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Hirano I, Collins MH, Assouline-Dayan Y, Evans L, Gupta S, Schoepfer AM, Straumann A, Safroneeva E, Grimm M, Smith H, Tompkins CA, Woo A, Peach R, Frohna P, Gujrathi S, Penenberg DN, Li C, Opiteck GJ, Olson A, Aranda R, Rothenberg ME, Dellon ES. RPC4046, a Monoclonal Antibody Against IL13, Reduces Histologic and Endoscopic Activity in Patients With Eosinophilic Esophagitis. Gastroenterology 2019; 156:592-603.e10. [PMID: 30395812 DOI: 10.1053/j.gastro.2018.10.051] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/18/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Eosinophilic esophagitis (EoE) is a chronic, esophageal, type 2 inflammatory response associated with increased serum levels of interleukin 13 (IL13), which might contribute to its pathogenesis. RPC4046, a recombinant humanized monoclonal antibody against IL13, prevents its binding to the receptor subunits IL13RA1 and IL13RA2. We performed a phase 2 trial to evaluate the efficacy and safety of RPC4046 in patients with EoE. METHODS We performed a multicenter, double-blind trial of 99 adults with active EoE randomly assigned (1:1:1) to groups given RPC4046 (180 or 360 mg) or placebo once weekly for 16 weeks, from September 2014 through December 2015. Patients were seen at day 1 (baseline) and weeks 2, 4, 8, 12, and 16. They underwent esophagogastroduodenoscopy and biopsies were collected at baseline and week 16. Patients completed a daily dysphagia symptom diary through week 16 and patient-reported outcome data were collected. The primary outcome was change in mean esophageal eosinophil count in the 5 high-power fields (hpfs) with the highest level of inflammation. RESULTS At week 16, mean changes in esophageal eosinophil count per hpf were a reduction of 94.8 ± 67.3 in patients who received 180 mg RPC4046 (P < .0001) and a reduction of 99.9 ± 79.5 in patients who received 360 mg RPC4046 (P < .0001) compared with a reduction of 4.4 ± 59.9 in patients who received placebo. The 360-mg RPC4046 group, compared with the placebo group, showed significant reductions in validated endoscopic severity score at all esophageal locations (P < .0001), validated histologic grade and stage scores (both P < .0001), and clinician's global assessment of disease severity (P = .0352); they had a numerical reduction in scores from the dysphagia symptom diary (P = .0733). Significant reductions in esophageal eosinophil counts and histologic and endoscopic features were observed in patients with steroid-refractory EoE who received RPC4046. The most common adverse events were headache and upper respiratory tract infection. CONCLUSIONS In a phase 2 trial of patients with EoE, we found RPC4046 (a monoclonal antibody against IL13) to reduce histologic and endoscopic features compared with placebo. RPC4046 was well tolerated. ClinicalTrials.gov no: NCT02098473.
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Affiliation(s)
- Ikuo Hirano
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Margaret H Collins
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Larry Evans
- Grand Teton Research Group, Idaho Falls, Idaho
| | - Sandeep Gupta
- University of Illinois College of Medicine, Peoria, Illinois
| | | | - Alex Straumann
- Swiss EoE Clinic, University Hospital Zürich, Zürich, Switzerland
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | | | - Amy Woo
- Celgene Corporation, Summit, New Jersey
| | | | | | | | | | - Caiyan Li
- Celgene Corporation, Summit, New Jersey
| | | | | | | | - Marc E Rothenberg
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Evan S Dellon
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
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Tran JQ, Hartung JP, Olson AD, Mendzelevski B, Timony GA, Boehm MF, Peach RJ, Gujrathi S, Frohna PA. Cardiac Safety of Ozanimod, a Novel Sphingosine-1-Phosphate Receptor Modulator: Results of a Thorough QT/QTc Study. Clin Pharmacol Drug Dev 2018; 7:263-276. [PMID: 28783871 PMCID: PMC5901414 DOI: 10.1002/cpdd.383] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ozanimod is a novel, selective, oral sphingosine-1-phosphate (1 and 5) receptor modulator in development for multiple sclerosis and inflammatory bowel disease. This randomized, double-blind, placebo-controlled, positive-controlled, parallel-group thorough QT study characterized the effects of ozanimod on cardiac repolarization in healthy subjects. Eligible subjects were randomized to 1 of 2 groups: ozanimod (escalated from 0.25 to 2 mg over 14 days) or placebo (for 14 days). A single dose of moxifloxacin 400 mg or placebo was administered on days 2 and 17. The primary end point was the time-matched, placebo-corrected, baseline-adjusted mean QTcF (ΔΔQTcF). A total of 113/124 (91.1%) subjects completed the study. The upper limits of the 2-sided 90% confidence intervals for ΔΔQTcF for both ozanimod 1 and 2 mg were below the 10-millisecond regulatory threshold. No QTcF >480 milliseconds or postdose change in QTcF of >60 milliseconds was observed. There was no evidence of a positive relationship between concentrations of ozanimod and its active metabolites and ΔΔQTcF. Although ozanimod blunted the observed diurnal increase in heart rate, excursions below predose heart rates were no greater than with placebo. Results demonstrate that ozanimod does not prolong the QTc interval or cause clinically significant bradycardia, supporting ozanimod's evolving favorable cardiac safety profile.
