent injections. Here we describe improved performance of the polymeric drug, even at low doses with less-frequent injections, through the modification of its architecture into a star-shaped GA (sGA). In a sGA, multiple GAs are covalently linked onto a core, which greatly changes their properties such as molecular weight, size, and shape. The spherical sGA is retained longer in the body after intraperitoneal injection, and is more readily internalized by RAW 264.7 macrophage cells and bone marrow-derived dendritic cells than GA. In C57BL/6 mice induced with experimental autoimmune encephalitis, a mouse model for MS, sGA treatment exerts disease amelioration effect that is significantly better than that of GA despite a lower dose and less frequent injection. Moreover, spinal cord pathologies of demyelination and leukocyte infiltration are dramatically less pronounced in the sGA treatment condition compared to the GA treatment condition. Thus, we propose that sGA with a higher-ordered architecture offers an attractive and potentially viable treatment option for MS patients.
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Affiliation(s)
- Ziyuan Song
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA. and Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
| | - Yee Ming Khaw
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA. and University of Illinois at Urbana-Champaign, Neuroscience Program, 405 North Matthews Avenue, Urbana, Illinois 61801, USA
| | - Lazaro A Pacheco
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
| | - Kuan-Ying Tseng
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
| | - Zhengzhong Tan
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
| | - Kaimin Cai
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
| | | | - Jianjun Cheng
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
| | - Makoto Inoue
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA. and University of Illinois at Urbana-Champaign, Neuroscience Program, 405 North Matthews Avenue, Urbana, Illinois 61801, USA
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Rafiee Zadeh A, Ghadimi K, Ataei A, Askari M, Sheikhinia N, Tavoosi N, Falahatian M. Mechanism and adverse effects of multiple sclerosis drugs: a review article. Part 2. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2019; 11:105-114. [PMID: 31523358 PMCID: PMC6737425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/18/2019] [Indexed: 06/10/2023]
Abstract
Multiple Sclerosis (MS) is an autoimmune, inflammatory disease of the central nervous system (CNS) mostly affecting young adults. The exact mechanism and pathogenesis of MS remain still undiscovered but there have been useful treatments with different efficacy rates. Most of these therapies are divided into the first line, second line and third line, impact on the immune system and immune cells. These drugs are approved to be useful in MS, but like any other therapies, adverse effects (AE) are associated with these drugs. In this review, we continue the survey over mechanisms of actions and AEs of MS drugs. Physicians must be aware of such AEs and complications to choose the best drug for each patient.
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Affiliation(s)
| | - Keyvan Ghadimi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Akram Ataei
- Department of Neurology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mozhde Askari
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Neda Sheikhinia
- Department of Neurology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Nooshin Tavoosi
- Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University Shahrekord BranchShahrekord, Iran
| | - Masih Falahatian
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Use of glatiramer acetate between 2010-2015: effectiveness, safety and reasons to start GA as first or second line treatment in Swiss multiple sclerosis patients. BMC Neurol 2019; 19:159. [PMID: 31299922 PMCID: PMC6626416 DOI: 10.1186/s12883-019-1383-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/27/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Glatiramer acetate (GA) is one of the first therapies approved for multiple sclerosis (MS). We prospectively included and monitored drug-naïve and pre-treated MS patients who had been prescribed GA for 1 year, to investigate reasons for GA prescription, its effectiveness and safety in real life clinical practice. METHODS One year, prospective, multicentre, observational study performed between 2010 and 2015 in consecutive MS and clinically isolated syndrome patients starting GA as a first ("naïve") or second ("switcher") line therapy. Primary endpoint was the annualized relapse rate (ARR) over 1 year of GA treatment (from baseline, V1, to 12 months, V2) in naïve and switchers compared to previous 24 months. Secondary endpoints were: EDSS changes between V1 and V2, frequency of adverse events, and reasons for prescribing and discontinuing GA. Baseline demographics and clinical characteristics were retrieved from medical records, and outcome measures were documented at V1 and V2, and in case of clinical worsening. RESULTS One hundred ninety-four consecutive patients were monitored over 12 months (N = 64 naïve, N = 130 switchers). Side effect profile (naïve = 36%, switchers = 28%) and comorbidities (naïve = 31%, switchers = 15%) were the most frequent reasons to start GA. The ARR was reduced in both naïve and switchers during V1-2 as compared to the 24 months preceding V1 [naïve: 0.0 (0.0-0.0) vs 0.5 (0.5-1.0, p = 2.9e-10); switchers: 0.0 (0.0-0.0) vs 0.5 (0.0-0.5, p = 0.022)]. EDSS at V2 was significantly reduced only in naïve [(1.5 (1.0-2.5) vs 2.0 (1.5-2.5), p = 0.003)]. Naïve status and EDSS at V1 were negatively associated with EDSS change between V1-V2 in multivariable analysis (regression coefficient = - 0.436, p = 0.008, and regression coefficient = - 0.263, p = 6.18e-05, respectively). No new unexpected AE was reported. CONCLUSION In our Swiss cohort, GA was prescribed mainly to naïve or switcher MS patients fearing interferon related side effects, with various comorbidities or considering pregnancy, and showed effectiveness and safety comparable with data of previous GA studies.
