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Jing S, Lin Y, Dockens R, Marchisin D, He B, Girgis IG, Chimalakonda A, Murthy B, Aras U. Pharmacokinetics and Safety of the Tyrosine Kinase 2 Inhibitor Deucravacitinib in Healthy Chinese Subjects. Dermatol Ther (Heidelb) 2023; 13:3153-3164. [PMID: 37981596 PMCID: PMC10689320 DOI: 10.1007/s13555-023-01050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, blocks cytokine signaling involved in psoriasis pathogenesis. This ethnic-bridging study evaluated deucravacitinib pharmacokinetics, tolerability, and safety in healthy Chinese subjects. METHODS This phase I, double-blind, single-/multiple-dose study randomized healthy Chinese subjects 4:1 to a single dose of deucravacitinib 6 mg or placebo (group 1) or deucravacitinib 12 mg or placebo (group 2) on day 1; groups 1 and 2 received deucravacitinib 6 mg and 12 mg once daily, respectively, or placebo on days 5-19. Blood samples were collected on days 1-5 (0 predose-96 h postdose), day 5 (0-24 h postdose), days 9 and 12 (0 h), and day 19 (0-24 h postdose). Deucravacitinib and metabolite (BMT-153261, BMT-158170) concentrations were determined using liquid chromatography/mass spectrometry; pharmacokinetic parameters were calculated using noncompartmental analysis. Urine was collected on days 1-4 (4 h predose-96 h postdose). Safety was monitored throughout. RESULTS Forty healthy Chinese subjects (groups 1 and 2: deucravacitinib, n = 32; placebo, n = 8) were enrolled. Deucravacitinib was rapidly absorbed after single-/multiple-dose administration, with median time to maximal plasma concentration of 1.5-2.3 h. Systemic exposure after single or multiple doses increased approximately twofold with twofold dose increase. Modest deucravacitinib accumulation was observed after multiple-dose administration (1.3- to 1.4-fold increase in area under the curve [AUC] under one dosing interval). Metabolite-to-parent ratios for maximal plasma concentration and AUC remained consistent in each dose group. Mean urinary percent recovery and renal clearance were similar between dose groups. Most adverse events (AEs) were mild/moderate, with no serious treatment-related AEs, deaths, or discontinuations due to AEs. CONCLUSION Deucravacitinib was safe and well tolerated in healthy Chinese subjects. Deucravacitinib exhibited rapid absorption, dose-related increases in exposure, comparable half-life, and no evidence of time-dependent pharmacokinetics, suggesting minimal effect of Chinese ethnicity on deucravacitinib pharmacokinetics. CLINICAL TRIAL REGISTRATION NCT03956953.
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Affiliation(s)
- Shan Jing
- Clinical Pharmacology Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Lin
- Clinical Pharmacology Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Randy Dockens
- Bristol Myers Squibb, 3551 Lawrenceville Road, Princeton, NJ, 08540, USA
| | - David Marchisin
- Bristol Myers Squibb, 3551 Lawrenceville Road, Princeton, NJ, 08540, USA
| | - Bing He
- Bristol Myers Squibb, 3551 Lawrenceville Road, Princeton, NJ, 08540, USA
| | - Ihab G Girgis
- Bristol Myers Squibb, 3551 Lawrenceville Road, Princeton, NJ, 08540, USA
| | | | - Bindu Murthy
- Bristol Myers Squibb, 3551 Lawrenceville Road, Princeton, NJ, 08540, USA
| | - Urvi Aras
- Bristol Myers Squibb, 3551 Lawrenceville Road, Princeton, NJ, 08540, USA.