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Affiliation(s)
- Jonathan Q. Tran
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
| | - Jeffrey P. Hartung
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
| | - Allan D. Olson
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
| | | | - Gregg A. Timony
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
| | - Marcus F. Boehm
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
| | - Robert J. Peach
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
| | - Sheila Gujrathi
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
| | - Paul A. Frohna
- Receptosa wholly owned subsidiary of Celgene CorporationSan DiegoCaliforniaUSA
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Tran JQ, Hartung JP, Peach RJ, Boehm MF, Rosen H, Smith H, Brooks JL, Timony GA, Olson AD, Gujrathi S, Frohna PA. Results From the First-in-Human Study With Ozanimod, a Novel, Selective Sphingosine-1-Phosphate Receptor Modulator. J Clin Pharmacol 2017; 57:988-996. [PMID: 28398597 PMCID: PMC5516232 DOI: 10.1002/jcph.887] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 12/28/2016] [Accepted: 02/10/2017] [Indexed: 01/01/2023]
Abstract
The sphingosine-1-phosphate 1 receptor (S1P1R ) is expressed by lymphocytes, dendritic cells, and vascular endothelial cells and plays a role in the regulation of chronic inflammation and lymphocyte egress from peripheral lymphoid organs. Ozanimod is an oral selective modulator of S1P1R and S1P5R receptors in clinical development for the treatment of chronic immune-mediated, inflammatory diseases. This first-in-human study characterized the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of ozanimod in 88 healthy volunteers using a range of single and multiple doses (7 and 28 days) and a dose-escalation regimen. Ozanimod was generally well tolerated up to a maximum single dose of 3 mg and multiple doses of 2 mg/d, with no severe adverse events (AEs) and no dose-limiting toxicities. The most common ozanimod-related AEs included headache, somnolence, dizziness, nausea, and fatigue. Ozanimod exhibited linear PK, high steady-state volume of distribution (73-101 L/kg), moderate oral clearance (204-227 L/h), and an elimination half-life of approximately 17 to 21 hours. Ozanimod produced a robust dose-dependent reduction in total peripheral lymphocytes, with a median decrease of 65% to 68% observed after 28 days of dosing at 1 and 1.5 mg/d, respectively. Ozanimod selectivity affected lymphocyte subtypes, causing marked decreases in cells expressing CCR7 and variable decreases in subsets lacking CCR7. A dose-dependent negative chronotropic effect was observed following the first dose, with the dose-escalation regimen attenuating the first-dose negative chronotropic effect. Ozanimod safety, PK, and PD properties support the once-daily regimens under clinical investigation.
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Affiliation(s)
- Jonathan Q Tran
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Jeffrey P Hartung
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Robert J Peach
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Marcus F Boehm
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Hugh Rosen
- Scripps Research Institute, San Diego, CA, USA
| | - Heather Smith
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Jennifer L Brooks
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Gregg A Timony
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Allan D Olson
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Sheila Gujrathi
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
| | - Paul A Frohna
- Receptos, a wholly owned subsidiary of Celgene Corporation, San Diego, CA, USA
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Sandborn WJ, Feagan BG, Wolf DC, D'Haens G, Vermeire S, Hanauer SB, Ghosh S, Smith H, Cravets M, Frohna PA, Aranda R, Gujrathi S, Olson A. Ozanimod Induction and Maintenance Treatment for Ulcerative Colitis. N Engl J Med 2016; 374:1754-62. [PMID: 27144850 DOI: 10.1056/nejmoa1513248] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [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: 02/05/2023]
Abstract
BACKGROUND Ozanimod (RPC1063) is an oral agonist of the sphingosine-1-phosphate receptor subtypes 1 and 5 that induces peripheral lymphocyte sequestration, potentially decreasing the number of activated lymphocytes circulating to the gastrointestinal tract. METHODS We conducted a double-blind, placebo-controlled phase 2 trial of ozanimod in 197 adults with moderate-to-severe ulcerative colitis. Patients were randomly assigned, in a 1:1:1 ratio, to receive ozanimod at a dose of 0.5 mg or 1 mg or placebo daily for up to 32 weeks. The Mayo Clinic score was used to measure disease activity on a scale from 0 to 12, with higher scores indicating more severe disease; subscores range from 0 to 3, with higher scores indicating more severe disease. The primary outcome was clinical remission (Mayo Clinic score ≤2, with no subscore >1) at 8 weeks. RESULTS The primary outcome occurred in 16% of the patients who received 1 mg of ozanimod and in 14% of those who received 0.5 mg of ozanimod, as compared with 6% of those who received placebo (P=0.048 and P=0.14, respectively, for the comparison of the two doses of ozanimod with placebo). Differences in the primary outcome between the group that received 0.5 mg of ozanimod and the placebo group were not significant; therefore, the hierarchical testing plan deemed the analyses of secondary outcomes exploratory. Clinical response (decrease in Mayo Clinic score of ≥3 points and ≥30% and decrease in rectal-bleeding subscore of ≥1 point or a subscore ≤1) at 8 weeks occurred in 57% of those receiving 1 mg of ozanimod and 54% of those receiving 0.5 mg, as compared with 37% of those receiving placebo. At week 32, the rate of clinical remission was 21% in the group that received 1 mg of ozanimod, 26% in the group that received 0.5 mg of ozanimod, and 6% in the group that received placebo; the rate of clinical response was 51%, 35%, and 20%, respectively. At week 8, absolute lymphocyte counts declined 49% from baseline in the group that received 1 mg of ozanimod and 32% from baseline in the group that received 0.5 mg. The most common adverse events overall were anemia and headache. CONCLUSIONS In this preliminary trial, ozanimod at a daily dose of 1 mg resulted in a slightly higher rate of clinical remission of ulcerative colitis than placebo. The trial was not large enough or of sufficiently long duration to establish clinical efficacy or assess safety. (Funded by Receptos; TOUCHSTONE ClinicalTrials.gov number, NCT01647516.).
