title: Ozanezumab dose selection for amyotrophic lateral sclerosis by pharmacokinetic-pharmacodynamic modelling of immunohistochemistry data from patient muscle biopsies.
abstract: Amyotrophic Lateral Sclerosis (ALS) is a rare and fatal neurodegenerative disease with a high unmet medical need. In this context, a potential therapy should be brought to patients in the most expeditious way and early exploration of pharmacology is highly beneficial. Ozanezumab, a humanised IgG monoclonal antibody against Nogo-A protein which is an inhibitor of neurite outgrowth, is currently under development for the treatment of ALS and has been recently assessed in 76 patients in a first-in-human study. Inadequate target engagement has been recognised as a major contributing reason for drug trial failures. In this work, we describe the development of a pharmacokinetic-pharmacodynamic (PKPD) model using immunohistochemistry (IHC) data of co-localization of ozanezumab with Nogo-A in skeletal muscle as a surrogate measure of target engagement. The rich plasma concentration data and the sparse IHC data after one or two intravenous doses of ozanezumab were modelled simultaneously using a non-linear mixed-effect approach. The final PKPD model was a two-compartment PK model combined with an effect compartment PD model that accounted for the delay in ozanezumab concentrations to reach the site of action which is skeletal muscle. Diagnostic plots showed a satisfactory fit of both PK and IHC data. The model was used as a simulation tool to design a dose regimen for sustained drug-target co-localization in a phase II study.
authors.affiliation: Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, London, United Kingdom.
authors.forename: Alienor
authors.initials: A
authors.lastname: Berges
authors.affiliation: Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bullman
authors.affiliation: Biopharm Translational Medicine, GlaxoSmithKline, Stevenage, United Kingdom.
authors.forename: Stewart
authors.initials: S
authors.lastname: Bates
authors.affiliation: Safety Assessment, GlaxoSmithKline, Research Triangle Park, North Carolina, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Krull
authors.affiliation: Clinical Statistics, GlaxoSmithKline, Stevenage, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Williams
authors.affiliation: Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, London, United Kingdom.
authors.forename: Chao
authors.initials: C
authors.lastname: Chen
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000627:therapeutic use; D001706:Biopsy; D003198:Computer Simulation; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006801:Humans; D007150:Immunohistochemistry; D008954:Models, Biological; D018482:Muscle, Skeletal / Q000378:metabolism* / Q000473:pathology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C000594256:ozanezumab