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Catlett IM, Aras U, Hansen L, Liu Y, Bei D, Girgis IG, Murthy B. First-in-human study of deucravacitinib: A selective, potent, allosteric small-molecule inhibitor of tyrosine kinase 2. Clin Transl Sci 2022; 16:151-164. [PMID: 36325947 PMCID: PMC9841305 DOI: 10.1111/cts.13435] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
This randomized, double-blind, single- and multiple-ascending dose study assessed the pharmacokinetics (PKs), pharmacodynamics, and safety of deucravacitinib (Sotyktu™), a selective and potent small-molecule inhibitor of tyrosine kinase 2, in 100 (75 active, 25 placebo) healthy volunteers (NCT02534636). Deucravacitinib was rapidly absorbed, with a half-life of 8-15 h, and 1.4-1.9-fold accumulation after multiple dosing. Deucravacitinib inhibited interleukin (IL)-12/IL-18-induced interferon (IFN)γ production ex vivo in a dose- and concentration-dependent manner. Following in vivo challenge with IFNα-2a, deucravacitinib demonstrated dose-dependent inhibition of lymphocyte count decreases and expression of 53 IFN-regulated genes. There were no serious adverse events (AEs); the overall frequency of AEs was similar in the deucravacitinib (64%) and placebo (68%) groups. In this first-in-human study, deucravacitinib inhibited IL-12/IL-23 and type I IFN pathways in healthy volunteers, with favorable PK and safety profiles. Deucravacitinib is a promising therapeutic option for immune-mediated diseases, including Crohn's disease, psoriasis, psoriatic arthritis, and systemic lupus erythematosus.
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Affiliation(s)
| | - Urvi Aras
- Bristol Myers SquibbPrincetonNew JerseyUSA
| | | | - Yali Liu
- Bristol Myers SquibbPrincetonNew JerseyUSA
| | - Di Bei
- Bristol Myers SquibbPrincetonNew JerseyUSA
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Chimalakonda A, Singhal S, Darbenzio R, Dockens R, Marchisin D, Banerjee S, Girgis IG, Throup J, He B, Aras U, Murthy B. Lack of Electrocardiographic Effects of Deucravacitinib in Healthy Subjects. Clin Pharmacol Drug Dev 2022; 11:442-453. [PMID: 35182043 PMCID: PMC9306920 DOI: 10.1002/cpdd.1056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/16/2021] [Indexed: 11/06/2022]
Abstract
Deucravacitinib is a novel, oral, selective inhibitor of the intracellular signaling kinase tyrosine kinase 2. This phase 1, randomized, partially double‐blind, 4‐period crossover study in healthy adults was conducted to determine whether deucravacitinib 12 mg (therapeutic dose) or 36 mg (supratherapeutic dose) had a clinically relevant effect on the corrected QT interval and other electrocardiographic (ECG) parameters. Subjects received 1 of 4 sequences of placebo, deucravacitinib 12 mg, deucravacitinib 36 mg, and moxifloxacin 400 mg (positive control) in a randomized crossover fashion. The placebo‐corrected change from baseline for the QT interval corrected for heart rate using the Fridericia method (QTcF), ECG parameters, and safety measures were evaluated. A clinically meaningful QTcF prolongation of >10 milliseconds was not found for deucravacitinib at tested doses. Assay sensitivity was demonstrated by the observation of known QT effects of moxifloxacin in the study. Deucravacitinib had no clinically relevant effect on other parameters and was generally well tolerated. The majority of adverse events (AEs) were mild, and all AEs resolved by study's end. Three treatment‐related serious AEs of pharyngitis, cellulitis, and lymphadenopathy occurred in 1 subject following administration of deucravacitinib 12 mg, but resolved by end of study. This study demonstrated that a single oral dose of deucravacitinib 12 or 36 mg did not produce a clinically relevant effect on the corrected QT interval or other measured ECG parameters in healthy adults.
