Thorough Overview Identifies and Addresses Critical Gaps in the Treatment of Several Chronic Diseases
With increasing numbers of patients suffering from Immune-Mediated Inflammatory Diseases (IMIDs), and with the increasing reliance on biopharmaceuticals to treat them, it is imperative that researchers and medical practitioners have a thorough understanding of the absorption, distribution, metabolism and excretion (ADME) of therapeutic proteins as well as translational pharmacokinetic/pharmacodynamic (PK/PD) modeling for them. This comprehensive volume answers that need to be addressed.
Featuring eighteen chapters from world-renowned experts and opinion leaders in pharmacology, translational medicine and immunology, editors Honghui Zhou and Diane Mould have curated a much-needed collection of research on the advanced applications of pharmacometrics and systems pharmacology to the development of biotherapeutics and individualized treatment strategies for the treatment of IMIDs. Authors discuss the pathophysiology of autoimmune diseases in addition to both theoretical and practical aspects of quantitative pharmacology for therapeutic proteins, current translational medicine research methodologies and novel thinking in treatment paradigm strategies for IMIDs. Other notable features include:
• Contributions from well-known authors representing leading academic research centers, specialized contract research organizations and pharmaceutical industries whose pipelines include therapeutic proteins
• Chapters on a wide range of topics (e.g., pathophysiology of autoimmune diseases, biomarkers in ulcerative colitis, model-based meta-analysis use in the development of therapeutic proteins)
• Case studies of applying quantitative pharmacology approaches to guiding therapeutic protein drug development in IMIDs such as psoriasis, inflammatory bowel disease, multiple sclerosis and lupus
Zhou and Mould’s timely contribution to the critical study of biopharmaceuticals is a valuable resource for any academic and industry researcher working in pharmacokinetics, pharmacology, biochemistry, or biotechnology as well as the many clinicians seeking the safest and most effective treatments for patients dealing with chronic immune disorders.
Table of Contents
List of Contributors xvii
About the Editors xxi
Foreword xxiii
Preface xxvii
1 Disease Interception in Autoimmune Diseases: From a Conceptual Framework to Practical Implementation 1
Anish Suri
1.1 Introduction to Disease Interception 1
1.2 Disease Interception in Autoimmune Diseases 3
1.3 Progress in Modulation of the Adaptive Immune Response in Autoimmune Inflammatory Diseases 5
1.4 The Complex Interplay between the Specificity of the Pathogenic Immune Repertoire and Its Sculpting by the Environment - Implications for Disease Interception 8
1.5 Clinical Application and Concluding Remarks 14
Acknowledgments 15
References 15
2 The Role of Biomarkers in Treatment Algorithms for Ulcerative Colitis (UC) 25
Reena Khanna and Brian G. Feagan
2.1 Background 25
2.2 Histology 32
2.2.1 Tissue Markers 33
2.3 Treatment Algorithms 34
2.3.1 Differentiating Inflammatory and Noninflammatory Disease 34
2.4 Assessing Response to Therapy 35
2.5 Predicting Relapse 35
2.6 Summary 35
References 35
3 Mechanism and Physiologically Based PK/PD Model in Assisting Translation from Preclinical to Clinical: Understanding PK/PD of Therapeutic Proteins at Site-of-Action 43
Xi Chen and Weirong Wang
3.1 Introduction 43
3.2 Biologic Distribution to Tissue Site of Action 44
3.3 Target Engagement of Biologics at Site of Action 50
3.4 Translational Application of Mechanistic PBPK Modeling 54
3.5 Conclusion 59
References 59
4 Application of Minimal Anticipated Biological Effect Level (MABEL) in Human Starting Dose Selection for Immunomodulatory Protein Therapeutics - Principles and Case Studies 65
