JP2019519470A - Il−6受容体へのil−6の結合を遮断する薬剤を用いたうつ病の治療 - Google Patents
Il−6受容体へのil−6の結合を遮断する薬剤を用いたうつ病の治療 Download PDFInfo
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Images
Classifications
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
- C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
- C07K16/24—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against cytokines, lymphokines or interferons
- C07K16/244—Interleukins [IL]
- C07K16/248—IL-6
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P25/00—Drugs for disorders of the nervous system
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- A—HUMAN NECESSITIES
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- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P25/00—Drugs for disorders of the nervous system
- A61P25/24—Antidepressants
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
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- A61K2039/54—Medicinal preparations containing antigens or antibodies characterised by the route of administration
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- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
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- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
- C07K2317/21—Immunoglobulins specific features characterized by taxonomic origin from primates, e.g. man
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
- C07K2317/24—Immunoglobulins specific features characterized by taxonomic origin containing regions, domains or residues from different species, e.g. chimeric, humanized or veneered
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
- C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
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- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
- C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
- C07K2317/565—Complementarity determining region [CDR]
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- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
- C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
Abstract
Description
a.対象からの生体試料中の可溶性IL−6受容体(sIL−6R)の量を測定することと、
b.sIL−6Rの量と応答性とを関連付ける閾値を提供することと、
c.sIL−6Rの量を前記閾値に比較することとを含み、sIL−6Rの量が閾値を超えるときに応答性が決定され、及び/又は、sIL−6Rの量が閾値を超えないときに応答性の欠如が決定される。
本明細書で使用するとき、単数形「a」、「an」、及び「the」は複数を含むものとする。
キメラ抗体
