george ngo march 22, 2012 university of georgia college of pharmacy class of 2012
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George Ngo March 22, 2012 University of Georgia College of Pharmacy Class of 2012. Effect of a Monoclonal Antibody to PCSK9 on LDL Cholesterol. The Basics. Monoclonal antibodies bind to a specific epitope (part of an antigen) that the body recognizes - PowerPoint PPT PresentationTRANSCRIPT
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George NgoMarch 22, 2012
University of GeorgiaCollege of Pharmacy
Class of 2012
Effect of a Effect of a Monoclonal Antibody Monoclonal Antibody
to PCSK9 on LDL to PCSK9 on LDL CholesterolCholesterol
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The Basics Monoclonal antibodies bind to a specific epitope (part of an
antigen) that the body recognizes The body's immune system recognizes the substance and
elicits a response to eliminate it 1) Hepatic LDL receptors → “The Victim” 2) PCSK9 → “The Bad Guy”
– An enzyme that binds to hepatic LDL receptors
– 1) accelerates their degradation
– 2) DECREASES LDL cholesterol intake into liver cells (liver cannot bind and remove LDL cholesterol)
– 3) INCREASES LDL cholesterol levels
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What's Our Hero's Name? 3) REGN727 → “The Hero”
– An investigational, fully human monoclonal antibody that is highly specific for human PCSK9
– Blocks PCSK9's interaction with the LDL receptor
Primary Endpoint – Occurrence of adverse effects
Secondary Endpoint – Effect on lipid profile
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Single-Dose Studies
40 pts received IV
32 pts received SQ
Inclusion
Men and women 18-65 years old BMI 18-30 LDL >100mg/dL Prohibited use of
other lipid drugs
• IV group
• Dose ↑ from 1 → 3 → 6 → 12 mg/kg
• Placebo
• SQ group
• Dose ↑ from 50 → 100 → 150 → 250mg
• Placebo
• Safety assessments:
• Vital signs, physical exam, blood tests, EKG
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Multiple-Dose Studies 51 pts → received
atorvastatin with LDL >100mg/dL
10 pts → modified diet only with LDL >130mg/dL
– Pts randomly assigned to receive SQ REGN727 (50, 100, or 150 mg) or placebo given on days 1, 29, and 43
• Safety assessments taken:
• vital signs
• physical examination
• blood tests
• echocardiography
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Results: Safety
• 2 pts in single-dose studies had ADEs (adverse drug events):
– 33 yr-old w/ abd pain + rectal bleeding on day 83
– 19 yr-old w/ hx of appendectomy rec'ving 50 mg of SQ REGN727...had small bowel obstruction on day 75
• Lab effects seen:
– ↑ total bilirubin (1 pt)
– ↑ creatinine kinase (1 pt)
• No pts in multiple-dose studies had serious ADEs
• All pts completed all visits
• No pt had an ↑ in AST or ALT >3 ULN or ↑ in SCr to > 1.7mg/dL
• Headache was the most common ADE
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Results: LDL Response
Single-dose studies ↓ in baseline LDL up
to 65% compared to placebo
Dose-dependent decrease
Higher dose → more decrease
Multiple-dose studies Compared with
placebo, REGN727 doses w/ atorvastatin ↓ baseline LDL by:
50 mg → ↓ 39.2% 100 mg → ↓
53.7% 150 mg → ↓
61.0%
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Results: Single-dose IV
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Results: Single-dose SQ
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Conclusions
REGN727 is a monoclonal antibody that blocks PCSK9 from binding to LDL receptors
REGN727 significantly reduced LDL cholesterol levels compared to placebo
In pts w/ familial or nonfamilial hypercholesterolemia
Also significant in pts also taking Lipitor
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Conclusions
MOA: both ↓ LDL by ↑ hepatic LDL receptor activity
***Key difference: Lipitor enhances production of receptors, REGN727 decreases degradation of receptors
REGN727 takes 2 weeks for max effect, statins can take longer
REGN727 significantly ↓ apolipoprotein B levels
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Limitations
- Small number of subjects
- Short duration of exposure
- Rates of infection or malignancy as possible ADEs not mentioned
- Supported by Regeneron Pharmaceuticals and Sanofi
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Level of Evidence: IIa-B
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References
Gary D Swergold, et al. "Effect Of A Monoclonal Antibody To PCSK9 On LDL Cholesterol." The New England Journal Of Medicine 366.12 (2012): 1108-1118. MEDLINE with Full Text. Web. 29 Mar. 2012.