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Affiliation(s)
- William J Sandborn
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Brian G Feagan
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Douglas C Wolf
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Geert D'Haens
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Severine Vermeire
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Stephen B Hanauer
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Subrata Ghosh
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Heather Smith
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Matthew Cravets
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Paul A Frohna
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Richard Aranda
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Sheila Gujrathi
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
| | - Allan Olson
- From the University of California, San Diego, La Jolla (W.J.S.), and Receptos, San Diego (H.S., M.C., P.A.F., R.A., S. Gujrathi, A.O.) - both in California; Robarts Clinical Trials, Robarts Research Institute, and the Department of Medicine, Western University, London, ON (B.G.F.), and the University of Calgary, Calgary, AB (S. Ghosh) - all in Canada; Atlanta Gastroenterology Associates, Atlanta (D.C.W.); Academic Medical Center, Amsterdam (G.D.); University Hospital Gasthuisberg, Leuven, Belgium (S.V.); and Northwestern University, Evanston, IL (S.B.H.)
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Cohen JA, Arnold DL, Comi G, Bar-Or A, Gujrathi S, Hartung JP, Cravets M, Olson A, Frohna PA, Selmaj KW. Safety and efficacy of the selective sphingosine 1-phosphate receptor modulator ozanimod in relapsing multiple sclerosis (RADIANCE): a randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2016; 15:373-81. [PMID: 26879276 DOI: 10.1016/s1474-4422(16)00018-1] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/04/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Modulation of sphingosine 1-phosphate (S1P) receptors in a non-selective manner decreases disease activity in patients with multiple sclerosis but has potential safety concerns. We assessed the safety and efficacy of the oral selective S1P receptor modulator ozanimod in patients with relapsing multiple sclerosis. METHODS RADIANCE is a combined phase 2/3 trial. Patients with relapsing multiple sclerosis were recruited from 55 academic and private multiple sclerosis clinics in 13 countries across Europe and the USA. Eligible participants were aged 18-55 years, had an Expanded Disability Status Scale (EDSS) score of 0-5·0, and had either one or more relapses in the previous 12 months, or one or more relapses in the past 24 months and one or more gadolinium-enhancing lesions on MRI in the previous 12 months before screening. Participants were assigned by a computer-generated randomisation sequence in a 1:1:1 ratio to ozanimod (0·5 mg or 1 mg) or matching placebo once daily for 24 weeks by an independent, unmasked, statistical team. Trial participants, study site personnel, MRI assessors, steering committee members, and the study statistician were masked to treatment assignment. To attenuate first-dose cardiac effects, ozanimod was up-titrated from 0·25 mg to 0·5 mg or 1 mg over 8 days. The primary endpoint was the cumulative number of total gadolinium-enhancing MRI lesions measured by an independent MRI analysis centre at weeks 12-24 after treatment initiation. Analysis was by intention to treat. Here, we report results from the 24-week phase 2 trial. This trial is registered with ClinicalTrials.gov, number NCT01628393. The 2-year phase 3 trial is ongoing. FINDINGS The first patient was randomised on Oct 18, 2012, and the final visit of the last randomised patient was on May 11, 2014. The intention-to-treat and safety population consisted of 258 participants, 88 were assigned placebo, 87 ozanimod 0·5 mg, and 83 ozanimod 1 mg; 252 (98%) patients completed the assigned treatment. The mean cumulative number of gadolinium-enhancing lesions at weeks 12-24 was 11·1 (SD 29·9) with placebo compared with 1·5 (3·7) with ozanimod 0·5 mg (odds ratio 0·16, 95% CI 0·08-0·30; p<0·0001) and 1·5 (3·4) with ozanimod 1 mg (odds ratio 0·11, 95% CI 0·06-0·21; p<0·0001). Three serious adverse events unrelated to treatment were reported in patients assigned ozanimod 0·5 mg: optic neuritis, somatoform autonomic dysfunction, and cervical squamous metaplasia (HPV-related). No serious infectious or cardiac adverse events were reported, and no cases of macular oedema arose. The most common adverse events in the ozanimod 0·5 mg and 1 mg groups compared with placebo were nasopharyngitis (11 and five vs 12), headache (five and three vs eight), and urinary-tract infections (six and two vs two). The maximum reduction in mean heart rate by Holter monitoring during the first 6 h in ozanimod-treated participants was less than 2 beats per min (bpm) compared with baseline, with no patient having a minimum hourly heart rate less than 45 bpm. Electrocardiograms and 24-h Holter monitoring showed no increased incidence of atrioventricular block or sinus pause with ozanimod. INTERPRETATION Ozanimod significantly reduced MRI lesion activity in participants with relapsing multiple sclerosis, with a favourable safety profile over a period of 24 weeks. These findings warrant phase 3 trials, which are ongoing. FUNDING Receptos, Inc.
