单克隆抗体的皮下给药:药理学、给药方式、免疫原性及临床开发应用经验

Subcutaneous Administration of Monoclonal Antibodies: Pharmacology, Delivery, Immunogenicity, and Learnings From Applications to Clinical Development.

作者信息

Davis John D, Bravo Padros Marçal, Conrado Daniela J, Ganguly Samit, Guan Xiaowen, Hassan Hazem E, Hazra Anasuya, Irvin Susan C, Jayachandran Priya, Kosloski Matthew P, Lin Kuan-Ju, Mukherjee Kamalika, Paccaly Anne, Papachristos Apostolos, Partridge Michael A, Prabhu Saileta, Visich Jennifer, Welf Erik S, Xu Xiaoying, Zhao An, Zhu Min

机构信息

Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA.

出版信息

Clin Pharmacol Ther. 2024 Mar;115(3):422-439. doi: 10.1002/cpt.3150. Epub 2024 Jan 10.

Abstract

Subcutaneous (s.c.) administration of monoclonal antibodies (mAbs) can reduce treatment burden for patients and healthcare systems compared with intravenous (i.v.) infusion through shorter administration times, made possible by convenient, patient-centric devices. A deeper understanding of clinical pharmacology principles related to efficacy and safety of s.c.-administered mAbs over the past decade has streamlined s.c. product development. This review presents learnings from key constituents of the s.c. mAb development pathway, including pharmacology, administration variables, immunogenicity, and delivery devices. Restricted mAb transportation through the hypodermis explains their incomplete absorption at a relatively slow rate (pharmacokinetic (PK)) and may impact mAb-cellular interactions and/or onset and magnitude of physiological responses (pharmacodynamic). Injection volumes, formulation, rate and site of injection, and needle attributes may affect PKs and the occurrence/severity of adverse events like injection-site reactions or pain, with important consequences for treatment adherence. A review of immunogenicity data for numerous compounds reveals that incidence of anti-drug antibodies (ADAs) is generally comparable across i.v. and s.c. routes, and complementary factors including response magnitude (ADA titer), persistence over time, and neutralizing antibody presence are needed to assess clinical impact. Finally, four case studies showcase how s.c. biologics have been clinically developed: (i) by implementation of i.v./s.c. bridging strategies to streamline PD-1/PD-L1 inhibitor development, (ii) through co-development with i.v. presentations for anti-severe acute respiratory syndrome-coronavirus 2 antibodies to support rapid deployment of both formulations, (iii) as the lead route for bispecific T cell engagers (BTCEs) to mitigate BTCE-mediated cytokine release syndrome, and (iv) for pediatric patients in the case of dupilumab.

摘要

与静脉输注相比,皮下注射单克隆抗体可缩短给药时间,从而减轻患者和医疗系统的治疗负担,这得益于便捷、以患者为中心的设备。在过去十年中,对皮下注射单克隆抗体的疗效和安全性相关临床药理学原理的更深入理解简化了皮下产品的开发。本综述介绍了皮下单克隆抗体开发途径的关键组成部分的经验教训,包括药理学、给药变量、免疫原性和给药装置。单克隆抗体在皮下的转运受限解释了它们以相对较慢的速度吸收不完全(药代动力学 (PK)),并可能影响单克隆抗体与细胞的相互作用和/或生理反应的起效和强度(药效学)。注射体积、制剂、注射速率和部位以及针头属性可能会影响药代动力学以及注射部位反应或疼痛等不良事件的发生/严重程度,对治疗依从性有重要影响。对众多化合物的免疫原性数据进行的综述表明,抗药抗体 (ADA) 的发生率在静脉内和皮下途径中通常具有可比性,并且需要包括反应强度(ADA 滴度)、随时间的持续性和中和抗体的存在等补充因素来评估临床影响。最后,四个案例研究展示了皮下生物制剂是如何进行临床开发的:(i) 通过实施静脉内/皮下桥接策略来简化 PD-1/PD-L1 抑制剂的开发,(ii) 通过与静脉内制剂共同开发抗严重急性呼吸综合征冠状病毒 2 抗体以支持两种制剂的快速部署,(iii) 作为双特异性 T 细胞衔接器 (BTCE) 的主要途径以减轻 BTCE 介导的细胞因子释放综合征,以及 (iv) 对于度普利尤单抗治疗的儿科患者。

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