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.
Highlights
Amyotrophic Lateral Sclerosis (ALS) is a rare neurodegenerative disorder characterised by progressive loss of motor neurons throughout the central nervous system
We developed a PKPD model using IHC data from muscle biopsies collected in a FiH study to predict the co-localization of membrane Nogo-A and ozanezumab as a function of ozanezumab dosing regimen
Adequate target binding by the drug molecule is a prerequisite for producing a clinically relevant level of pharmacology
Summary
Amyotrophic Lateral Sclerosis (ALS) is a rare neurodegenerative disorder characterised by progressive loss of motor neurons throughout the central nervous system. ALS is classified as an orphan disease, i.e. a rare medical condition with a lack of safe and efficacious drugs that, in this case, slow or reverse the decline of function and significantly prolong life. The only approved drug for ALS affecting the disease course, has a modest effect of prolonging survival by about 2 to 3 months but only a marginal effect on function [2] [3] [4] [5]. Since the approval of riluzole, the field has seen many failed trials. In this context, early exploration of any indication of drug pharmacology would be highly beneficial
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