本発明にしたがい、抗IL−6 cCLB−8抗体は、可変領域又はCDRが、ヒトIL−6に結合し、その機能を阻害することができるマウスCLB−8抗体由来であり、抗体のフレームワーク及び定常領域が、1つ以上の人抗体由来である、抗体を含む。マウスCLB−8抗体由来の可変領域又はCDRは、好ましくは、マウスCLB−8抗体の可変領域又はCDRと約90%〜100%の同一性を有するが、置換、挿入及び欠失を含む、すべての修飾は、キメラ抗体がIL−6に結合し、阻害する能力を維持する限り、検討される。ヒト抗体由来である、キメラ、ヒト、又はCDRグラフト化抗体の領域は、ヒト抗体と100%の同一性を有する必要はない。好ましい実施形態において、免疫原性が無視できる量で可能な限り多くのヒトアミノ酸残基が維持されるが、ヒト残基、特にフレームワーク領域の残基は、必要に応じて、本発明に従い以下の教示のように、置換される。本明細書に開示されたかかる修飾は、抗体のヒト化を最大限にすると同時に、CDRによって形成される抗原結合部位を支持するために必要である。
重鎖可変領域(配列番号139):
1 EVQLVESGGK LLKPGGSLKL SCAASGFTFS SFAMSWFRQS PEKRLEWVAE ISSGGSYTYY
61 PDTVTGRFTI SRDNAKNTLY LEMSSLRSED TAMYYCARGL WGYYALDYWG QGTSVTVSS
軽鎖可変領域(配列番号140):
1 QIVLIQSPAI MSASPGEKVT MTCSASSSVS YMYWYQQKPG SSPRLLIYDT SNLASGVPVR
61 FSGSGSGTSY SLTISRMEAE DAATYYCQQW SGYPYTFGGG TKLEIK
本発明の一態様において、治療的有効量のIL−6抗原結合タンパク質又はその断片を、これを必要とする患者に投与することを含む、うつ病及び/又は疲労のようなIL−6介在障害の治療又は予防のための方法が提供される。
i)配列番号135に記載されたCDRH1、又は
ii)配列番号136に記載されたCDRH2、又は
iii)配列番号137に記載されたCDRH3、又は
iv)配列番号132に記載されたCDRL1、又は
v)配列番号133に記載されたCDRL2、又は
vi)配列番号134に記載されたCDRL3、のうちの1つ以上のCDRを含み、
X1はA又はGであり、X2はS又はRであり、X3はH、I、S、又はYであり、X4はS又はYであり、X5はS又はFであり、X6はF、L、M、又はTであり、X7はN又はEであり、X8はA又はTであり、X9はM、C、S又はQであり、X10はQ又はCであり、X11はT又はQであり、X12はF、S、又はTであり、X13はS又はPであり、X14はL又はMであり、X15はA又はIであり、X16はS又はPであり、X17はY又はWであり、X18はT、E、又はYであり、X19はY又はFであり、X20はP、S、D、又はYであり、X21はV又はDであり、X22はT又はAであり、X23はG又はPであり、X24はS、Y、T、又はNであり、X25はY、T、F、又はIである。
i)配列番号135に記載されたCDRH1、又は
ii)配列番号136に記載されたCDRH2、又は
iii)配列番号137に記載されたCDRH3、又は
iv)配列番号132に記載されたCDRL1、又は
v)配列番号133に記載されたCDRL2、又は
vi)配列番号134に記載されたCDRL3、のうちの1つ以上のCDRを含み、
X1はA又はGであり、X2はS又はRであり、X3はH、I、S、又はYであり、X4はS又はYであり、X5はS又はFであり、X6はF、L、M、又はTであり、X7はN又はEであり、X8はA又はTであり、X9はM、C、S又はQであり、X10はQ又はCであり、X11はT又はQであり、X12はF、S、又はTであり、X13はS又はPであり、X14はL又はMであり、X15はA又はIであり、X16はS又はPであり、X17はY又はWであり、X18はT、E、又はYであり、X19はY又はFであり、X20はP、S、D、又はYであり、X21はV又はDであり、X22はT又はAであり、X23はG又はPであり、X24はS、Y、T、又はNであり、X25はY、T、F、又はIである。
配列G−F−X11−X12−S−X13−F−A−X14−Sを含み、X11がT又はQであり、X12がF、S、又はTであり、X13がS又はPであり、X14がL又はMである、配列番号135のCDRH1と、
配列K−X15−S−X16−G−G−S−X17−X18−Y−X19−X20−D−TX21−X22−X23を含み、X15がA又はIであり、X16がS又はPであり、X17がY又はWであり、X18がT、E、又はYであり、X19がY又はFであり、X20がP、S、D、又はFであり、X21がV又はDであり、X22がT又はAであり、X23がG又はPである、配列番号136のCDRH2と、配列Q−L−W−G−X24−Y−A−L−D−X25を含み、X24がS、Y、T、又はNであり、X25がY、T、F、又はIである、配列番号137のCDRH3アミノ酸配列と、
配列S−X1−X2−X3−X4−V−X5−Y−M−Yを含み、X1がA又はGであり、X2がS又はRであり、X3がH、I、S、又はYであり、X4がS又はYであり、X5がS又はFである、配列番号132のCDRL1と、
配列D−X6−S−X7−L−X8−Sを含み、X6がF、L、M、又はTであり、X7がN又はEであり、X8がA又はTである、配列番号133のCDRL2と、
配列X9−X10−W−S−G−Y−P−Y−Tを含み、X9がM、C、又はS、X10がQ又はCである、配列番号134のCDRL3とを含む。