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Affiliation(s)
- Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Douglas L Arnold
- NeuroRx Research and Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Giancarlo Comi
- San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Neurology, Milan, Italy
| | - Amit Bar-Or
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | | | | | - Matt Cravets
- Receptos Inc, Clinical Development, San Diego, CA, USA
| | - Allan Olson
- Receptos Inc, Clinical Development, San Diego, CA, USA
| | - Paul A Frohna
- Receptos Inc, Clinical Development, San Diego, CA, USA
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Mayer L, Sandborn WJ, Stepanov Y, Geboes K, Hardi R, Yellin M, Tao X, Xu LA, Salter-Cid L, Gujrathi S, Aranda R, Luo AY. Anti-IP-10 antibody (BMS-936557) for ulcerative colitis: a phase II randomised study. Gut 2014; 63:442-50. [PMID: 23461895 PMCID: PMC3933070 DOI: 10.1136/gutjnl-2012-303424] [Citation(s) in RCA: 143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Interferon-γ-inducible protein-10 (IP-10 or CXCL10) plays a role in inflammatory cell migration and epithelial cell survival and migration. It is expressed in higher levels in the colonic tissue and plasma of patients with ulcerative colitis (UC). This phase II study assessed the efficacy and safety of BMS-936557, a fully human, monoclonal antibody to IP-10, in the treatment of moderately-to-severely active UC. DESIGN In this 8-week, phase II, double-blind, multicentre, randomised study, patients with active UC received placebo or BMS-936557 (10 mg/kg) intravenously every other week. The primary endpoint was the rate of clinical response at Day 57; clinical remission and mucosal healing rates were secondary endpoints. Post hoc analyses evaluated the drug exposure-response relationship and histological improvement. RESULTS 109 patients were included (BMS-936557: n=55; placebo: n=54). Prespecified primary and secondary endpoints were not met; clinical response rate at Day 57 was 52.7% versus 35.2% for BMS-936557 versus placebo (p=0.083), and clinical remission and mucosal healing rates were 18.2% versus 16.7% (p=1.00) and 41.8% versus 35.2% (p=0.556), respectively. However, higher BMS-936557 steady-state trough concentration (Cminss) was associated with increased clinical response (87.5% vs 37.0% (p<0.001) for patients with Cminss 108-235 μg/ml vs placebo) and histological improvements (73.0% vs 41.0%; p=0.004). Infections occurred in 7 (12.7%) BMS-936557-treated patients and 3 (5.8%) placebo-treated patients. 2 (3.6%) BMS-936557 patients discontinued due to adverse events. CONCLUSIONS Anti-IP-10 antibody, BMS-936557, is a potentially effective therapy for moderately-to-severely active UC. Higher drug exposure correlated with increasing clinical response and histological improvement. Further dose-response studies are warranted. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT00656890.
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Affiliation(s)
- Lloyd Mayer
- Immunology Institute, Mount Sinai School of Medicine, New York, New York, USA
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Yuriy Stepanov
- Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine
| | - Karel Geboes
- Department of Pathologie, University Hospital KU Leuven, Leuven, Belgium
| | - Robert Hardi
- Chevy Chase Clinical Research, Chevy Chase, Maryland, USA
| | | | - Xiaolu Tao
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Li An Xu
- Bristol-Myers Squibb, Princeton, New Jersey, USA
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Weinblatt ME, Moreland LW, Westhovens R, Cohen RB, Kelly SM, Khan N, Pappu R, Delaet I, Luo A, Gujrathi S, Hochberg MC. Safety of abatacept administered intravenously in treatment of rheumatoid arthritis: integrated analyses of up to 8 years of treatment from the abatacept clinical trial program. J Rheumatol 2013; 40:787-97. [PMID: 23588946 DOI: 10.3899/jrheum.120906] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the overall safety, including rare events, of intravenous (IV) abatacept treatment in rheumatoid arthritis (RA). METHODS Data from 8 clinical trials of IV abatacept in RA were pooled. Safety events were assessed during the short-term (duration ≤ 12 months) and cumulative (short-term plus longterm extensions) abatacept treatment periods. Incidence rates per 100 patient-years were calculated. Standardized incidence ratios (SIR) for hospitalized infections and malignancies were compared with external RA cohorts and, for malignancies, with the US general population. RESULTS There were 3173 IV abatacept-treated patients with 2331 patient-years of exposure in the short-term periods, and 4149 IV abatacept-treated patients with 12,132 patient-years of exposure in the cumulative period. Incidence rates for serious infections were low and consistent over time (3.68 for abatacept vs 2.60 for placebo during the short-term, and 2.87 for abatacept during the cumulative period). Hospitalized infections were generally similar to external RA patient cohorts and were consistent over time. Incidence rates of malignancies were similar for abatacept- and placebo-treated patients during the short-term period (0.73 vs 0.59) and remained low during the abatacept cumulative period (0.73). SIR of some tissue-specific malignancies (e.g., colorectal and breast) in the cumulative period tended to be lower, while others (lymphoma and lung) tended to be higher, compared with the general population; however, incidence rates were comparable with RA cohorts. Autoimmune events were rare and infusion reactions uncommon. CONCLUSION Longterm safety of IV abatacept was consistent with the short-term, with no unexpected events and low incidence rates of serious infections, malignancies, and autoimmune events.