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Affiliation(s)
| | | | | | | | | | | | | | - John Throup
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Bing He
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Urvi Aras
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Bindu Murthy
- Bristol Myers Squibb, Princeton, New Jersey, USA
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Chimalakonda A, Burke J, Cheng L, Catlett I, Tagen M, Zhao Q, Patel A, Shen J, Girgis IG, Banerjee S, Throup J. Selectivity Profile of the Tyrosine Kinase 2 Inhibitor Deucravacitinib Compared with Janus Kinase 1/2/3 Inhibitors. Dermatol Ther (Heidelb) 2021; 11:1763-1776. [PMID: 34471993 PMCID: PMC8484413 DOI: 10.1007/s13555-021-00596-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Deucravacitinib, a novel, oral, selective inhibitor of tyrosine kinase 2 (TYK2) signaling, acts via an allosteric mechanism by binding to the enzyme's regulatory domain instead of the catalytic domain. This unique binding provides high functional selectivity for TYK2 versus the closely related Janus kinases (JAKs) 1/2/3. Deucravacitinib was efficacious in phase 2 and 3 psoriasis trials, without clinical or laboratory parameters indicative of JAK 1/2/3 inhibition being observed. This analysis compared the kinase specificities of deucravacitinib versus JAK 1/2/3 inhibitors at therapeutic exposures. METHODS Signaling via JAK 1/3, JAK 2/2, and TYK2/JAK 2 dimers was measured in in vitro whole blood assays. Concentrations providing half-maximal inhibition (IC50) in these assays were determined for deucravacitinib and the JAK 1/2/3 inhibitors tofacitinib, upadacitinib, and baricitinib. Newly derived whole blood IC50 values were plotted against available pharmacokinetic profiles using doses evaluated in phase 2/3 trials. Simulated average daily inhibition and durations over which concentrations exceeded IC50 were evaluated. RESULTS At clinically relevant exposures, projected steady-state deucravacitinib plasma concentrations were higher than TYK2 IC50 for approximately 9-18 h. Maximal plasma concentrations (Cmax) of deucravacitinib were 8- to 17-fold lower than JAK 1/3 IC50 and > 48- to > 102-fold lower than JAK 2/2 IC50. Simulated daily average TYK2 inhibition by deucravacitinib ranged from 50% to 69%. Simulations indicated that tofacitinib, upadacitinib, and baricitinib at steady state exhibited varying degrees of JAK 1/3 (daily average inhibition, 70-94%) and JAK 2/2 (23%-67%) inhibition at therapeutic concentrations, with Cmax values 17- to 33-fold lower than their TYK2 IC50 levels. CONCLUSION At clinically relevant doses and exposures, deucravacitinib demonstrates highly selective inhibition of TYK2 and not JAK 1/2/3. Tofacitinib, upadacitinib, and baricitinib variably inhibit JAK 1/2/3 but not TYK2. These results indicate that deucravacitinib is a distinct class of kinase inhibitor compared with JAK 1/2/3 inhibitors.
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Affiliation(s)
| | | | | | | | | | | | | | - Jun Shen
- Bristol Myers Squibb, Princeton, NJ, USA
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Bihorel S, Singhal S, Shevell D, Sun H, Xie J, Basdeo S, Liu A, Dutta S, Ludwig E, Huang H, Lin KJ, Fura A, Throup J, Girgis IG. Population Pharmacokinetic Analysis of BMS-986166, a Novel Selective Sphingosine-1-Phosphate-1 Receptor Modulator, and Exposure-Response Assessment of Lymphocyte Counts and Heart Rate in Healthy Participants. Clin Pharmacol Drug Dev 2020; 10:8-21. [PMID: 33090733 PMCID: PMC7821288 DOI: 10.1002/cpdd.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/08/2020] [Indexed: 11/09/2022]
Abstract
Sphingosine‐1‐phosphate (S1P) binding to the S1P‐1 receptor (S1P1R) controls the egress of lymphocytes from lymphoid organs and targets modulation of immune responses in autoimmune diseases. Pharmacologic modulation of S1P receptors has been linked to heart rate reduction. BMS‐986166, a prodrug of the active phosphorylated metabolite BMS‐986166‐P, presents an improved cardiac safety profile in preclinical studies compared to other S1P1R modulators. The pharmacokinetics, safety, and pharmacodynamics of BMS‐986166 versus placebo after single (0.75–5.0 mg) and repeated (0.25–1.5 mg/day) oral administration were assessed in healthy participants after a 1‐day lead‐in placebo period. A population model was developed to jointly describe BMS‐986166 and BMS‐986166‐P pharmacokinetics and predict individual exposures. Inhibitory sigmoid models described the relationships between average daily BMS‐986166‐P concentrations and nadir of time‐matched (day –1) placebo‐corrected heart rate on day 1 (nDDHR, where DD represents ∆∆) and nadir of absolute lymphocyte count (nALC). Predicted decreases in nDDHR and nALC were 9 bpm and 20% following placebo, with maximum decreases of 10 bpm in nDDHR due to drug effect, and approximately 80% in nALC due to drug and placebo. A 0.5‐mg/day dose regimen achieves the target 65% reduction in nALC associated with a 2‐bpm decrease in nDDHR over placebo.
