Tildrakizumab (MK-3222), an anti-interleukin-23p19 monoclonal antibody, improves psoriasis in a phase IIb randomized placebo-controlled trial

BACKGROUND

Tildrakizumab is a high-affinity, humanized, IgG1/κ, anti-interleukin (IL)-23p19 monoclonal antibody that does not bind human IL-12 or p40 is being developed for the treatment of chronic plaque psoriasis.

OBJECTIVES

To evaluate the safety and efficacy of subcutaneous tildrakizumab in patients with moderate-to-severe chronic plaque psoriasis.

METHODS

A three-part, randomized, double-blind, phase IIb trial was conducted in 355 adults with chronic plaque psoriasis. Participants were randomized to receive subcutaneous tildrakizumab (5, 25, 100, 200 mg) or placebo at weeks 0 and 4 (part I) and every 12 weeks thereafter until week 52 (part II). Study drug was discontinued at week 52 and participants were followed through week 72 (part III). Primary efficacy end point was Psoriasis Area and Severity Index (PASI) 75 response at week 16. Adverse events (AEs) and vital signs were monitored throughout the study.

RESULTS

At week 16, PASI 75 responses were 33·3% (n = 14), 64·4% (n = 58), 66·3% (n = 59), 74·4% (n = 64) and 4·4% (n = 2) in the 5-, 25-, 100- and 200-mg tildrakizumab and placebo groups, respectively (P ≤ 0·001 for each tildrakizumab dose vs. placebo). PASI 75 response was generally maintained through week 52; only eight of 222 participants who achieved PASI 75 response at week 52 and continued to part III relapsed following discontinuation up to week 72. Possible drug-related serious AEs included bacterial arthritis and lymphoedema (part I), and melanoma, stroke, epiglottitis and knee infection (part II).

CONCLUSIONS

Tildrakizumab had treatment effects that were superior to placebo, maintained for 52 weeks of treatment, and persisted for 20 weeks after cessation. Tildrakizumab was generally safe and well tolerated. These results suggest that IL-23p19 is a key target for suppressing psoriasis.

Tumor necrosis factor release by murine macrophages stimulated by the cytotoxic ether lipid 1-O-hexadecyl-2-O-methyl-SN-glycero-3-phosphorylcholine (ET-18-O-OCH3)

The cytotoxic ether lipid 1-O-hexadecyl-2-O-methyl-SN-glycero-3-phosphorylcholine (ET-18-O-OCH3) is a structural analog of the mediator of inflammation platelet-activating factor (PAF). Recent studies demonstrated that ET-18-O-OCH3 activates human monocytes selectively at non-cytotoxic concentrations. The current studies determined the capacity of ET-18-O-OCH3 to stimulate release of TNF alpha by murine peritoneal macrophages. Macrophage receptors for ET-18-OCH3 and PAF were also assessed. ET-18-O-OCH3 and PAF stimulated TNF alpha release by resident BALB/c macrophages in the presence of LPS but not in the absence of this co-factor. In contrast, both ET-18-O_OCH3 and PAF stimulated TNF alpha release by thioglycollate-elicited macrophages in the absence of LPS although release was greater in the presence of this co-stimulus. Optimal stimulation of TNF alpha release occurred at 10(-14)-10(-11) M ET-18-O-OCH3 and PAF. Elicited macrophages and splenic macrophages from C57Bl/6 mice, unlike those from BALB/c mice, did not respond to 10(-15)-10(-8) M ET-18-O-OCH3 or PAF without or with LPS. Scatchard analysis of [3H]PAF binding to elicited BALB/c macrophages revealed the existence of high affinity receptors for PAF. In contrast, there was no evidence for receptors for ET-18-O-OCH3. ET-18-O-OCH3 did not compete with PAF for binding; macrophage activation by ET-18-O-OCH3 was not stereospecific; and, binding studies using [3H]ET-18-O-OCH3 did not reveal saturable binding characteristic of binding to specific receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Separation of a murine leukaemia virus protein kinase activity from its Pr65gag polyprotein substrate after DNA--cellulose chromatography

We have recently found that, in vitro, the murine leukaemia virus (MuLV)-associated protein kinase activity predominantly phosphorylates Pr65gag, a virus protein present in relatively small amounts in partially purified virus preparations. Other virus proteins, such as p10, Pr27gag and Pr40gag, are also phosphorylated in vitro, but to a lesser degree. Furthermore, when immature core subparticles which are enriched in Pr65gag are prepared from virions by Sepharose 6B exclusion column chromatography, about 50% of the kinase activity (as assayed with the exogenous substrate phosvitin) remains associated with the cores. We report here that this core-associated activity is distinct from Pr65gag since it can be separated from Pr65gag by chromatography on denatured DNA--cellulose columns followed by centrifugation of the 0.2 M-NaCl-eluted fraction. Under these conditions, Pr65gag is pelleted while the kinase activity, which can phosphorylate both endogenous (MuLV Pr65gag and p10) as well as exogenous (phosvitin) substrates, remains in the supernatant. Interestingly, when the amount of Pr65gag is reduced, as in such preparations, p10 then becomes more heavily phosphorylated.