Minimal Physiologically-Based Pharmacokinetic (mPBPK) Metamodeling of Target Engagement in Skin Informs Anti-IL17A Drug Development in Psoriasis

Abstract

The pharmacologic effect(s) of biotherapeutics directed against soluble targets are driven by the magnitude and duration of free target suppression at the tissue site(s) of action. Interleukin (IL)-17A is an inflammatory cytokine that plays a key role in the pathogenesis of psoriasis. In this work, clinical trial data from two monoclonal antibodies (mAbs) targeting IL-17A for treatment of psoriasis (secukinumab and ixekizumab) were analyzed simultaneously to quantitatively predict their target engagement (TE) profiles in psoriatic skin. First, a model-based meta-analysis (MBMA) for clinical responses was conducted separately for each drug based on dose. Next, a minimal physiologically-based pharmacokinetic (mPBPK) model was built to assess skin site IL-17A target engagement for ixekizumab and secukinumab simultaneously. The mPBPK model captured the observed drug PK, serum total IL-17A, and skin drug concentration-time profiles reasonably well across the different dosage regimens investigated. The developed mPBPK model was then used to predict the average TE (i.e., free IL-17A suppression) in skin achieved over a 12-weeks treatment period for each drug following their respective regimens and subsequently assess the TE-efficacy response relationship. It was predicted that secukinumab achieved 98.6% average TE in the skin at 300 mg q4w SC while ixekizumab achieved 99.9% average TE under 160 mg (loading) followed by 80 mg q2w SC. While direct quantification of free IL-17A levels at the site of action is technically challenging, integrated mPBPK-MBMA approaches offer quantitative predictions of free IL-17A levels at the site of action to facilitate future drug development via IL-17A suppression in psoriasis.

Prediction of relative change in free nerve growth factor following subcutaneous administration of tanezumab, a novel monoclonal antibody to nerve growth factor

“…However, it is expected, as per published literature, that the synovium and surrounding tissue would be relatively leaky due to the ongoing inflammation, 34 so overall impact of tissue distribution on suppression is expected to be the minimal. Whereas the overall dynamics of the system are considered more related to the dual nociceptive effects of NGF suppression already described, there are some reports that minimal physiologically‐based PK models can characterize relationships between anti‐inflammatory drug kinetics at the site of action and responses using preclinical or clinical data 34–36 . Therefore, further work in this regard for tanezumab is warranted.…”

“…Whereas the overall dynamics of the system are considered more related to the dual nociceptive effects of NGF suppression already described, there are some reports that minimal physiologically‐based PK models can characterize relationships between anti‐inflammatory drug kinetics at the site of action and responses using preclinical or clinical data. 34 , 35 , 36 Therefore, further work in this regard for tanezumab is warranted.…”

Editorial: Model-informed decision making in the preclinical stages of pharmaceutical research and development

“…Beyond prospective predictions, retrospective analysis of existing clinical data through PBPK modeling can provide valuable information about target engagement required for efficacy at the site of action that may not be easily assessed using experimental methods ( Ayyar et al, 2022 ; Bloomingdale et al, 2022 ). These studies also help to bridge preclinical information with clinical outcome, hence facilitate future discovery and development of similar therapies.…”