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Affiliation(s)
- Sébastien Bihorel
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | | | | | - Huadong Sun
- Previously employed at Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Jenny Xie
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Ang Liu
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Elizabeth Ludwig
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | - Hannah Huang
- Cognigen Corporation, a SimulationsPlus Company, Buffalo, New York, USA
| | - Kuan-Ju Lin
- Previously employed at Cognigen Corporation, a SimulationPlus Company, Buffalo, New York, USA
| | - Aberra Fura
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - John Throup
- Bristol Myers Squibb, Princeton, New Jersey, USA
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Singhal S, Girgis IG, Xie J, Dutta S, Shevell DE, Throup J. The safety and pharmacokinetics of a novel, selective S1P1R modulator in healthy participants. Expert Opin Investig Drugs 2020; 29:411-422. [DOI: 10.1080/13543784.2020.1742322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Shalabh Singhal
- Immunology and Fibrosis, Bristol Myers Squibb, Princeton, NJ, USA
| | - Ihab G. Girgis
- Research and Animal Development, Bristol MyersSquibb, Princeton, NJ, USA
| | - Jenny Xie
- Discovery Biology, Bristol MyersSquibb, Princeton, NJ, USA
| | - Santanu Dutta
- Global Biostatistics, Bristol MyersSquibb, Princeton, NJ, USA
| | - Diane E. Shevell
- Precision Medicine and Companion Diagnostics, Bristol MyersSquibb, Princeton, NJ, USA
| | - John Throup
- Immunology and Fibrosis, Bristol MyersSquibb, Princeton, NJ, USA
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Catlett IM, Nowak M, Kundu S, Zheng N, Liu A, He B, Girgis IG, Grasela DM. Safety, pharmacokinetics and pharmacodynamics of branebrutinib (BMS-986195), a covalent, irreversible inhibitor of Bruton's tyrosine kinase: Randomised phase I, placebo-controlled trial in healthy participants. Br J Clin Pharmacol 2020; 86:1849-1859. [PMID: 32198939 PMCID: PMC7444767 DOI: 10.1111/bcp.14290] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 12/23/2022] Open
Abstract
Aims Branebrutinib (BMS‐986195) is a potent, highly selective, oral, small‐molecule, covalent inhibitor of Bruton's tyrosine kinase (BTK). This study evaluated safety, pharmacokinetics and pharmacodynamics of branebrutinib in healthy participants. Methods This double‐blind, placebo‐controlled, single‐ and multiple‐ascending dose (SAD; MAD) Phase I study (NCT02705989) enrolled participants into 3 parts: SAD, MAD and JMAD (MAD in first‐generation Japanese participants). In each part, participants were randomised 3:1 to receive branebrutinib (SAD: 0.3–30 mg; [J]MAD: 0.3–10 mg) or placebo. Participants in the MAD parts received branebrutinib daily for 14 days and were followed for 14 days postdosing. Safety was assessed by monitoring, laboratory and physical examinations, vital signs, and recording adverse events (AEs). Pharmacodynamics were assessed with a mass spectrometry assay that measured drug‐occupied and free BTK. Results The SAD, MAD and JMAD parts of the study included 40, 32 and 24 participants. Branebrutinib was well tolerated and AEs were mild/moderate, except for 1 serious AE that led to discontinuation. Branebrutinib was rapidly absorbed, with maximum plasma concentration occurring within 1 hour and a half‐life of 1.2—1.7 hours, dropping to undetectable levels within 24 hours. BTK occupancy was rapid, with 100% occupancy reached after a single 10‐mg dose. BTK occupancy decayed predictably over time (mean half‐life in MAD panels: 115–154 hours), such that pharmacodynamic effects were maintained after branebrutinib plasma levels fell below the lower limit of quantification. Conclusion Rapid and high occupancy of BTK and the lack of notable safety findings support further clinical development of branebrutinib.