Haiqing Wang, Zheng Yang, and Rong Shi
4.1 Introduction 65
4.2 Safety and Immune-Related Toxicities of Immunomodulatory Protein Therapeutics 66
4.3 Uncertainties of Toxicology Approach in FIH Safe Starting Dose Selection for Immunomodulatory Protein Therapeutics 68
4.4 Incorporating Mabel Approach in FIH Starting Dose Selection for High-Risk Immunomodulatory Protein Therapeutics 71
4.5 Case Studies of Mabel Calculation 75
4.6 Discussion and Conclusion 85
References 87
5 Model-Based Meta-Analysis Use in the Development of Therapeutic Proteins 93
Timothy J. Taylor, Bill Frame, and Angela D. Taylor
5.1 Introduction 93
5.2 Types of MBMA and Database Considerations 94
5.3 Data Analytic Models Useful for MBMA 96
5.4 Example 1: MBMA in Inflammatory Bowel Disease 97
5.5 MBMA Literature Search 99
5.6 Kinetic-Pharmacodynamic Models 100
5.7 MBMA Implications for Inflammatory Bowel Disease 116
5.8 Example 2: MBMA in Rheumatoid Arthritis 117
5.9 Conclusion 119
References 120
6 Utility of Joint Population Exposure-Response Modeling Approach to Assess Multiple Continuous and Categorical Endpoints in Immunology Drug Development 125
Chuanpu Hu and Honghui Zhou
6.1 Introduction 125
6.2 Latent Variable Indirect Response Models 126
6.3 Residual Correlation Modeling Between a Continuous and a Categorical Endpoint 128
6.4 Structural Correlation Modeling Between a Continuous Endpoint and a Categorical Endpoint 134
6.4.1 Application Example: Rheumatoid Arthritis 134
6.5 Conclusion 145
References 145
7 Modeling Approaches to Characterize Target-Mediated Pharmacokinetics and Pharmacodynamics for Therapeutic Proteins 149
Leonid Gibiansky and Ekaterina Gibiansky
7.1 Introduction 149
7.2 Target-Mediated Drug Disposition Model 150
7.3 Data and Practical Considerations 152
7.4 What to Expect from the Concentration-Time Course 154
7.5 Approximations of the TMDD Model 157
7.6 Identifiability of Model Parameters 166
7.7 Summary 167
References 168
8 Tutorial: Numerical (NONMEM) Implementation of the Target-Mediated Drug Disposition Model 173
Leonid Gibiansky and Ekaterina Gibiansky
8.1 Introduction 173
8.2 Notations and Data 174
8.3 NONMEM Code for TMDD Model and Approximations 174
8.4 How to Select Correct Approximation 179
8.4.2 Approach Based on Biological Considerations 180
8.5 Numerical Implementation 181
8.5.1 Choice of ADVAN Subroutines 181
8.5.2 Parallel Computing 181
8.6 Summary 182
References 182
9 Translational Considerations in Developing Bispecific Antibodies: What Can We Learn from Quantitative Pharmacology? 187
Pradeep B. Lukka, Santosh Wagh, and Bernd Meibohm
9.1 Introduction 187
9.2 Quantitative Pharmacokinetic Considerations of BsAbs 187
9.3 Preclinical Considerations 189
9.4 Translational Considerations 196
9.5 Immunogenicity 197
9.6 Clinical Development of BsAbs 198
9.7 Conclusion 200
References 202
10 Application of Pharmacometrics and Systems Pharmacology to Current and Emerging Biologics in Inflammatory Bowel Diseases 209
Sihem Ait-Oudhia, Yi Ting (Kayla) Lien, Sumit Basu, Lawrence Lesko, and Stephan Schmidt
10.1 Introduction 209
10.2 Pharmacological Approaches for the Treatment of IBD 215
10.3 Mathematical Models in IBD 224
10.4 Role of FDA in the Drug Development of Biologics in the Treatment of IBD 228
10.5 Summary 231
References 231
11 Pharmacokinetics-Based Dosing for Therapeutic Monoclonal Antibodies in Inflammatory Bowel Disease 243
Niels Vande Casteele and William J. Sandborn
11.1 Inflammatory Bowel Disease 243
11.2 Population Pharmacokinetics 244
11.3 Exposure-Response 246
11.4 Exposure-Based Dosing Strategies 247
11.5 Discussion 249
References 251
12 Pharmacokinetics-Based Dosing Strategies for Therapeutic Proteins in Inflammatory Bowel Disease 255
Diane R.Mould, Richard N. Upton, and Jessica Wojciechowski
12.1 Introduction 255
12.2 The Need for Understanding and Controlling Variability in Exposure 256