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Sandborn WJ, Colombel JF, Sands BE, Rutgeerts P, Targan SR, Panaccione R, Bressler B, Geboes K, Schreiber S, Aranda R, Gujrathi S, Luo A, Peng Y, Salter-Cid L, Hanauer SB. Abatacept for Crohn's disease and ulcerative colitis. Gastroenterology 2012; 143:62-69.e4. [PMID: 22504093 DOI: 10.1053/j.gastro.2012.04.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 03/30/2012] [Accepted: 04/06/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The efficacy of abatacept, a selective costimulation modulator, in Crohn's disease (CD) and ulcerative colitis (UC) is unknown. METHODS Four placebo-controlled trials evaluated the efficacy and safety of abatacept as induction (IP) and maintenance (MP) therapy in adults with active, moderate-to-severe CD (CD-IP; CD-MP) and UC (UC-IP1; UC-MP). In CD-IP and UC-IP1, 451 patients with CD and 490 patients with UC were randomized to abatacept 30, 10, or 3 mg/kg (according to body weight) or placebo, and dosed at weeks 0, 2, 4, and 8. In MP, 90 patients with CD and 131 patients with UC who responded to abatacept at week 12 in the induction trials were randomized to abatacept 10 mg/kg or placebo every 4 weeks through week 52. RESULTS In CD-IP, 17.2%, 10.2%, and 15.5% of patients receiving abatacept 30, 10, and 3 mg/kg achieved a clinical response at weeks 8 and 12, vs 14.4% receiving placebo (P = .611, P = .311, and P = .812, respectively). In UC-IP1, 21.4%, 19.0%, and 20.3% of patients receiving abatacept 30, 10, and 3 mg/kg achieved a clinical response at week 12, vs 29.5% receiving placebo (P = .124, P = .043, and P = .158, respectively). In CD-MP, 23.8% vs 11.1% of abatacept vs placebo patients were in remission at week 52. In UC-MP, 12.5% vs 14.1% of patients receiving abatacept vs placebo were in remission at week 52. Safety generally was comparable between groups. CONCLUSIONS The studies showed that abatacept is not efficacious for the treatment of moderate-to-severe CD or UC.
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, 92093-0956,USA.
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Keystone EC, Kremer JM, Russell A, Box J, Abud-Mendoza C, Elizondo MG, Luo A, Aranda R, Delaet I, Swanink R, Gujrathi S, Luggen M. Abatacept in subjects who switch from intravenous to subcutaneous therapy: results from the phase IIIb ATTUNE study. Ann Rheum Dis 2012; 71:857-61. [PMID: 22302417 DOI: 10.1136/annrheumdis-2011-200355] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess safety, immunogenicity and efficacy in rheumatoid arthritis (RA) patients switched from long-term intravenous to subcutaneous (SC) abatacept. METHODS In this phase IIIb, open-label, single-arm trial, patients who completed ≥4 years of intravenous abatacept (in long-term extensions of two phase III studies) were enrolled to receive SC abatacept (125 mg/week). The primary objective was safety during the first 3 months after switching from intravenous therapy. RESULTS 123 patients entered the study (mean Disease Activity Score 28 (based on C reactive protein) and HAQ-DI of 3.4 and 0.94, respectively). At month 3, 120 (97.6%) patients were continuing to receive SC abatacept; no patients discontinued due to lack of efficacy. Adverse events (AEs) were reported in 49 (39.8%) patients through month 3. One patient (0.8%) discontinued due to an AE and one patient (0.8%) experienced a serious AE. Two (1.6%) patients had SC injection site reactions (erythema, pain), both with mild intensity. Clinical efficacy was maintained throughout. Limited impact on immunogenicity was observed when switching routes of administration. CONCLUSION These data demonstrate that patients can switch from long-term monthly intravenous abatacept to a weekly fixed dose of 125 mg SC abatacept with no increased safety concerns. This study further supports SC abatacept as an alternative treatment option for patients with RA.