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Affiliation(s)
| | | | | | | | - Ang Liu
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Bing He
- Bristol Myers Squibb, Princeton, NJ, USA
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Hotchkiss RS, Colston E, Yende S, Crouser ED, Martin GS, Albertson T, Bartz RR, Brakenridge SC, Delano MJ, Park PK, Donnino MW, Tidswell M, Mayr FB, Angus DC, Coopersmith CM, Moldawer LL, Catlett IM, Girgis IG, Ye J, Grasela DM. Immune checkpoint inhibition in sepsis: a Phase 1b randomized study to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of nivolumab. Intensive Care Med 2019; 45:1360-1371. [PMID: 31576433 DOI: 10.1007/s00134-019-05704-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/17/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Sepsis-associated immunosuppression increases hospital-acquired infection and viral reactivation risk. A key underlying mechanism is programmed cell death protein-1 (PD-1)-mediated T-cell function impairment. This is one of the first clinical safety and pharmacokinetics (PK) assessments of the anti-PD-1 antibody nivolumab and its effect on immune biomarkers in sepsis. METHODS Randomized, double-blind, parallel-group, Phase 1b study in 31 adults at 10 US hospital ICUs with sepsis diagnosed ≥ 24 h before study treatment, ≥ 1 organ dysfunction, and absolute lymphocyte count ≤ 1.1 × 103 cells/μL. Participants received one nivolumab dose [480 mg (n = 15) or 960 mg (n = 16)]; follow-up was 90 days. Primary endpoints were safety and PK parameters. RESULTS Twelve deaths occurred [n = 6 per study arm; 40% (480 mg) and 37.5% (960 mg)]. Serious AEs occurred in eight participants [n = 1, 6.7% (480 mg); n = 7, 43.8% (960 mg)]. AEs considered by the investigator to be possibly drug-related and immune-mediated occurred in five participants [n = 2, 13.3% (480 mg); n = 3, 18.8% (960 mg)]. Mean ± SD terminal half-life was 14.7 ± 5.3 (480 mg) and 15.8 ± 7.9 (960 mg) days. All participants maintained > 90% receptor occupancy (RO) 28 days post-infusion. Median (Q1, Q3) mHLA-DR levels increased to 11,531 (6528, 19,495) and 11,449 (6225, 16,698) mAbs/cell in the 480- and 960-mg arms by day 14, respectively. Pro-inflammatory cytokine levels did not increase. CONCLUSIONS In this sepsis population, nivolumab administration did not result in unexpected safety findings or indicate any 'cytokine storm'. The PK profile maintained RO > 90% for ≥ 28 days. Further efficacy and safety studies are warranted. TRIAL REGISTRATION NUMBER (CLINICALTRIALS.GOV): NCT02960854.
