POS0641 A RANDOMISED PHASE I PHARMACOKINETIC STUDY COMPARING HIGH-CONCENTRATION, LOW-VOLUME, AND CITRATE-FREE SB5 (40 MG/0.4 ML) WITH PRIOR SB5 FORMULATION, AND ADALIMUMAB BIOSIMILAR, IN HEALTHY MALE SUBJECTS

Background

SB5, an adalimumab (ADL) biosimilar, was developed in a low-concentration (40 mg/0.8 mL, SB5-LC) aligned with the reference ADL product. Pharmacokinetics (PK) equivalence of SB5 and reference ADL was demonstrated in a Phase I study conducted in healthy subjects1. Equivalent efficacy and comparable safety between 40 mg/0.8 mL SB5 and 40 mg/0.8 mL reference ADL were demonstrated in a Phase III study conducted in patients with rheumatoid arthritis2. High-concentration, low-volume, citrate-free SB5 (40 mg/0.4 mL, SB5-HC) has been developed as a part of life cycle management in line with the reference ADL formulation.

Objectives

To compare the PK, safety, and tolerability of the newly developed SB5-HC (40 mg/0.4 mL) to prior SB5-LC (40 mg/0.8 mL) in healthy male subjects.

Methods

This study was a randomised, single-blind, two-arm, parallel group, single-dose study in healthy male subjects. Subjects were randomised in a ratio of 1:1 to receive a single dose of either SB5-HC or SB5-LC by subcutaneous injection on Day 1 and then observed for 57 days during which the PK, safety, and immunogenicity were evaluated. The serum concentration of ADL was measured using an enzyme-linked immunosorbent assay. The primary PK parameters were area under the concentration-time curve from time zero to infinity (AUCinf) and maximum serum concentration (Cmax). Equivalence for the primary PK parameters was to be concluded if the 90% confidence intervals (CIs) for the ratio of geometric least squares means (LSMeans) of the treatment groups compared were completely contained within the pre-defined equivalence margin of 0.80 to 1.25 using an analysis of variance.

Results

Of 188 randomised subjects, 187 subjects were analysed as PK Analysis Set (PKS) (n=93 in SB5-HC and n=94 in SB5-LC). One subject was excluded from the PKS in SB5-HC group (major protocol deviation for not being withdrawn in the event of confirmed COVID-19). The geometric LSMeans ratios for the comparison of SB5-HC and SB5-LC for AUCinf and Cmax were 0.920 and 0.984, respectively, and the corresponding 90% CIs were within the pre-defined equivalence margin of 0.80 to 1.25 (Table 1), indicating the two treatment groups are bioequivalent. There were no deaths, serious adverse events or discontinuation of the study due to treatment-emergent adverse events (TEAEs) during the study. The proportions of subjects who experienced TEAEs were comparable between the two treatment groups (44.7% in SB5-HC vs 51.1% in SB5-LC). The most frequent TEAEs were headache (10.6% in SB5-HC vs 12.8% in SB5-LC).

Table 1.

Comparison of Primary PK Parameters between the Treatments

PK ParameterTreatmentGeometric LSMeanRatio90% CIAUCinf (h·μg/mL)SB5-HC2616.10.9200.8262; 1.0239SB5-LC2844.3Cmax (μg/mL)SB5-HC4.10.9840.9126; 1.0604SB5-LC4.1

Conclusion

This study demonstrated PK equivalence between SB5-HC and SB5-LC in healthy subjects. Both SB5-HC and SB5-LC were generally well tolerated with similar safety profiles.

References

[1]Shin D et al. J Clin Pharm Ther. 2017 Dec;42(6):672-678.

[2]Weinblatt ME et al. Arthritis Rheumatol. 2018 Jun;70(6):832-840.

Disclosure of Interests

None declared

Association of vancomycin trough concentration on the treatment outcome of patients with bacteremia caused by Enterococcus species

Background

Pharmacokinetic-pharmacodynamic (PK/PD) targets of vancomycin therapy have been recognized for methicillin-resistant Staphylococcus aureus infections but not for other gram-positive bacterial infections. Therefore, we investigated whether vancomycin concentration targets such as the trough level and ratio of the area under the curve to minimum inhibitory concentration (AUC/MIC) are associated with the treatment outcome in enterococcal bacteremia.

Methods

A retrospective cohort analysis enrolled patients with bacteremia caused by vancomycin-susceptible Enterococcus faecium and Enterococcus faecalis who were treated with vancomycin from January 2007 to December 2017 at a tertiary hospital located in Seoul, South Korea. Patients without vancomycin concentrations were excluded from the study. The primary outcome was 28-day all-cause mortality.