配列番号39に応じるCDRH1、
配列番号59に応じるCDRH2、
配列番号89に応じるCDRH3、
配列番号3に応じるCDRL1、
配列番号21に応じるCDRL2、又は
配列番号29に応じるCDRL3のCDR配列のうちの1つ以上を有する。
X1=A又はG
X2=S又はR
X3=H、I、S、又はY
X4=S又はY
X5=S又はF
X6=F、L、M、又はT
X7=N又はE
X8=A又はT
X9=M、C、又はS
X10=Q又はC
X11=T又はQ
X12=F、S、又はT
X13=S又はP
X14=L又はM
X15=A又はI
X16=S又はP
MNSFSTSAFGPVAFSLGLLLVLPAAFPAPVPPGEDSKDVAAPHRQPLTSSERIDKQIRYILDGISALRKETCNKSNMCESSKEALAENNLNLPKMAEKDGCFQSGFNEETCLVKIITGLLEFEVYLEYLQNRFESSEEQARAVQMSTKVLIQFLQKKAKNLDAITTPDPTTNASLLTKLQAQNQWLQDMTTHLILRSFKEFLQSSLRALRQM
抗IL−6抗体は、プロテインA精製、硫酸アンモニウム又はエタノール沈殿、酸抽出、アニオン又はカチオン交換クロマトグラフィー、ホスホセルロースクロマトグラフィー、疎水性相互作用クロマトグラフィー、アフィニティクロマトグラフィー、ヒドロキシルアパタイトクロマトグラフィー及びレクチンクロマトグラフィーが挙げられるがこれらに限定されない、よく知られている方法により、組換え細胞培養物から回収し、精製することができる。高速液体クロマトグラフィー(「HPLC」)を精製に利用することもできる。例えば、Colligan、Current Protocols in Immunology又はCurrent Protocols in Protein Science,John Wiley & Sons,Inc.,NY,NY(1997〜2001)の、例えば、第1、4、6、8、9、10章を参照されたく、それぞれは参照により全体が本明細書に組み込まれる。
IL−6抗体の発現のために、ベクターpC4が使用される。プラスミドpC4は、プラスミドpSV2−dhfr(ATCC受託番号37146)の誘導体である。このプラスミドは、SV40初期プロモーターの制御下でマウスDHFR遺伝子を含有する。これらのプラスミドでトランスフェクトされる、ジヒドロ葉酸活性を欠くチャイニーズハムスター卵巣細胞又はその他の細胞は、化学療法剤メトトレキサートを補充した選択的培地(例えば、α−MEM、Life Technologies,Gaithersburg,MD)中で細胞を成長させることによって選択することができる。メトトレキサート(MTX)に耐性の細胞におけるDHFR遺伝子の増幅は、十分に文書化されている(例えば、F.W.Alt,et al.,J.Biol.Chem.253:1357〜1370(1978))、J.L.Hamlin and CMa,Biochem.et Biophys.Acta 1097:107〜143(1990)及びM.J.Page and M.A.Sydenham,Biotechnology 9:64〜68(1991)を参照のこと)。増大したMTX濃度において成長した細胞は、DHFR遺伝子の増幅の結果として、標的酵素であるDHFRの過剰生成により、薬物に対する耐性を発達させる。第2の遺伝子がDHFR遺伝子に連結されている場合、通常、共増幅され、過剰発現される。このアプローチを使用して、増幅遺伝子(複数可)の1,000を超えるコピーを有する細胞株を開発することができることが、当該技術分野において知られている。続いて、メトトレキサートを回収する際、宿主細胞の1つ以上の染色体(複数可)に組み込まれた増幅遺伝子を含有する細胞株が得られる。
本発明の抗IL−6抗体を構成するアミノ酸は、しばしば、略字表記される。アミノ酸表記は、当該技術分野においてよく理解されているように、その1文字コード、その3文字コード、名称、又は3つのヌクレオチドのコドンによりアミノ酸を表記することによって示すことができる(Alberts,B.ら、Molecular Biology of The Cell(第3版)Garland Publishing,Inc.(New York)1994を参照のこと)。
本発明はまた、本明細書に記載され、かつ/又は当該技術分野において既知であるように、非自然発生組成物、混合物又は形態で提供される、少なくとも1つ、少なくとも2つ、少なくとも3つ、少なくとも4つ、少なくとも5つ、少なくとも6つ、又はそれ以上のその抗IL−6抗体を含む、少なくとも1つの抗IL−6抗体組成物も提供する。かかる組成物は、本明細書に開示される抗体配列、例えば、配列番号1〜92のいずれかの隣接アミノ酸の70〜100%、又はその特定された断片、ドメイン若しくは変異体からなる群から選択される抗IL−6抗体のアミノ酸配列の少なくとも1つ又は2つの完全長、C及び/若しくはN末端欠失変異体、ドメイン、断片、又は特定される変異体を含む非自然発生組成物を含む。好ましい抗IL−6抗体組成物は、例えば、配列番号1〜92の70〜100%の抗IL−6抗体配列、又はその特定された断片、ドメイン若しくは変異体の、少なくとも1つのCDR又はLBR含有部分として少なくとも1つ又は2つの完全長、断片、ドメイン、又は変異体を含む。更に好ましい組成物は、配列番号1〜92の70〜100%、又はその特定された断片、ドメイン若しくは変異体のうちの少なくとも1つを40〜99%含む。このような組成物の百分率は、当該技術分野において既知であるように、又は本明細書に記載されるように、重量、体積、濃度、容量モル濃度、あるいは液体若しくは乾燥溶液、混合物、懸濁液、エマルション、又はコロイドとしての容量モル濃度によるものである。