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Affiliation(s)
- Richard S Hotchkiss
- Departments of Anesthesiology, Medicine, and Surgery, Washington University School of Medicine, St Louis, 660 South Euclid Avenue, St Louis, MO, 63110-1093, USA.
| | - Elizabeth Colston
- Innovative Medicines Development, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Sachin Yende
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Greg S Martin
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Timothy Albertson
- Department of Internal Medicine, University of California, Davis, Davis, CA, USA.,Northern California Veterans Administration Health Care System, Mather, CA, USA
| | - Raquel R Bartz
- Department of Anesthesiology and Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Scott C Brakenridge
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Matthew J Delano
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Pauline K Park
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael W Donnino
- Department of Emergency Medicine and Department of Medicine (Division of Pulmonary and Critical Care), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark Tidswell
- Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Florian B Mayr
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Derek C Angus
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Lyle L Moldawer
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ian M Catlett
- Innovative Medicines Development, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Ihab G Girgis
- Innovative Medicines Development, Bristol-Myers Squibb, Princeton, NJ, USA
| | - June Ye
- Innovative Medicines Development, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Dennis M Grasela
- Innovative Medicines Development, Bristol-Myers Squibb, Princeton, NJ, USA
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Papp K, Gordon K, Thaçi D, Morita A, Gooderham M, Foley P, Girgis IG, Kundu S, Banerjee S. Phase 2 Trial of Selective Tyrosine Kinase 2 Inhibition in Psoriasis. N Engl J Med 2018; 379:1313-1321. [PMID: 30205746 DOI: 10.1056/nejmoa1806382] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tyrosine kinase 2 (TYK2) signaling pathways, which mediate cytokine signaling, are implicated in the pathophysiology of psoriasis. Selective inhibitors of TYK2 may be effective in treating psoriasis. METHODS We conducted a phase 2, double-blind trial of a TYK2 inhibitor, BMS-986165, in adults with moderate-to-severe psoriasis, excluding patients with a previous lack of response to agents targeting cytokine signaling through the same tyrosine kinase pathway. Patients were randomly assigned to receive the drug orally at a dose of 3 mg every other day, 3 mg daily, 3 mg twice daily, 6 mg twice daily, or 12 mg daily or to receive placebo. The primary end point was a 75% or greater reduction from baseline in the Psoriasis Area and Severity Index (PASI) score at week 12 (higher scores indicate greater severity of psoriasis). RESULTS A total of 267 patients received at least one dose in an intervention group of the trial. At week 12, the percentage of patients with a 75% or greater reduction in the PASI score was 7% (3 of 45 patients) with placebo, 9% (4 of 44 patients) with 3 mg of BMS-986165 every other day (P=0.49 vs. placebo), 39% (17 of 44 patients) with 3 mg daily (P<0.001 vs. placebo), 69% (31 of 45 patients) with 3 mg twice daily (P<0.001 vs. placebo), 67% (30 of 45 patients) with 6 mg twice daily (P<0.001 vs. placebo), and 75% (33 of 44 patients) with 12 mg daily (P<0.001 vs. placebo). There were three serious adverse events in patients receiving the active drug, as well as one case of malignant melanoma 96 days after the start of treatment. CONCLUSIONS Selective inhibition of TYK2 with the oral agent BMS-986165 at doses of 3 mg daily and higher resulted in greater clearing of psoriasis than did placebo over a period of 12 weeks. Larger and longer-duration trials of this drug are required to determine its safety and durability of effect in patients with psoriasis. (Funded by Bristol-Myers Squibb; ClinicalTrials.gov number, NCT02931838 .).
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Affiliation(s)
- Kim Papp
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Kenneth Gordon
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Diamant Thaçi
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Akimichi Morita
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Melinda Gooderham
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Peter Foley
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Ihab G Girgis
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Sudeep Kundu
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
| | - Subhashis Banerjee
- From K. Papp Clinical Research and Probity Medical Research, Waterloo (K.P.), the SKiN Centre for Dermatology and Probity Medical Research, Peterborough (M.G.), and Queen's University, Kingston (M.G.) - all in Ontario, Canada; Medical College of Wisconsin, Milwaukee (K.G.); the University of Luebeck, Luebeck, Germany (D.T.); Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the University of Melbourne, St. Vincent's Hospital Melbourne, Skin and Cancer Foundation, and Probity Medical Research, Melbourne, VIC, Australia (P.F.); and Bristol-Myers Squibb, Princeton, NJ (I.G.G., S.K., S.B.)