Results

A total of 37 patients were enrolled—26 with E. faecium infection and 11 with E. faecalis infection. The 28-day all-cause mortality rate was 21.6 %. In univariate analysis, vancomycin trough level (≤ 15 µg/mL; p = 0.042), age (p = 0.044), and septic shock (p = 0.049) were associated with 28-day mortality but not AUC24/MIC (> 389; p = 0.479). In multivariate analysis, vancomycin trough concentration (≤ 15 µg/mL; p = 0.041) and younger age (p = 0.031) were associated with 28-day mortality in patients with enterococcal bacteremia.

Conclusions

In this study, a vancomycin trough level of 15 µg/mL or lower was associated with 28-day mortality in enterococcal bacteremia. However, relatively large prospective studies are needed to examine the efficacy of vancomycin PK/PD parameters in patients with enterococcal bacteremia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06809-x.

Impact of immunogenicity on efficacy and tolerability of tumour necrosis factor inhibitors: pooled analysis of biosimilar studies in rheumatoid arthritis

Objective: SB4, SB2, and SB5 are biosimilars of etanercept (ETN), infliximab (INF), and adalimumab (ADA), respectively. This pooled analysis evaluated the immunogenicity of these treatments across three phase III randomized controlled trials of patients with rheumatoid arthritis (RA). Methods: Patients had to have at least one anti-drug antibody (ADAb) assessment up to the time of the primary endpoint from each study (week 24 in SB4 and SB5 studies; week 30 in SB2 study). The effect of ADAbs on American College of Rheumatology 20% (ACR20) response and the incidences of injection-site reactions (ISRs)/infusion-related reactions (IRRs) were evaluated. Results: The study included 1709 patients. The cumulative incidences of ADAbs were 30.3% in the all-treatments-combined group, 29.1% in the biosimilars combined group, and 31.5% in the reference products combined group. ACR20 response rates were significantly lower in ADAb-positive patients in the all-treatments-combined [odds ratio (95% confidence interval) 1.77 (1.37, 2.27), p < 0.0001], biosimilars combined [2.24 (1.53, 3.30), p < 0.0001], and reference products combined [1.49 (1.06, 2.09), p = 0.0225] groups. ADAb-positive patients also had a higher likelihood of developing ISRs/IRRs in the all-treatments-combined group [0.56 (0.31, 1.01), p = 0.0550], predominantly due to the results observed with SB2 + INF combined rather than with SB4 + ETN or SB5 + ADA combined. Conclusion: In this pooled analysis, ADAbs were associated with reduced efficacy in patients with RA treated with biosimilars (SB4, SB2, and SB5) or their reference products (ETN, INF, and ADA). ADAbs were associated with an increased incidence of ISRs/IRRs in those treated with SB2 + INF. Clinical trial registration numbers: NCT01936181 (SB2 study), NCT01895309 (SB4 study), and NCT02167139 (SB5 study).

Microsurgical skill assessment: toward skill-based surgical robotic control

A surgical skill assessment system was developed to quantify microsurgical skills. Infrared optical makers, an inertial measurement unit, and strain gauges were mounted on tweezers to record surgical tasks. In preliminary experiments, the tool tip trajectory, acceleration, and applied force were measured and microsurgery videos were evaluated by three expert surgeons. The preliminary results indicated the feasibility of the system by showing the significant difference between unskilled and skilled surgeons.

Augmentation of mitochondrial reduced glutathione by S-adenosyl-L-methionine administration in ischemia-reperfusion injury of the rat steatotic liver induced by choline-methionine-deficient diet

We examined whether warm ischemia-reperfusion (I/R) damage of the rat steatotic liver can be reduced by administration of S-adenosyl-L-methionine (SAMe). We examined the effect of SAMe on the mitochondrial reduced-glutathione (GSH) pool. Sixty minutes of partial left lobar vascular clamping followed by 2 h of reperfusion were employed for a model of hepatic warm ischemia. Either 5% dextrose or SAMe was injected intraperitoneally 2 h before I/R in steatotic rats (S-D5% or S-SAMe group). Serum liver enzyme concentrations 2 h after reperfusion were significantly lower in the S-SAMe group than in the S-D5% group. The cytosolic and mitochondrial GSH concentrations after I/R were significantly higher in the S-SAMe group than in the S-D5% group (p < 0.05). The cytosolic and mitochondrial oxidized-glutathione/GSH ratios after I/R were significantly greater in the S-D5% group than in the S-SAMe group (p < 0.01). The adenosine triphosphate concentration was higher in the S-SAMe group than in the S-D5% group (p = 0.0515). These results show that hepatocellular and mitochondrial oxidative stress after I/R in the steatotic liver can be reduced by administration of SAMe. The results also show that mitochondrial function and hepatocellular integrity can be restored by administration of SAMe in steatotic rats.