上述したとおり、本発明は、好ましくは、生理食塩水又は選択された塩を含むリン酸緩衝剤である安定した製剤、並びに保存剤を含有する保存溶液及び製剤、並びに製薬学的に許容できる製剤中に少なくとも1つの抗IL−6抗体を含む薬剤学的又は獣医学的用途に好適な多用途保存製剤を提供する。保存処方は、水性希釈剤中に、少なくとも1種の既知の、すなわち所望によりフェノール、m−クレゾール、p−クレゾール、o−クレゾール、クロロクレゾール、ベンジルアルコール、硝酸フェニル水銀、フェノキシエタノール、ホルムアルデヒド、クロロブタノール、塩化マグネシウム(例えば、六水和物)、アルキルパラベン(メチル、エチル、プロピル、ブチルなど)、塩化ベンザルコニウム、塩化ベンゼトニウム、デヒドロ酢酸ナトリウム及びチメロサール、ポリマー、又はそれらの混合物からなる群から選択される少なくとも1種の保存剤を含有する。当該技術分野において既知であるように、任意の好適な濃度又は混合物、例えば約0.0015%、又は所望の範囲、値、又はこのうちの一部を使用することができる。非限定的な例として、保存剤無添加、約0.1〜2%mクレゾール(例えば、0.2、0.3、0.4、0.5、0.9、1.0%)、約0.1〜3%のベンジルアルコール(例えば、0.5、0.9、1.1、1.5、1.9、2.0、2.5%)、約0.001〜0.5%のチメロサール(例えば、0.005、0.01)、約0.001〜2.0%のフェノール(例えば、0.05、0.25、0.28、0.5、0.9、1.0%)、0.0005〜1.0%のアルキルパラベン(複数可)(例えば、0.00075、0.0009、0.001、0.002、0.005、0.0075、0.009、0.01、0.02、0.05、0.075、0.09、0.1、0.2、0.3、0.5、0.75、0.9、1.0%)などが挙げられる。
本発明による少なくとも1つの抗IL−6抗体の誠意薬学的に有効な量を投与するために、本発明に従い、多くの既知の及び開発された方法を使用することができる。以下の記述では経肺投与が使用されているが、本発明に従ってその他の投与方式を使用して、適切な結果を得てもよい。本発明のIL−6抗体は、担体中で、溶液、エマルション、コロイド若しくは懸濁液として、又は乾燥粉末として、吸入によるか、又は本明細書に記載される若しくは当該技術分野において既知である他の方法による投与に適した様々なデバイス及び方法のいずれかを使用して、送達することができる。
非経口投与用処方は、一般的な賦形剤として滅菌水又は生理食塩水、ポリエチレングリコールなどのポリアルキレングリコール、植物性油、水素化ナフタレンなどを含有してよい。注射用の水性又は油性懸濁液は、既知の方法に従って、適切な乳化剤又は加湿剤及び懸濁剤を使用することによって調製可能である。注射剤は、例えば水溶液、無菌注射液又は溶媒中懸濁液などの非毒性の非経口投与可能な希釈剤であってよい。使用可能なビヒクル又は溶媒としては、水、リンゲル液、等張生理食塩水などが可能であり、通常の溶媒又は懸濁溶媒としては、無菌の不揮発性油を使用することができる。これらの目的では、天然又は合成若しくは半合成の、脂肪油又は脂肪酸、天然又は合成若しくは半合成の、モノグリセリド又はジグリセリド又はトリグリセリドを含む、あらゆる種類の不揮発性油及び脂肪酸を使用することができる。非経口投与は当該技術分野において既知であり、従来の注射手段、米国特許第5,851,198号に記載されているようなガス加圧式無針注入デバイス、及び米国特許第5,839,446号に記載されているようなレーザー穿孔機デバイスが挙げられるが、これらに限定されず、これらは参照によって全体が本明細書に組み込まれる。
本発明は更に、非経口、皮下、筋肉内、静脈内、関節内、気管支内、腹内、包内、軟骨内、洞内、腔内、小脳内、脳室内、結腸内、頚管内、胃内、肝内、心筋内、骨内、骨盤内、心膜内、腹腔内、胸膜内、前立腺内、肺内、直腸内、腎臓内、網膜内、脊髄内、滑液嚢内、胸郭内、子宮内、膀胱内、病巣内、ボーラス、膣内、直腸、口腔内、舌下、鼻腔内又は経皮手段による少なくとも1つの抗IL−6抗体の投与に関する。少なくとも1つの抗IL−6抗体組成物は、非経口(皮下、筋肉内又は静脈内)又は任意のその他の投与、特に、液体溶液若しくは懸濁液の形態で使用するために、特に、クリーム及び座薬などであるがこれらに限定されない半固体形態で、膣若しくは直腸の投与における使用のために、錠剤若しくはカプセルなどであるがこれらに限定されない形態で、口腔若しくは舌下投与用に、あるいは粉末、点鼻薬若しくはエアロゾル、又はある特定の薬剤などであるがこれらに限定されない形態で、鼻腔内に、あるいは皮膚構造を改変するか、又は経皮パッチ中の薬物濃度を増加させるかのいずれかのために、ジメチルスルホキシドなどの化学的促進剤を用いて(Junginger,et al.In「Drug Permeation Enhancement;」Hsieh,D.S.,Eds.,pp.59〜90(Marcel Dekker,Inc.New York 1994、参照により全体が本明細書に組み込まれる)、又はタンパク質及びペプチドを含有する製剤の皮膚への適用(国際公開第98/53847号)、又はエレクトロポレーションなどの一過性の輸送経路を作り出すための、若しくはイオントフォレシスなどの皮膚を通して荷電薬物の移動度を増加させるための電界の適用、又は超音波導入などの超音波の適用(米国特許第4,309,989号及び同第4,767,402号)を可能にする酸化剤を用いて、ゲル、軟膏、ローション、懸濁液若しくはパッチ送達系などであるが、これらに限定されない、経皮的に、調製することができる(上記の刊行物及び特許は、参照により全体が本明細書に組み込まれる)。