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Rohrbacher J, Damiano BP, Girgis IG, Pugsley MK, Teisman A, Gallacher DJ. The source of hERG IC50 values (manual vs. automated patch clamp) may influence in silico modeling. J Pharmacol Toxicol Methods 2015. [DOI: 10.1016/j.vascn.2015.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Girgis IG, Patel MR, Peters GR, Moore KT, Mahaffey KW, Nessel CC, Halperin JL, Califf RM, Fox KAA, Becker RC. Population pharmacokinetics and pharmacodynamics of rivaroxaban in patients with non-valvular atrial fibrillation: results from ROCKET AF. J Clin Pharmacol 2014; 54:917-27. [PMID: 24668660 DOI: 10.1002/jcph.288] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 03/12/2014] [Indexed: 11/10/2022]
Abstract
Two once-daily rivaroxaban dosing regimens were compared with warfarin for stroke prevention in patients with non-valvular atrial fibrillation in ROCKET AF: 20 mg for patients with normal/mildly impaired renal function and 15 mg for patients with moderate renal impairment. Rivaroxaban population pharmacokinetic (PK)/pharmacodynamic (PD) modeling data from ROCKET AF patients (n = 161) are reported and are used to confirm established rivaroxaban PK and PK/PD models and to re-estimate values of the models' parameters for the current AF population. An oral one-compartment model with first-order absorption adequately described rivaroxaban PK. Age, renal function, and lean body mass influenced the PK model. Prothrombin time and prothrombinase-induced clotting time exhibited a near-linear relationship with rivaroxaban plasma concentration; inhibitory effects were observed through to 24 hours post-dose. Rivaroxaban plasma concentration and factor Xa activity had an inhibitory maximum-effect (Emax ) relationship. Renal function (on prothrombin time; prothrombinase-induced clotting time) and age (on factor Xa activity) had moderate effects on PK/PD models. PK and PK/PD models were shown to be adequate for describing the current dataset. These findings confirm the modeling and empirical results that led to the selection of doses tested against warfarin in ROCKET AF.
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Affiliation(s)
- I G Girgis
- Janssen Pharmaceuticals Research & Development, Raritan, NJ, USA
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Girgis IG, Nandy P, Nye JS, Ford L, Mohanty S, Wang S, Ochalski S, Eerdekens M, Cox E. Pharmacokinetic-pharmacodynamic assessment of topiramate dosing regimens for children with epilepsy 2 to <10 years of age. Epilepsia 2010; 51:1954-62. [PMID: 20880232 DOI: 10.1111/j.1528-1167.2010.02598.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To identify and validate the efficacious monotherapy dosing regimen for topiramate in children aged 2 to <10 years with newly diagnosed epilepsy using pharmacokinetic-pharmacodynamic (PK-PD) modeling and simulation bridging. METHODS Several models were developed in pediatric and adult populations to relate steady-state trough plasma concentrations (C(min)) of topiramate to the magnitude of clinical effect in monotherapy and adjunctive settings. These models were integrated to derive and support the monotherapy dosing regimen for pediatric patients. KEY FINDINGS A two-compartmental population PK model with first-order absorption described the time course of topiramate C(min) as a function of dosing regimen. Disposition of topiramate was related to age, body weight, and use of various concomitant antiepileptic drugs. The PK-PD model for monotherapy indicated that the hazard of time to first seizure decreased with increasing C(min) and time since randomization. Higher baseline seizure frequency increased risk for seizures. Age did not significantly influence hazard of time to first seizure after randomization to monotherapy. For adjunctive therapy, the distribution of drug and placebo responses was not significantly different among age groups. Based on the available PK-PD modeling data, the dosing regimen expected to achieve a 65-75% seizure freedom rate after 1 year for pediatric patients age 2-10 years is approximately 6-9 mg/kg per day. SIGNIFICANCE This analysis indicated no difference in PK-PD of topiramate between adult and pediatric patients. Effects of indication and body weight on PK were adequately integrated into the model, and monotherapy dosing regimens were identified for children 2-10 years of age.