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Kaine J, Gladstein G, Strusberg I, Robles M, Louw I, Gujrathi S, Pappu R, Delaet I, Pans M, Ludivico C. Evaluation of abatacept administered subcutaneously in adults with active rheumatoid arthritis: impact of withdrawal and reintroduction on immunogenicity, efficacy and safety (phase Iiib ALLOW study). Ann Rheum Dis 2011; 71:38-44. [PMID: 21917824 PMCID: PMC3233696 DOI: 10.1136/annrheumdis-2011-200344] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [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] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the effect of a temporary interruption in subcutaneous (SC) abatacept on immunogenicity, safety and efficacy in patients with active rheumatoid arthritis despite methotrexate in a phase III trial. METHODS Following a 12-week open-label introduction (period I; intravenous abatacept loading dose and weekly fixed-dose SC abatacept 125 mg), patients were randomised 2:1 to double-blind SC placebo or SC abatacept for 12 weeks (period II). At the end of period II, patients receiving SC abatacept continued treatment and patients on placebo were reintroduced to SC abatacept (12-week open-label period III). The co-primary end points were ELISA-detected immunogenicity rate and safety at the end of period II. Efficacy was also monitored. RESULTS Of 167 patients entering period I, 72% qualified for period II; during periods II and III, three patients discontinued treatment. Mean (SD) disease duration was 6.6 (6.5) years and Disease Activity Score 28 was 4.8 (0.8). The primary end point was met, with a non-significant increase in immunogenicity upon withdrawal (7/73 placebo vs 0/38 abatacept in period II; p=0.119) which was reversed upon reintroduction of SC abatacept (2/73 vs 1/38, end period III). Safety was comparable regardless of withdrawal, with no unexpected events upon reintroduction. Two patients experienced reactions at the SC injection site. On withdrawal, patients experienced slight worsening in efficacy which improved following reintroduction. CONCLUSIONS Overall immunogenicity to SC abatacept is low, consistent with intravenous abatacept, and is not significantly affected by a 3-month interruption and reintroduction. This stop-start schedule was well tolerated, with little impact on safety and efficacy. These are important considerations for the clinical use of SC abatacept. CLINICALTRIALS gov Identifier NCT00533897.
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Affiliation(s)
- Jeffrey Kaine
- Sarasota Arthritis Research Center, 1945 Versailles Street #101, Sarasota, FL 34239, USA.
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Nishikawa M, Owaki H, Fuji T, Soliman MM, Ashcroft DM, Watson KD, Lunt M, Symmons D, Hyrich KL, Atkinson F, Malik S, Heycock C, Saravanan V, Rynne M, Hamilton J, Kelly C, Burmester G, Kary S, Unnebrink K, Guerette B, Oezer U, Kupper H, Dennison E, Jameson K, Hyrich K, Watson K, Landewe R, Keystone E, Smolen J, Goldring M, Guerette B, Patra K, Cifaldi M, van der Heijde D, Lloyd LA, Owen C, Breslin A, Ahmad Y, Emery P, Matteson EL, Genovese M, Sague S, Hsia EC, Doyle MK, Fan H, Elashoff M, Kirkham B, Wasco MC, Bathon J, Hsia EC, Fleischmann R, Genovese MC, Matteson EL, Liu H, Fleischmann R, Goldman J, Leirisalo-Repo M, Zanetakis E, El-Kadi H, Kellner H, Bolce R, Wang J, Dehoratius R, Decktor D, Kremer J, Taylor P, Mendelsohn A, Baker D, Kim L, Ritchlin C, Taylor P, Mariette X, Matucci Cerenic M, Pavelka K, van Vollenhoven R, Heatley R, Walsh C, Lawson R, Reynolds A, Emery P, Iaremenko O, Mikitenko G, Smolen J, van Vollenhoven R, Kavanaugh A, Luijtens K, van der Heijde D, Curtis J, van der Heijde D, Schiff M, Keystone E, Landewe R, Kvien T, Curtis J, Khanna D, Luijtens K, Furst D, Behrens F, Koehm M, Scharbatke EC, Kleinert S, Weyer G, Tony HP, Burkhardt H, Blunn KJ, Williams RB, Young A, McDowell J, Keystone E, Weinblatt M, Haraoui B, Guerette B, Mozaffarian N, Patra K, Kavanaugh A, Khraishi M, Alten R, Gomez-Reino J, Rizzo W, Schechtman J, Kahan A, Vernon E, Taylor M, Smolen J, Hogan V, Holweg C, Kummerfeld S, Teng O, Townsend M, van Laar JM, Gullick NJ, De Silva C, Kirkham BW, van der Heijde D, Landewe R, Guerette B, Roy S, Patra K, Keystone E, Emery P, Fleischmann R, van der Heijde D, Keystone E, Genovese MC, Conaghan PG, Hsia EC, Xu W, Baratelle A, Beutler