経肺投与のためには、好ましくは、少なくとも1つの抗IL−6抗体組成物は、肺の下気道又は洞に達するために有効な粒径で送達される。本発明により、少なくとも1つの抗IL−6抗体は、吸入により治療薬を投与するための、当該技術分野において既知の様々な吸入又は鼻腔内デバイスのいずれかにより送達することができる。患者の洞腔又は肺胞内にエアロゾル化した製剤を被着させることができるこれらのデバイスとしては、定量吸入器、ネブライザー、乾燥粉末発生器、噴霧器などが挙げられる。抗体の経肺又は鼻腔内投与を目的とするのに適したその他のデバイスも、当該技術分野において既知である。かかるデバイスは全てエアロゾル中の抗体を分配するための投与に適した製剤を使用することができる。このようなエアロゾルは、溶液(水性及び非水性の両方)又は固体粒子のいずれかで構成されることができる。
IL−6抗体組成物タンパク質を含むスプレーは、少なくとも1つの抗IL−6抗体の懸濁液又は溶液に加圧下でノズルを通過させることにより生じさせることができる。ノズルの大きさ及び構成、適用される圧力並びに液体供給速度は、所望の出力及び粒径を達成するように選定することができる。例えば、キャピラリー又はノズルフィードとともに電界により電気スプレーを作製することができる。有利に、噴霧器により送達される少なくとも1つの抗IL−6抗体組成物タンパク質の粒子は、約10μm未満、好ましくは約1μm〜約5μm、最も好ましくは約2μm〜約3μmの範囲の粒径を有する。
経口投与のための処方は、腸壁の浸透性を人工的に増大させるためのアジュバント(例えば、レゾルシノール、並びにポリオキシエチレンオレイルエーテル及びn−ヘキサデシルポリエチレンエーテルのような非イオン性界面活性剤)の同時投与、並びに酵素的分解を阻害するための酵素阻害剤(例えば、膵トリプシン阻害剤、ジイソプロピルフルオロリン酸(DFF)及びトラシロール)の同時投与による。経口、口腔内、粘膜、鼻、肺、膣経膜、又は直腸投与を意図する、タンパク質及び抗体並びに少なくとも2つの界面活性剤の組み合わせを包含する親水性剤の送達のための処方が、米国特許第6,309,663号に教示されている。経口投与のための固体型剤形の活性成分化合物は、ショ糖、乳糖、セルロース、マンニトール、トレハロース、ラフィノース、マルチトール、デキストラン、デンプン、寒天、アルギン酸塩、キチン、キトサン、ペクチン、トラガカントガム、アラビアゴム、ゼラチン、コラーゲン、カゼイン、アルブミン、合成又は半合成ポリマー、及びグリセリドなどの、少なくとも1つの添加物と混合することができる。これらの剤形はまた、他の種類の添加剤、例えば、不活性希釈剤、滑沢剤(ステアリン酸マグネシウムなど)、パラベン保存剤(ソルビン酸、アスコルビン酸、アルファ−トコフェロールなど)、抗酸化剤(システインなど)、崩壊剤、結合剤、増粘剤、緩衝剤、甘味剤、着香剤、香料などを含有してもよい。
生じるマイクロカプセルの大きさが適正であるために、消化管を通過した後にも有効さを損うことなく集合リンパ小節(動物の「パイエル板」又は別名「GALT」として知られる)に達して取り込まれるような剤をもたらすマイクロカプセルを提供する、1つ以上の生体適合性ポリマー又はコポリマー賦形剤、好ましくは生物分解性ポリマー又はコポリマー中に、生物活性薬剤を封入して経口投与するための処方。類似の集合リンパ小節は気管支(BALT)及び大腸に見ることができる。上述の組織は一般に粘膜関連リンパ組織(MALT)と称される。粘膜表面を通る吸収のため、少なくとも1つの抗IL−6抗体を投与するための組成物及び方法は、複数のサブミクロン粒子と、粘膜付着性巨大分子と、生物活性ペプチドと、エマルション粒子の粘膜付着を達成することにより粘膜表面を通る吸収を促進する水性連続相と、を含む、エマルションを含む(米国特許第5,514,670号)。本発明のエマルションの適用に適する粘膜表面には、角膜、結膜、口腔内、舌下、鼻、膣、肺、胃、腸及び直腸投与経路を挙げることができる。膣又は直腸投与のための処方、例えば、坐剤は、賦形剤として、例えば、ポリアルキレングリコール、ワセリン、カカオバターなどを含有してよい。鼻内投与のための処方は固体であってよく、賦形剤として、例えば乳糖を含有することができ、又は水性若しくは油性溶液の点鼻薬であることができる。口腔内投与のために、賦形剤として、糖、ステアリン酸カルシウム、ステアリン酸マグネシウム、前ゼラチン化デンプンなどが挙げられる(米国特許第5,849,695号)。
経皮投与のために、少なくとも1つの抗IL−6抗体を、リポソーム若しくはポリマーナノ粒子、微小粒子、マイクロカプセル又はミクロスフェア(特に明示しない限り、集合的に微小粒子と称する)などの送達デバイス中にカプセル化する。ポリ乳酸、ポリグリコール酸及びそれらのコポリマーのようなポリヒドロキシ酸、ポリオルトエステル、ポリ無水物及びポリホスファゼンのような合成ポリマー、並びにコラーゲン、ポリアミノ酸、アルブミン及び他のタンパク質、アルギン酸塩及び他の多糖類のような天然ポリマー、並びにそれらの組み合わせから作成される微小粒子を包含する多くの好適なデバイスが既知である(米国特許第5,814,599号)。