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Atypical Post-Injection Reactions with Delayed Onset Following Glatiramer Acetate 40 mg: Need for Titration? CNS Drugs 2018; 32:653-660. [PMID: 29949101 DOI: 10.1007/s40263-018-0529-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Glatiramer acetate (GA) 20 mg/day (GA20) is associated with immediate post-injection reactions (PIRs). For convenience of use, approved GA 40 mg three times weekly (GA40) delivers a similar weekly dose. The dose and concentration of a single GA40 injection are, however, twice as high as for GA20, and post-injection adverse events may differ. Cases of atypical PIRs to GA40 prompted us to systematically monitor such events. OBJECTIVE The aim was to characterize atypical PIRs in multiple sclerosis (MS) patients treated with GA40. METHODS Clinical practice data were prospectively collected in consecutive relapsing-remitting MS patients. Descriptive statistics for categorical and continuous variables, Mann-Whitney and Chi-squared tests for baseline comparisons, and Cox regression models for association of variables to first atypical PIRs were applied. RESULTS Forty-six out of 173 patients (26.6%) given GA40 experienced any PIRs. Of those, 38 (22.0%) had atypical, 14 (8.1%) had combined typical and atypical, and 26 (15.0%) had recurrent atypical PIRs, most frequently shivering (13.3%) and nausea/vomiting (8.1%). Compared to typical PIRs, onset of atypical PIRs was significantly delayed (median 30 vs 1 min, p < 0.0001), and their median duration longer (median 120 vs 6 min, p = 0.00013). Previous exposure to GA20 was associated with a lower risk of atypical PIRs [hazard ratio (HR) = 0.35, 95% confidence interval (CI) 0.17-0.72, p = 0.0039]. Patients experiencing PIRs with GA20 were at elevated risk for atypical PIRs with GA40 (HR = 5.75, 95% CI 1.66-19.94, p = 0.0059). CONCLUSIONS Atypical PIRs with GA40, especially gastrointestinal symptoms and/or fever/shivering, had a delayed onset and occurred in a significant proportion of our patients. Their real prevalence should be assessed in appropriately designed studies accounting for nocebo responses. Initial dose titration might reduce PIR frequency.