A, Rahman MU, Nikiphorou E, Kiely P, Walsh DA, Williams R, Young A, Shah D, Knight GD, Hutchinson DG, Dass S, Atzeni F, Vital EM, Bingham SJ, Buch M, Beirne P, Emery P, Keystone E, Fleischmann R, Emery P, Dougados M, Williams S, Reynard M, Blackler L, Gullick NJ, Zain A, Oakley S, Rees J, Jones T, Mistlin A, Panayi G, Kirkham BW, Westhovens R, Durez P, Genant H, Robles M, Becker JC, Covucci A, Bathon J, Genovese MC, Schiff M, Luggen M, Le Bars M, Becker JC, Aranda R, Li T, Elegbe A, Dougados M, Smolen J, van Vollenhoven R, Kavanaugh A, Fichtner A, Strand V, Vencovsky J, van der Heijde D, Davies R, Galloway J, Watson KD, Lunt M, Hochberg M, Westhovens R, Aranda R, Kelly S, Khan N, Qi K, Pappu R, Delaet I, Luo A, Torbeyns A, Moreland L, Cohen R, Gujrathi S, Weinblatt M, Bykerk VP, Alvaro-Gracia J, Andres Roman Ivorra J, Nurmohamed MT, Pavelka K, Bernasconi C, Stancati A, Sibilia J, Ostor A, Strangfeld A, Eveslage M, Listing J, Herzer P, Liebhaber A, Krummel-Lorenz B, Zink A, Haraoui B, Emery P, Mozaffarian N, Guerette B, Kupper H, Patra K, Keystone E, Genovese MC, Breedveld FC, Emery P, Cohen SB, Keystone E, Matteson EL, Burke L, Chai A, Reiss W, Sweetser M, Shaw T, Ellis SD, Ehrenstein MR, Notley CA, Yazici Y, Curtis J, Ince A, Baraf H, Malamet R, Chung CY, Kavanaugh A, Hughes C, Faurholm B, Dell'Accio F, Manzo A, Seed M, Eltawil N, Marrelli A, Gould D, Subang C, Al-Kashi A, De Bari C, Winyard P, Chernajovsky Y, Nissim A, van Vollenhoven R, Emery P, Bingham C, Keystone E, Fleischmann RM, Furst DE, Macey KM, Sweetser MT, Lehane P, Farmer P, Long SG, Kremer JM, Furst DE, Burgos-Vargas R, Dudler J, Mela CM, Vernon E, Fleischmann RM, Wegner N, Lugli H, Quirke AM, Guo Y, Potempa J, Venables P. Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vincenti F, Blancho G, Durrbach A, Friend P, Grinyo J, Halloran PF, Klempnauer J, Lang P, Larsen CP, Mühlbacher F, Nashan B, Soulillou JP, Vanrenterghem Y, Wekerle T, Agarwal M, Gujrathi S, Shen J, Shi R, Townsend R, Charpentier B. Five-year safety and efficacy of belatacept in renal transplantation. J Am Soc Nephrol 2010; 21:1587-96. [PMID: 20634298 PMCID: PMC3013525 DOI: 10.1681/asn.2009111109] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Belatacept is a first-in-class co-stimulation blocker in development for primary maintenance immunosuppression. A Phase II study comparing belatacept with cyclosporine (CsA) for prevention of acute rejection and protection of renal function in kidney transplant recipients demonstrated similar efficacy and significantly higher measured GFR at 1 year for belatacept, but the incidence of posttransplantation lymphoproliferative disorder was higher. Here, we present the results for the extension of this trial, which aimed to assess long-term safety and efficacy of belatacept. Seventy-eight of 102 patients who were receiving belatacept and the 16 of 26 who were receiving CsA completed the long-term extension period. GFR remained stable in patients who were receiving belatacept for 5 years, and the incidences of death/graft loss or acute rejection were low. The frequencies of serious infections were 16% for belatacept and 27% for CsA, and neoplasms occurred in 12% of each group. No patients who were treated with belatacept and one patient who was treated with CsA developed posttransplantation lymphoproliferative disorder during the follow-up period. Serious gastrointestinal disorders occurred more frequently with belatacept (12% belatacept versus 8% CsA), and serious cardiac disorders occurred more frequently with CsA (2% belatacept versus 12% CsA). Pharmacokinetic analyses showed consistent exposure to belatacept over time. CD86 receptor saturation was higher in patients who were receiving belatacept every 4 weeks (74%) compared with every 8 weeks (56%). In conclusion, this study demonstrated high patient persistence with intravenous belatacept, stable renal function, predictable pharmacokinetics, and good safety with belatacept over 5 years.
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Affiliation(s)
- Flavio Vincenti
- Division of Nephrology, University of California, San Francisco, 505 Parnassus Avenue, Moffitt 884, San Francisco, CA 94143-0780, USA.
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Affiliation(s)
- Nathan J Felix
- Department of Immunology, Bristol-Myers Squibb Co., Princeton, NJ 08543, USA.