本発明の化合物を、単回投与により、長期間にわたり、例えば、1週〜1年間、被験体に送達することが望ましい場合がある。様々な徐放、デポー又は埋め込み剤形を利用することができる。例えば、剤形は、体液において溶解度が低い化合物の製薬的に許容できる非毒性塩、例えば、(a)リン酸、硫酸、クエン酸、酒石酸、タンニン酸、パモ酸、アルギン酸、ポリグルタミン酸、ナフタレンモノ−又はジスルホン酸、ポリガラクツロン酸などの多塩基酸との酸付加塩、(b)亜鉛、カルシウム、ビスマス、バリウム、マグネシウム、アルミニウム、銅、コバルト、ニッケル、カドミウムなどの多価金属カチオン、又は例えば、N,N’−ジベンジル−エチレンジアミン若しくはエチレンジアミンから形成された有機カチオンを有する塩、あるいは(c)(a)及び(b)の組み合わせ、例えば、タンニン酸亜鉛塩を含有し得る。加えて、本発明の化合物、又は好ましくは前述したものなどの比較的不溶性の塩を、注射に好適な例えば、ゴマ油とともに、例えば、モノステアリン酸アルミニウムゲルなどのゲル中で処方することができる。とりわけ好ましい塩は、亜鉛塩、亜鉛タンニン酸塩、パモ酸塩などである。別の種類の注射用徐放デポー処方は、例えば米国特許第3,773,919号に記述されるところのポリ乳酸/ポリグリコール酸ポリマーのようなゆっくりと分解する非毒性の非抗原性ポリマー中にカプセル化のため分散された化合物又は塩を含有する。化合物、又は好ましくは上述したものなどの比較的不溶性の塩は、特に動物での使用のためコレステロールマトリックスのシラスティックペレット中でもまた処方することができる。更なる徐放デポー又は注入処方、例えば、気体又は液体リポソームは、文献(米国特許第5,770,222号、及び「Sustained and Controlled Release Drug Delivery Systems」、J.R.Robinson編、Marcel Dekker,Inc.,N.Y.,1978)で既知である。
IL−6に対するモノクローナル抗体を使用する複数の臨床試験は、プラズマ細胞白血病、多発性骨髄腫、Bリンパ増殖性疾患、関節リウマチ、腎癌、及びAIDS関連リンパ腫を含む、複数の疾患において実施されている。
シルクマブデータセットは、CRP≧10mg/LのスクリーニングによるMTX抵抗性RA患者における、第2相無作為化、二重盲検プラセボ対照臨床試験、NCT00718718からである(Smolen,J.S.,et al.,Ann Rheum Dis 73:1616〜1625(2014))。治療薬は、皮下投与された(2週間毎に100mg、又は4週間毎に25、50、若しくは100mg)。全用量群は、サンプルサイズを最大にするために、ここに示される分析のために組み合わされた。抗うつ剤療法の使用を報告した11人の対象は、分析から除外された。176人のRA患者が、ベースライン統計の分析に含まれ、脱落又は通院不能による欠落データを考慮する、それぞれの分析の正確なサンプルサイズは、図面内に示される。RA症状の重症度は、C反応性タンパク質、DAS28−CRPを使用する疾患活動性スコアを使用して測定した(Husley,T.C.,et al.,J S C Med Assoc 85:357〜384(1989))。RA応答者のステータスは、第12週目に、ベースラインからの関節腫脹及び圧痛の50%変化に相当する、米国リウマチ学会50応答(ACR50)を使用して決定した(Aletaha,D.,et al,Arthritis Rheum 62:2569〜2581(2010))。
シルクマブ研究において、血清検体が分離され、更に処理するまで−80℃で保管された。ELISAアッセイは、高感度C反応性タンパク質(CRP)及び血清アミロイドA(SAA)に対して、Quintiles Labによって実施された。IL−6アッセイは、Mesoscale Diagnostics(MSD)超高感度キット(K111AKC)を使用して実施した。sIL6R ELISAアッセイは、R&D Systems(DR600)を使用して、sgp130アッセイは、R&D Systems(DGP00)を使用して実施した。シルツキシマブ研究において、CRP検体は、0.20mg/Lの定量下限(LLOQ)で高感度CRPアッセイを使用して、Covanceで分析された。
2つの主要うつ病症状(抑鬱気分及び快感消失)及び2つの疲労症状(消耗及び疲労)が、SF−36健康調査票、バージョン2.0に記録された(Ware J.E.et al.,QualityMetric(2001))。患者は、高頻度の抑鬱気分及び快感消失(PDMA)の存在/不在、つまり、4週間に、うつ病症状のうちの1つが、少なくとも「ほとんどの時間」存在したか、少なくとも「時には」存在したか、によってグループ分けされた。治療グループは、任意の治療用量を投与されると定義された。