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Abstract
Growing evidence indicates that B cells play a key role in the pathogenesis of multiple sclerosis (MS). B cells occupy distinct central nervous system (CNS) compartments in MS, including the cerebrospinal fluid and white matter lesions. Also, it is now known that, in addition to entering the CNS, B cells can circulate into the periphery via a functional lymphatic system. Data suggest that the role of B cells in MS mainly involves their in situ activation in demyelinating lesions, leading to altered pro- and anti-inflammatory cytokine secretion, and a highly effective antigen-presenting cell function, resulting in activation of memory or naïve T cells. Clinically, B cell-depleting agents show significant efficacy in MS. In addition, many disease-modifying therapies (DMTs) traditionally understood to target T cells are now known to influence B cell number and function. One of the earliest DMTs to be developed, glatiramer acetate (GA), has been shown to reduce the total frequency of B cells, plasmablasts, and memory B cells. It also appears to promote a shift toward reduced inflammation by increasing anti-inflammatory cytokine release and/or reducing pro-inflammatory cytokine release by B cells. In the authors' opinion, this may be mediated by cross-reactivity of B cell receptors for GA with antigen (possibly myelin basic protein) expressed in the MS lesion. More research is required to further characterize the role of B cells and their bidirectional trafficking in the pathogenesis of MS. This may uncover novel targets for MS treatments and facilitate the development of B cell biomarkers of drug response.
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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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10
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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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Davis MD, Ashtamker N, Steinerman JR, Knappertz V. Time course of glatiramer acetate efficacy in patients with RRMS in the GALA study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e327. [PMID: 28210662 PMCID: PMC5299631 DOI: 10.1212/nxi.0000000000000327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/27/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the time to efficacy onset of glatiramer acetate (GA) 40 mg/mL 3-times-weekly formulation (GA40). METHODS This post hoc analysis of data from the 1-year, double-blind, placebo-controlled phase of the Glatiramer Acetate Low-Frequency Administration study (NCT01067521) of GA40 in patients with relapsing-remitting MS (RRMS) sought to determine the timing of efficacy onset using a novel data-censoring approach. RESULTS Compared with placebo-treated patients, those receiving GA40 exhibited a >30% reduction in the accumulated annualized relapse rate (ARR) within 2 months of initiating treatment and generally sustained this treatment difference during the 1-year study. Similarly, the proportion of GA40-treated patients who remained relapse-free was distinctly greater by month 2 and continued to increase up to a 10.8% difference at the end of the study. In addition, GA40 treatment was associated with a significant reduction in the number of gadolinium-enhancing T1 lesions and new/enlarging T2 lesions by month 6, with full treatment effect observed after 1 year. CONCLUSIONS GA40 contributes to efficacy within 2 months of the start of treatment in patients with RRMS. These results are consistent with the observed time to efficacy onset for patients treated with GA 20 mg/mL daily in previous randomized, placebo-controlled clinical trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with RRMS, a 3-times-weekly formulation of GA 40 mg/mL leads to a >30% reduction in the ARR within 2 months.
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Affiliation(s)
- Mat D Davis
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
| | - Natalia Ashtamker
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
| | - Joshua R Steinerman
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
| | - Volker Knappertz
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
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Zecca C, Mainetti C, Blum R, Gobbi C. Recurrent Nicolau syndrome associated with subcutaneous glatiramer acetate injection--a case report. BMC Neurol 2015; 15:249. [PMID: 26630967 PMCID: PMC4668705 DOI: 10.1186/s12883-015-0504-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/21/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Glatiramer acetate is worldwide used as first line treatment in relapsing remitting multiple sclerosis. Local skin reactions associated with glatiramer acetate are common, however, only isolated cases of severe local injection site reactions known as Nicolau Syndrome have been reported so far. CASE PRESENTATION We describe the case of a recurrent Nicolau Syndrome occurred during longstanding glatiramer acetate treatment in a woman with multiple sclerosis. The haemorrhagic patch necrotized and was treated locally as a deep second degree burn with excision of dead skin tissue and was healed. Treatment with glatiramer acetate was definitely suspended. CONCLUSIONS GA injections can be complicated by isolated or recurrent Nicolau Syndrome, a potentially life-threatening condition of which neurologists should be aware.
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Affiliation(s)
- Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale, Lugano, 6903, Switzerland.
| | - Carlo Mainetti
- Department of Dermatology, Ospedale Regionale Bellinzona e Valli, Bellinzona, 6500, Switzerland.
| | - Roland Blum
- Department of Dermatology, Inselspital, University Hospital, University of Bern, Bern, 3010, Switzerland.
| | - Claudio Gobbi
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale, Lugano, 6903, Switzerland.
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