Administration of prostaglandin E1 reduces post-operative hepatocellular damage and restores hepatic integrity in patients undergoing hepatectomy

BACKGROUND/AIMS

The direct protective effects of prostaglandin E1 against hepatic dysfunction are unclear in recent studies. The aim of the present study was to investigate whether post-operative administration of prostaglandin E1 reduces serum concentrations of alpha-glutathione S-transferase, a new indicator of hepatocellular injury, in patients undergoing hepatectomy.

METHODOLOGY

The subjects were 15 patients with hepatocellular carcinoma or hilar cholangiocarcinoma undergoing hepatectomy. Prostaglandin E1 was administered to 10 patients (PGE1 group) and was not administered to 5 patients (control group). Prostaglandin E1 was administered for 24 hours from noon on post-operative day 1 to noon on post-operative day 2. Serum concentrations of alpha-glutathione S-transferase, reduced glutathione, cyclic adenosine monophosphate, and total bilirubin, and the concentration of reduced glutathione in bile were measured post-operatively.

RESULTS

The serum concentration of alpha-glutathione S-transferase was significantly lower and the serum bilirubin concentration was lower in the PGE1 group than in the control group. The serum concentrations of reduced glutathione and cyclic adenosine monophosphate were significantly higher in the PGE1 group than in the control group. Reduced glutathione in bile was higher in the PGE1 group than in the control group.

CONCLUSIONS

The present results show that administration of prostaglandin E1 reduces hepatocellular injury and restores hepatic integrity, post-operatively, in patients undergoing hepatectomy.

Predicting survival and post-operative complications with Tc-GSA liver scintigraphy in hepatocellular carcinoma

BACKGROUND/AIMS

Technetium-99m galactosyl human serum albumin is a novel liver scintigraphic agent. The aim of the present study was to examine whether liver scintigraphy with this agent could predict changes in hepatic function affecting survival in patients with inoperable hepatocellular carcinoma and liver cirrhosis. We also investigated whether the risk of major complications after hepatectomy for hepatocellular carcinoma could be assessed.

METHODOLOGY

Liver scintigraphy was performed in 42 patients with inoperable hepatocellular carcinoma and cirrhosis and 40 patients undergoing hepatectomy. The ratio of liver to heart plus liver radioactivity 15 min after injection (LHL15) was calculated.

RESULTS

The 1-year survival rates were higher in patients with higher LHL15: 100%, LHL15 > or = 0.91; 77.8%, 0.81 < or = LHL15 < or = 0.90; and 28.6%, LHL15 < or = 0.80. On multifactorial analysis, LHL15 significantly predicted the 1-year mortality rate in the 42 patients (p<0.001). Pre-operative LHL15 was significantly lower in 9 patients with major post-operative complications (0.88+/-0.02) than in 31 patients with uneventful courses or minor post-operative complications (0.93+/-0.01, p<0.001).

CONCLUSIONS

Our results suggest that technetium-99m galactosyl human serum albumin liver scintigraphy is effective for predicting short-term survival in patients with inoperable HCC and cirrhosis and for assessing the risk of major complications after hepatectomy.

One-dimensional quadratic walking solitons

The properties of one-dimensional quadratic walking solitons were investigated in planar lithium niobate waveguides near the type I phase-matching condition for second-harmonic generation. Wave propagation was studied under different conditions of phase matching, walk-off angle, and incident fundamental power.

Efficacy of preconditioning with N-acetylcysteine against reperfusion injury after prolonged cold ischaemia in rats liver in which glutathione had been reduced by buthionine sulphoximine

OBJECTIVE

To investigate the ability of N-acetylcysteine (NAC) to prevent cold ischaemic-reperfusion injury and improve hepatic integrity in a glutathione-depleted condition.

DESIGN

Open laboratory study.

SETTING

University hospitals, Japan and France.

MATERIALS

40 male Wistar rats.

INTERVENTIONS

To produce a glutathione-depleted liver, buthionine sulphoximine (BSO) was injected intraperitoneally 2 hours before either NAC or 5% dextrose was infused 15 minutes before the liver was harvested. We used an isolated perfused rat liver model that had undergone prolonged hypothermic ischaemia, cold-storage for 48 hours and reperfusion for 120 minutes.

MAIN OUTCOME MEASURES

Concentrations of hepatic enzymes released into samples of perfusate, concentration of adenosine triphosphate in liver tissue, concentrations of reduced and oxidized glutathione in perfusate, and bile production.