比較は、ベースラインの臨床測定、人口動態、及び血清バイオメーカーのベースラインレベルに対して、適切な時点で、カイ二乗検定又はウィルコクソンの2検体順位和検定を使用して、ベースラインでPDMA有り及び無しの患者グループ間で行われた。ベースライン血清バイオマーカーとの相関は、(部分的)スピアマン相関係数を使用して評価した。治療効果は、反復測定混合モデル(MMRM:Mixed Models with Repeated Measures)を使用して確認された。個別のモデルは、ベースラインでのPDMA有り及び無しの患者に対して適合された。依存変数は、うつ病症状スコアであった。治療、通院、通院毎の治療は、反復測定値として含まれる通院による固定効果である。シルツキシマブ研究のために、コルチコステロイドの使用が、追加の固定効果として含まれる。RA又はMCD症状の変化を考慮するために、DAS28−CRP又はMCDOS(それぞれ)が、時間依存固定効果として追加された。治療群内の改善は、対応する治療群の治療前及び治療後の通院時のうつ病症状のスコアの最小二乗平均を対比させることによって、推定した。治療効果は、治療群の改善とプラセボ群の改善とを対比することによって推定した。統計的有意を宣言するために、0.05のp値の閾値が使用された。すべての分析は、SAS9.2を使用して実施された。
高頻度の抑鬱気分及び快感消失(PDMA)は、ベースラインで、176人のRA患者のうち46人(26%)、及び77人のMCD患者のうちの15人(20%)によって経験されている。PDMA有り及び無しのシルクマブ及びシルツキシマブ患者コホートの重要な人口動態及びベースライン特徴は、表11に示される。全体的に、PDMAを有するRA患者の間では、やや若い年齢を例外として有意な人口動態の差は存在せず、人種分布に有意な差は存在しない。
シルクマブ治療は、PDMA有り及び無しの対象において、DAS28−CRPによって評価されるRA重症度を有意に改善し、臨床効果もプラセボよりも有意に向上した(図3A)。シルツキシマブ治療は、PDMA有り及び無しの対象において、MCDDOSによって評価される、MCD症状の重症度を有意に改善したが、6週間時点では、プラセボ群との有意な差は存在しない(図3B)。
PDMAを有するRA患者において、抑鬱気分及び快感消失の評価は、シルクマブの下で有意に改善し、この改善は、シルクマブにおいて検出されるベースラインRA重症度の調整あり及びなしの両方で有意であった。プラセボ群のうつ病症状の対応する変化は有意ではなかった(図2A)。気分の改善は、DAS28CRP重症度を調整しないと、プラセボ群よりもシルクマブ群のほうが有意に高いが、調整すると高くない(図2A)。シルクマブもまた、ACR50によって定義されるように、RA非応答者における抑うつ気分及び快感消失の評価を有意に改善した(図3A)。シルクマブもプラセボも、ベースラインでPDMAのなかった患者の気分評価を有意に変化させなかった(可能性として天井効果に起因、図2A)。
シルクマブ研究において、治験参加時にPDMAを有するMCD患者は、プラセボ群よりもシルクマブにおいて疲労評価で有意により大きい改善を示す。DAS28−CRP重症度を調整すると、シルクマブ治療のみで、効果が有意なままである(図3A)。治験参加時にPDMAを有さない患者において、疲労は、治療グループとプラセボグループの両方で、ベースラインから第12週目まで、有意に改善した(図3A)。
治療前にPDMAを有したRA患者では、RA応答者(ACR50)又は非応答者(図4A)として分類されるかどうかにかかわらず、シルクマブで治療した対象において、抑鬱気分及び快感消失に有意な改善が検出された。対照的に、シルクマブ治療は、RA応答者において疲労評価に関して有意な改善を得たが、非応答者では得られなかった(図5A)。
PDMAを有するRA患者において、シルクマブ群では、抑鬱気分及び快感消失の変化とCRP、IL−6及びsgp130の治療前レベルとの間には、有意な相関付けが全く見出されなかった(表13)。抑鬱気分及び快感消失の改善は、ベースラインsIL−6Rレベルと有意に相関付けられた(p=0.015、表13)。sIL−6R(≧45ng/mL)の中央値折半に基づく「高」対「低」グループへのPDMA対象の更なる階層化は、シルクマブを用いて治療した際に気分が改善した患者の増加を明らかにした(図4B)。PDMAを有するMCD患者において、シルツキシマブを用いた治療による気分の改善とCRP又はIL−6のベースラインレベルとの間の有意な相関は全く検出されなかった(表12)。sIL−6R及びsgp130は、MCD治験において測定されなかった。
Claims (20)
- 対象のうつ病又は疲労を治療するための方法であって、IL−6受容体へのIL−6の結合を遮断する薬剤を含む医薬組成物の有効量を前記対象に投与することを含む、方法。
- 前記対象が、抑鬱気分、疲労、又は快感消失を有する、請求項1に記載の方法。
- 前記対象が、関節リウマチを有する、請求項1に記載の方法。
- 前記対象が、多中心性キャッスルマン病を有する、請求項1に記載の方法。
- IL−6受容体へのIL−6の結合を遮断する前記薬剤が、単離された抗体又はその抗原結合断片を含む、請求項1〜4のいずれかに記載の方法。
- 前記単離された抗体又はその抗原結合断片が、
i)配列番号135に記載されたCDRH1と、
ii)配列番号136に記載されたCDRH2と、
iii)配列番号137に記載されたCDRH3と、
iv)配列番号132に記載されたCDRL1と、
v)配列番号133に記載されたCDRL2と、
vi)配列番号134に記載されたCDRL3と、であるCDRを含み、
