Pfizer Inc., South San Francisco and San Diego, CA, USA.
Mirati Therapeutics Inc., San Diego, CA, USA.
Cardiovasc Ther. 2018 Feb;36(1). doi: 10.1111/1755-5922.12309. Epub 2017 Nov 23.
AIMS: Three single-dose and one multiple-dose phase I studies were conducted in subjects with primary hypercholesterolemia to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of bococizumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor. METHODS: The dosing schedules for hypercholesterolemic subjects randomized in the four phase I studies were (1) ascending, single, intravenous (IV) bococizumab (0.3, 1, 3, 6, 12, or 18 mg/kg), or placebo (N = 48; baseline low-density lipoprotein cholesterol [LDL-C] ≥130 mg/dL); (2) single, IV bococizumab (0.5 or 4 mg/kg; no placebo) added to ongoing atorvastatin 40 mg/day (N = 24); (3) single, fixed, subcutaneous (SC) bococizumab (100 or 200 mg), or IV bococizumab (200 mg; no placebo; N = 49; baseline LDL-C ≥130 mg/dL); and (4) weekly IV bococizumab (0.25, 0.5, 1, or 1.5 mg/kg) or placebo for 4 weeks (N = 67; baseline LDL-C ≥130 mg/dL). RESULTS: Bococizumab pharmacokinetics were well characterized following single IV or SC doses and following multiple IV doses. Exposure to single-dose bococizumab increased slightly greater than dose-proportionally and clearance decreased with increasing dose. In the single-dose studies, maximal mean percent reductions from baseline in LDL-C ranged from 43% (0.3 mg/kg) to 84% (18 mg/kg) in bococizumab-treated subjects, compared with 2% for placebo. For the multiple-dose study, maximal reductions in LDL-C ranged from 55% (0.25 mg/kg) to 66% (1 mg/kg) in bococizumab-treated subjects, compared with 9% for placebo. In all studies, adverse events were infrequent, transient, and not dose-related. CONCLUSIONS: Bococizumab was generally safe and well tolerated. Bococizumab lowered LDL-C levels substantially in all four studies.
目的:四项 I 期研究招募了原发性高胆固醇血症患者,旨在评估 bococizumab(一种前蛋白转化酶枯草溶菌素/克那霉 9(PCSK9)抑制剂)单次和多次给药的安全性、耐受性、药代动力学和药效学。
方法:四项 I 期研究中,高胆固醇血症受试者的给药方案如下:(1)单次递增静脉内(IV) bococizumab(0.3、1、3、6、12 或 18mg/kg)或安慰剂(n=48;基线低密度脂蛋白胆固醇[LDL-C]≥130mg/dL);(2)在阿托伐他汀 40mg/天的基础上加用单次 IV bococizumab(0.5 或 4mg/kg;无安慰剂)(n=24);(3)单次固定皮下(SC) bococizumab(100 或 200mg)或 IV bococizumab(200mg;无安慰剂;n=49;基线 LDL-C≥130mg/dL);(4)每周 IV bococizumab(0.25、0.5、1 或 1.5mg/kg)或安慰剂 4 周(n=67;基线 LDL-C≥130mg/dL)。
结果:单次 IV 或 SC 剂量及多次 IV 剂量后,bococizumab 的药代动力学特征良好。单次给药 bococizumab 的暴露量呈剂量依赖性增加,清除率随剂量增加而降低。在单次给药研究中,与安慰剂组相比,接受 bococizumab 治疗的受试者的 LDL-C 基线平均最大百分比降幅范围为 43%(0.3mg/kg)至 84%(18mg/kg);在多次给药研究中,接受 bococizumab 治疗的受试者的 LDL-C 最大降幅范围为 55%(0.25mg/kg)至 66%(1mg/kg),而安慰剂组的降幅为 9%。在所有研究中,不良事件均不常见、短暂且与剂量无关。
结论:bococizumab 通常安全且耐受良好。四项研究中,bococizumab 均显著降低 LDL-C 水平。
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