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Genovese MC, Kaine JL, Lowenstein MB, Del Giudice J, Baldassare A, Schechtman J, Fudman E, Kohen M, Gujrathi S, Trapp RG, Sweiss NJ, Spaniolo G, Dummer W. Ocrelizumab, a humanized anti-CD20 monoclonal antibody, in the treatment of patients with rheumatoid arthritis: a phase I/II randomized, blinded, placebo-controlled, dose-ranging study. ACTA ACUST UNITED AC 2010; 58:2652-61. [PMID: 18759293 DOI: 10.1002/art.23732] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Ocrelizumab, a humanized anti-CD20 monoclonal antibody, was studied in a first-in-human trial in rheumatoid arthritis (RA) patients receiving concomitant methotrexate (MTX). METHODS The ACTION trial was a combined phase I/II study of placebo plus MTX versus ocrelizumab plus MTX in 237 RA patients (intent-to-treat population). During phase I, 45 patients were treated with 1 of 5 escalating doses of study drug (infusions on days 1 and 15, 10-1,000 mg per each infusion). An additional 192 patients were randomized during phase II. Eligible patients had active disease, an inadequate response to treatment with at least MTX, rheumatoid factor positivity, and elevated levels of acute-phase reactants. The total study duration was 72 weeks. B cell pharmacodynamics over time was investigated. RESULTS Baseline demographics were similar among the treatment groups. Based on the entire 72-week data set, the incidence of serious adverse events in the ocrelizumab-treated patients was 17.9%, as compared with 14.6% in placebo-treated patients. The incidence of serious infections was 2.0% in all ocrelizumab-treated patients and 4.9% in placebo-treated patients. Infusion-associated adverse events were mostly grade 1 or grade 2 and were more frequent around the time of the first infusion. No serious infusion-associated adverse events were reported in the ocrelizumab group. Evidence of clinical activity was observed at all doses evaluated. Peripheral B cell depletion after infusion was rapid at all doses, with earlier repletion of B cells at doses of 10 mg and 50 mg. Human anti-human antibodies were detected in 19% and 10%, respectively, of those receiving 10 mg and 50 mg of ocrelizumab, compared with 0-5% of those receiving 200, 500, and 1,000 mg. CONCLUSION Ocrelizumab therapy in combination with MTX was well tolerated. Doses of 200 mg (2 infusions) and higher showed better clinical responses, better reduction of C-reactive protein levels, and very low immunogenicity.
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Affiliation(s)
- Mark C Genovese
- Division of Rheumatology, Stanford University, Stanford, California 94304, USA.
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Miller MK, Lee JH, Blanc PD, Pasta DJ, Gujrathi S, Barron H, Wenzel SE, Weiss ST. TENOR risk score predicts healthcare in adults with severe or difficult-to-treat asthma. Eur Respir J 2006; 28:1145-55. [PMID: 16870656 DOI: 10.1183/09031936.06.00145105] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of the present study was to predict which patients with severe or difficult-to-treat asthma are at highest risk for healthcare utilisation can be predicted so as to optimise clinical management. Data were derived from 2,821 adults with asthma enrolled in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. Multiple potential predictors were assessed at baseline using a systematic algorithm employing stepwise logistic regression. Outcomes were asthma-related hospitalisations or emergency department (ED) visits within 6 months following baseline. Overall, 239 subjects (8.5%) reported hospitalisation or ED visits at follow-up. Predictors retained after multivariate analysis were as follows: younger age; female sex; non-white race; body mass index > or =35 kg x m(-2); post-bronchodilator per cent predicted forced vital capacity <70%; history of pneumonia; diabetes; cataracts; intubation for asthma; and three or more steroid bursts in the prior 3 months. A final risk score derived from the logistic regression model ranged from 0-18 and was highly predictive (c-index: 0.78) of hospitalisation or ED visits. This tool was re-tested in a prospective validation using outcomes at 12- to 18-months follow-up among the same cohort (c-index: 0.77). The risk score derived is a clinically useful tool for assessing the likelihood of asthma-related hospitalisation or emergency department visits in adults with severe and difficult-to-treat asthma.
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Affiliation(s)
- M K Miller
- Genentech, Inc, 1 DNA Way, MS 214B, South San Francisco, CA 94044, USA.
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Borish L, Chipps B, Deniz Y, Gujrathi S, Zheng B, Dolan CM. Total serum IgE levels in a large cohort of patients with severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol 2005; 95:247-53. [PMID: 16200815 DOI: 10.1016/s1081-1206(10)61221-5] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Limited data are available on levels of IgE in large cohorts of patients with severe or difficult-to-treat asthma. OBJECTIVE To examine IgE levels and disease in patients from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. METHODS From January 2001 to October 2001, 4,923 patients were screened for inclusion in the study. Of these, 4,756 patients 6 years or older with severe or difficult-to-treat asthma were enrolled and completed a baseline study visit. Total serum IgE levels were measured at the baseline visit and are summarized by geometric means. RESULTS The mean total IgE level of the population is 106.6 IU/mL (95% confidence interval, 101.5-112.0 IU/mL). Children (6-12 years old) and adolescents (13-17 years old) have higher mean IgE levels than adults (> or =18 years old) (P < .001). Males have a higher mean IgE level than females (P < .001). IgE levels are higher among nonwhite patients than white patients (P < .001). Current smokers have higher IgE levels than past smokers or never smokers (P < .001). Among children, patients with severe asthma have a higher mean IgE level (280.2 IU/mL) than patients with moderate (145.8 IU/mL) or mild (137.8 IU/mL) asthma (P < .001). Among adults, patients with childhood-onset asthma have higher IgE levels (124.3 IU/mL [n = 1,348]) than patients with adult-onset asthma (65.7 IU/mL [n = 1,956]) (P < .001). CONCLUSION In patients with severe or difficult-to-treat asthma from the TENOR study, higher total IgE levels were observed in males, children, smokers, nonwhite racial/ethnic groups, and adults with childhood-onset disease. In addition, IgE levels are associated with asthma severity among younger patients.
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Affiliation(s)
- Larry Borish
- University of Virginia, Charlottesville, Virginia, USA
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