RESULTS

The concentrations of the hepatocellular enzymes and oxidised glutathione in the perfusate samples were significantly reduced in the NAC group compared with the 5% dextrose group. Bile production improved significantly in the NAC group compared with the 5% dextrose group. The concentration of reduced glutathione in liver tissue was not increased by NAC.

CONCLUSION

In a glutathione-depleted liver NAC prevented hepatic injury and improved liver integrity after a cold ischaemic-reperfusion injury, by acting not as a substrate for glutathione synthesis but as a direct free radical scavenger.

Interactions between one-dimensional quadratic solitons

The interaction between two one-dimensional quadratic solitons has been investigated experimentally in lithium niobate planar waveguides for both parallel- and crossing-launched solitons.

The effects of N-acetylcysteine and anti-intercellular adhesion molecule-1 monoclonal antibody against ischemia-reperfusion injury of the rat steatotic liver produced by a choline-methionine-deficient diet

Abundant fat in the liver has been implicated in poor outcome after liver transplantation or liver surgery, but the reasons for this association are still unclear. The aim of the present study was to examine mechanisms that may be involved in hepatic dysfunction after ischemia-reperfusion (I/R) of the steatotic rat liver. Steatosis was produced by a choline-methionine-deficient (CMDD) diet. In the first experiment, isolated perfused rat livers, subjected to 24-hour cold storage followed by 120-minute reperfusion, were used to investigate hypothermic I/R injury of the steatotic rat liver. In the second experiment, livers were subjected to 60-minute partial left lobar vascular clamping to allow study of normothermic I/R injury. In the first experiment, compared with normal nonsteatotic liver, steatotic livers showed significantly greater injury, as assessed by amounts of hepatic enzymes released into the perfusate, bile production, the concentrations of reduced glutathione (GSH) in the perfusate, as well as in the livers themselves, and electron microscopic findings of sinusoidal microcirculatory injury. The addition of N-acetylcysteine (NAC), a precursor of glutathione, to the liver before cold storage significantly improved these parameters in steatotic livers. The second experiment showed that, compared with nonsteatotic livers, steatotic livers had lower concentrations of GSH and impaired rates of bile production. There was also evidence of increased oxidative stress in polymorphonuclear leukocytes (PMNLs) in liver or peripheral blood of rats with fatty livers. An anti-rat intercellular adhesion molecule-1 (ICAM-1) monoclonal antibody inhibited neutrophil infiltration into pericentral sinusoids and improved these parameters in the steatotic rats. We conclude that sinusoidal microcirculatory injury is involved in hypothermic I/R injury, that oxidative stress produced by PMNLs is involved in normothermic I/R injury, and that NAC and anti-rat ICAM-1 monoclonal antibody restore liver integrity in I/R injury.

All-optical switching in lithium niobate directional couplers with cascaded nonlinearity

We report on intensity-dependent switching in lithium niobate directional couplers. Large nonlinear phase shifts that are due to cascading detune the coupling between the coupler branches, which makes all-optical switching possible. Depending on the input intensity, the output could be switched between the cross and the bar coupler branches with a switching ratio of 1:5 and a throughput of 80%.

Optimizing conditions for the growth of Lactobacillus casei YIT 9018 in tryptone-yeast extract-glucose medium by using response surface methodology

This study was undertaken to find optimum conditions of tryptone, yeast extract, glucose, Tween 80, and incubation temperature for the growth of Lactobacillus casei YIT 9018 and to assess the effects of these factors by use of response surface methodology. A central composite design was used as an experimental design for allocation of treatment combinations. A second-order polynomial regression model, which was used at first for analysis of the experiment, had a significant lack of fit. Therefore, cubic and quartic terms were incorporated into the regression model through variable selection procedures. Effects involving incubation temperature, yeast extract, glucose, and tryptone were significant, whereas the only significant effect involving Tween 80 was the interaction effect between temperature and Tween 80. It turned out that growth of L. casei YIT 9018 was most strongly affected by the incubation temperature. Estimated optimum conditions of the factors for growth of L. casei YIT 9018 are as follows: tryptone, 3.04%; yeast extract, 0.892%; glucose, 1.58%; Tween 80, 0%; incubation temperature, 35 degrees C.

Direct measurement of cascaded nonlinearity in lithium niobate channel waveguides

We report on interferometric measurements of nonlinear phase shifts of the fundamental mode that are due to cascading in a second-harmonic-generation experiment in lithium niobate channel waveguides. With temperature tuning of the wave-vector mismatch the nonlinear phase shifts were adjustable in sign and magnitude. Varying the wave-vector matching condition along the waveguide leads to large phase shifts with low depletion and dispersion of the fundamental.