12.3 History of Dose Individualization 258
12.4 Bayesian Methods for Dose Individualization 260
12.5 Clinical Need for Improved Dosing with mAbs 265
12.6 Expectations for Bayesian Adaptive Dosing 268
12.7 Summary and Conclusions 277
References 278
13 Quantitative Pharmacology Approach to Select Optimal Dose and Study the Important Factors in Determining Disposition of Therapeutic Monoclonal Antibody in Pediatric Subjects - Some Considerations 285
Deni Hardiansyah and Chee M. Ng
13.1 Introduction 285
13.2 Pharmacokinetics of Therapeutic Monoclonal Antibody in Pediatric Population 289
13.3 Quantitative Pharmacology Considerations to Select Optimal Pediatric Dose of mAbs Based on Adult PK Studies 291
13.4 Using mPBPK Model to Study the Effects of FcRn Developmental
Pharmacology on the PK of mAbs in Pediatric Subjects 299
References 307
14 Quantitative Pharmacology Assessment Strategy Therapeutic Proteins in Pediatric Subjects - Challenges and Opportunities 315
Jeremiah D. Momper, Andrew Mulberg, Nitin Mehrotra, Dan Turner, William Faubion, Laurie Conklin, Karim Azer, and Marla C. Dubinsky
14.1 Introduction 315
14.2 Extrapolation of Efficacy 315
14.3 Initiation of Pediatric Trials 321
14.4 Trial Design Considerations 322
14.5 Challenges in Pediatric Trials for First-in-Class vs. Follow-on Drug-in-Class 330
References 331
15 Case Examples of Using Quantitative Pharmacology in Developing Therapeutic Proteins for Plaque Psoriasis - Guselkumab 337
Zhenling Yao, Yaowei Zhu, Chuanpu Hu, Yang Chen, Shu Li, Bruce Randazzo, Zhenhua Xu, Amarnath Sharma, and Honghui Zhou
15.1 Introduction 337
15.1.1 Pathogenesis of Plaque Psoriasis 337
15.1.2 Current Treatment Paradigms for Psoriasis 338
15.2 Understanding of Exposure-Response (ER) Relationship of Guselkumab in Psoriasis 339
15.3 Dose Selection for Guselkumab in Psoriasis 342
15.4 Quantitative Pharmacology in Post-submission Support 358
15.5 Conclusion 359
References 360
16 Vedolizumab - A Case Example of Using Quantitative Pharmacology in Developing Therapeutic Biologics in Inflammatory Bowel Disease 363
Maria Rosario, Nathanael L. Dirks, Diane R.Mould, Catherine Scholz, Timothy Wyant, Asit Parikh, and Irving Fox
Abbreviations 363
16.1 Introduction 364
16.2 Dose Selection for Adult Patients in Phase 3 Trials 365
16.3 Pharmacokinetic Profile of Vedolizumab 366
16.4 Population Pharmacokinetics in Phase 1 and 2 Trials 368
16.5 Comparison of Simulated vs. Measured Vedolizumab Trough Concentrations 372
16.6 Population Pharmacokinetics in Phase 3 Trials 372
16.7 Dose Selection for Pediatric Populations 374
16.8 Exposure-Response Analysis 376
16.9 Logistic Regression Analyses 378
16.10 Exposure-Response: Causal Inferences 381
16.11 Conclusion 384
Disclosure 384
References 384
17 Case Examples of Using Quantitative Pharmacology in Developing Therapeutic Proteins in Systemic Lupus Erythematosus - Belimumab 389
Herbert Struemper
17.1 Introduction 389
17.2 Overview of Supporting Data and Methods 390
17.3 Body Size Characterizations and Impact on Switching from Weight Proportional to Fixed Dosing 390
17.4 The Yin and Yang of FcRn - Opposing Effect of Albumin and IgG on mAb Clearance 392
17.5 Lost in Filtration - Renal Contributions to mAb Clearance 395
17.6 Conclusion 397
References 398
18 Case Examples of Using Quantitative Pharmacology in Developing Therapeutic Proteins in Multiple Sclerosis - Peginterferon Beta-1a, Daclizumab Beta, Natalizumab 401
Xiao Hu, Yaming Hang, Lei Diao, Kumar K.Muralidharan, and Ivan Nestorov
18.1 Introduction 401
18.2 Application of Quantitative Clinical Pharmacology for Dosing Regimen Recommendation of Peginterferon Beta- 1a 403
18.3 Population PK/PD Analyses of Daclizumab Beta and Phase 3 Dose Selection 414
18.4 Model-Based Approach for the Clinical Development of Subcutaneous Natalizumab 419
18.5 Summary 431
References 431
Index 437