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Affiliation(s)
- Ihab G Girgis
- Advanced Statistical Modeling & Simulation, Clinical Biostatistics, Johnson & Johnson Pharmaceutical Research & Development, LLC, Raritan, New Jersey 08869, USA.
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Pai SM, Girgis S, Batra VK, Girgis IG. Population pharmacodynamic parameter estimation from sparse sampling: effect of sigmoidicity on parameter estimates. AAPS J 2009; 11:535-40. [PMID: 19629711 DOI: 10.1208/s12248-009-9131-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 07/02/2009] [Indexed: 11/30/2022] Open
Abstract
The objective of this stimulation study was to evaluate effect of simoidicity of the concentration-effect (C-E) relationship on the efficiency of population parameter estimation from sparse sampling and is a continuation of previous work that addressed the effect of sample size and number of samples on parameters estimation from sparse sampling for drugs with C-E relationship characterized by high sigmoidicity (gamma > 5). The findings are based on observed C-E relationships for two drugs, octreotide and remifentanil, characterized by simple E (max) and sigmoid E (max) models (gamma = ~2.5), respectively. For each model, C-E profiles (100 replicates of 100 subjects each) were simulated for several sampling designs, with four or five samples/individual randomly obtained from within sampling windows based on EC(50)-normalized plasma drug concentrations, PD parameters based on observed population mean values, and inter-individual and residual variability of 30% and 25%, respectively. The C-E profiles were fitted using non-linear mixed effect modeling with the first-order conditional estimation method; variability parameters were described by an exponential error model. The results showed that, for the sigmoid E (max) model, designs with four or five samples reliably estimated the PD parameters (EC(50), E (max), E (0), and gamma), whereas the five-sample design, with two samples in the 2-3 E (max) region, provided in addition more reliable estimates of inter-individual variability; increasing the information content of the EC(50) region was not critical as long as this region was covered by a single sample in the 0.5-1.5 EC(50) window. For the simple E (max) model, because of the shallower profile, enriching the EC(50) region was more important. The impact of enrichment of appropriate regions for the two models can be explained based on the shape (sigmoidicity) of the concentration-effect relationships, with shallower C-E profiles requiring data enrichment in the EC(50) region and steeper curves less so; in both cases, the E (max) region needs to be adequately delineated, however. The results provide a general framework for population parameter estimation from sparse sampling in clinical trials when the underlying C-E profiles have different degrees of sigmoidicity.
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Affiliation(s)
- Sudhakar M Pai
- Clinical Pharmacology, Akros Pharma Inc, Princeton, NJ 08540, USA
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Abstract
The purpose of this study was to evaluate the effects of population size, number of samples per individual, and level of interindividual variability (IIV) on the accuracy and precision of pharmacodynamic (PD) parameter estimates. Response data were simulated from concentration input data for an inhibitory sigmoid drug efficacy (E(max)) model using Nonlinear Mixed Effect Modeling, version 5 (NONMEM). Seven designs were investigated using different concentration sampling windows ranging from 0 to 3 EC(50) (EC(50) is the drug concentration at 50% of the E(max)) units. The response data were used to estimate the PD and variability parameters in NONMEM. The accuracy and precision of parameter estimates after 100 replications were assessed using the mean and SD of percent prediction error, respectively. Four samples per individual were sufficient to provide accurate and precise estimate of almost all of the PD and variability parameters, with 100 individuals and IIV of 30%. Reduction of sample size resulted in imprecise estimates of the variability parameters; however, the PD parameter estimates were still precise. At 45% IIV, designs with 5 samples per individual behaved better than those designs with 4 samples per individual. For a moderately variable drug with a high Hill coefficient, sampling from the 0.1 to 1, 1 to 2, 2 to 2.5, and 2.5 to 3 EC(50) window is sufficient to estimate the parameters reliably in a PD study.
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Affiliation(s)
- Suzette Girgis
- Department of Drug Metabolism and Pharmacokinetics, Schering-Plough Research Institute, Kenilworth, NJ, USA.
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