X1がA又はGであり、X2がS又はRであり、X3がH、I、S、又はYであり、X4がS又はYであり、X5がS又はFであり、X6がF、L、M、又はTであり、X7がN又はEであり、X8がA又はTであり、X9がM、C、S、又はQであり、X10がQ又はCであり、X11がT又はQであり、X12がF、S、又はTであり、X13がS又はPであり、X14がL又はMであり、X15がA又はIであり、X16がS又はPであり、X17がY又はWであり、X18がT、E、又はYであり、X19がY又はFであり、X20がP、S、D、又はYであり、X21がV又はDであり、X22がT又はAであり、X23がG又はPであり、X24がS、Y、T、又はNであり、X25がY、T、F、又はIである、請求項1〜5のいずれかに記載の方法。 - 前記単離された抗体又はその抗原結合断片が、それぞれ配列番号99及び配列番号97の重鎖可変領域及び軽鎖可変領域を含む、請求項1〜5のいずれかに記載の方法。
- 前記単離された抗体又はその抗原結合断片が、それぞれ配列番号139及び配列番号140の重鎖可変領域及び軽鎖可変領域を含む、請求項1〜5のいずれかに記載の方法。
- 前記単離された抗体又はその抗原結合断片が、配列番号141のアミノ酸配列を含む重鎖CDR1と、配列番号142のアミノ酸配列を含む重鎖CDR2と、配列番号143のアミノ酸配列を含む重鎖CDR3と、配列番号144のアミノ酸配列を含む軽鎖CDR1と、配列番号145のアミノ酸配列を含む軽鎖CDR2と、配列番号146のアミノ酸配列を含む軽鎖CDR3と、を含む、請求項1〜5のいずれかに記載の方法。
- 前記単離された抗体又はその抗原結合断片が、2〜4週間毎に25〜100mgの用量で投与される、請求項5に記載の方法。
- 前記単離された抗体又はその抗原結合断片が、2週間毎に100mg、4週間毎に25mg、4週間毎に50mg、及び4週間毎に100mgを含む群から選択される用量で投与される、請求項10に記載の方法。
- 前記単離された抗体又はその抗原結合断片が、3週間毎に11mg/kgの用量で投与される、請求項5に記載の方法。
- 前記単離された抗体又はその抗原結合断片が皮下投与される、請求項5に記載の方法。
- 前記単離された抗体又はその抗原結合断片が静脈内投与される、請求項5に記載の方法。
- IL−6抗体又はその断片を用いる治療に対する、うつ病を有する個体の応答性を決定するための方法であって、
a.前記対象からの生体試料中の可溶性IL−6受容体(sIL−6R)の量を測定することと、
b.前記sIL−6Rの量と応答性とを関連付ける閾値を提供することと、
c.sIL−6Rの量を前記閾値に比較することと、ここで、前記sIL−6Rの量が、前記閾値を超えるときに応答性が決定され、及び/又は、前記sIL−6Rの量が前記閾値を超えないときに応答性の欠如が決定され、
d.IL−6受容体へのIL−6の結合を遮断する薬剤を用いて前記個体を治療することと、を含む、方法。 - 前記閾値が45ng/mLである、請求項15に記載の方法。
- 前記生体試料が血清である、請求項15に記載の方法。
- 前記患者が、関節リウマチ又は多中心性キャッスルマン病を有する、請求項15に記載の方法。
- 前記IL−6抗体又はその断片が、それぞれ、配列番号99及び配列番号97の重鎖可変領域及び軽鎖可変領域を含む、請求項15に記載の方法。
- 前記IL−6抗体又はその断片が、それぞれ、配列番号139及び配列番号140の重鎖可変領域及び軽鎖可変領域を含む、請求項15に記載の方法。
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PCT/US2017/026395 WO2017177032A2 (en) | 2016-04-07 | 2017-04-06 | Treatment of depression using agents that block binding of il-6 to il-6 receptor |
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PE20061324A1 (es) * | 2005-04-29 | 2007-01-15 | Centocor Inc | Anticuerpos anti-il-6, composiciones, metodos y usos |
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ANNALS OF THE RHEUMATIC DISEASES, vol. 74, no. 2, JPN6021013524, 2015, pages 0182 - 720, ISSN: 0004656507 * |
EUROPEAN NEUROPSYCHOPHARMACOLOGY, vol. Vol. 25, Abstract No. P.2.b.033, JPN6021013530, 2015, pages 403 - 404, ISSN: 0004656509 * |
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PATIENT, vol. 8, no. 2, JPN6021013537, 2015, pages 207 - 216, ISSN: 0004656510 * |
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WO2017177032A3 (en) | 2017-11-16 |
CA3019828A1 (en) | 2017-10-12 |
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WO2017177032A2 (en) | 2017-10-12 |
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