JP2021507902A - Fgf21変異体を用いて代謝障害を治療する方法 - Google Patents
Fgf21変異体を用いて代謝障害を治療する方法 Download PDFInfo
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Abstract
Description
本開示は、Fc−FGF21変異体融合タンパク質を含む、FGF21タンパク質変異体を用いて、代謝又は心血管障害を治療、予防、及び管理する方法、並びに心血管リスクを減少させる方法に関する。
インスリン抵抗性は、一般的であり、複数の疾患の病態形成における中心的役割を担う。中心性脂肪蓄積は、インスリン感受性に対して有害な効果を有することが示されている、炎症性サイトカイン及び非エステル化脂肪酸の重要な供給源である。インスリン抵抗性及び脂肪蓄積に関連する代謝障害は、糖尿病、肥満、脂質異常症、冠動脈心疾患、及びNAFLD/NASHなどの様々な形態で顕在化する。線維芽細胞増殖因子21(FGF21)は、インスリン感受性を改善し、トリグリセリドを低下させ、且つ脂肪蓄積を減少させるため、肝臓及び脂肪組織に対して作用すると考えられる。したがって、臨床的に許容できる投与計画を備えたFGF21類似体は、これらの代謝障害に対するフロントライン治療になることが期待される。
FGF21に対する新規な改良により、野生型FGF21に対して半減期及び/又は効力が改善され、臨床的に好ましい投与計画で、代謝若しくは心血管障害を治療若しくは管理する(例えば、障害の1つ以上の症状を軽減する)、又は心血管リスクを減少させるためのFGF21治療法を提示することができる。
代謝障害又は心血管障害を治療、予防、又は管理する(例えば、障害の1つ以上の症状を軽減する)際の使用のための方法及び医薬組成物であって、それを必要とする対象に、ヒトFGF21タンパク質変異体(例えば、Fc−FGF21突然変異体融合タンパク質、例えばV103(配列番号11))を、100mg〜600mgの範囲内の用量又は量で投与することを含む、方法及び医薬組成物が本明細書に提供される。具体的態様では、ヒトFGF21タンパク質変異体、例えばV103(配列番号11)は、200mg〜400mgの範囲内の用量で投与される。具体的態様では、ヒトFGF21タンパク質変異体、例えばV103(配列番号11)は、少なくとも200mg、少なくとも300mg、又は少なくとも400mgの用量で投与される。具体的態様では、ヒトFGF21タンパク質変異体、例えばFc−FGF21突然変異体融合タンパク質、例えばV103(配列番号11)は、100mg〜600mg、例えば250mg〜350mgの範囲内の用量で、4週ごとに1回(又は1月ごとに1回)、又は3週ごとに1回又は2週ごとに1回、投与される。
FGF21に関連する用語「天然」又は「野生型」は、生物活性のある天然に存在するFGF21、例えば生物活性のある天然に存在するFGF21変異体を指す。例示的なヒトFGF21野生型配列は、NCBI参照配列番号NP_061986.1を有し、例えば米国特許第6,716,626B1号明細書などの交付済み特許中に見出すことができる(配列番号1)。
完全長FGF21ポリペプチドをコードする対応するmRNA配列(NCBI参照配列番号NM_019113.2)は以下に示される(配列番号2):
成熟FGF21配列は、リーダー配列を欠いており、ポリペプチドの他の修飾、例えば、アミノ末端(リーダー配列の存在下又は不在下)及び/又はカルボキシル末端のタンパク質分解プロセシング、より大きい前駆物質からのより小さいポリペプチドの切断、N結合型及び/又はO結合型グリコシル化、並びに当業者によって理解されている他の翻訳後修飾をさらに含んでもよい。成熟FGF21配列の代表例は、以下の配列を有する(完全長FGF21タンパク質配列(NCBI参照配列番号NP_061986.1)のアミノ酸29〜209位を表す配列番号3):
成熟FGF21ポリペプチド(配列番号3)をコードする対応するcDNA配列が以下に示される(配列番号4):
代謝障害又は心血管障害を治療、予防、又は管理する(例えば、その1つ以上の症状を軽減する)際の使用のための方法及び医薬組成物であって、それを必要とする対象に、ヒトFGF21タンパク質変異体(例えば、Fc−FGF21突然変異体融合タンパク質、例えばV103(配列番号11))を、100mg〜600mgの範囲内の用量で、例えば、1日1回、2、3、4、5、若しくは6日ごとに1回、1週ごとに1回、2週ごとに1回、3週ごとに1回、又は4週ごとに1回(又は1月ごとに1回)、投与することを含む、方法及び医薬組成物が本明細書に提供される。具体的態様では、ヒトFGF21タンパク質変異体(例えば、Fc−FGF21突然変異体融合タンパク質、例えばV103(配列番号11))は、200mg〜400mgの範囲内の用量で投与される。具体的態様では、ヒトFGF21タンパク質変異体(例えば、Fc−FGF21突然変異体融合タンパク質、例えばV103(配列番号11))は、約200mg、250mg、300mg、350mg、又は400mgの用量で、例えば、1週ごとに1回、2週ごとに1回、3週ごとに1回又は4週ごとに1回(又は1月に1回)、投与される。具体的態様では、ヒトFGF21タンパク質変異体(例えば、Fc−FGF21突然変異体融合タンパク質、例えばV103(配列番号11))は、4週ごとに1回(又は1月に1回)、投与される。特定の態様では、ヒトFGF21タンパク質変異体、例えばV103(配列番号11)は、3週ごとに1回、2週ごとに1回、又は1週ごとに1回、投与される。
・肝性脳症、食道静脈瘤、若しくは門脈大静脈シャントの病歴による、又は超音波スクリーニング時の肝胆道疾患、胆石症、又は胆泥の病歴;
・スクリーニング又はベースライン時、正常上限を超える異常な肝機能試験(ALT、AST、GGT、アルカリホスファターゼ、又は血清ビリルビン)によって示されるときの肝疾患又は肝損傷;
・ヒト免疫不全ウイルス(HIV)、B型肝炎(HBV)又はC型肝炎(HCV)による慢性感染;
・HBV表面抗原(HBsAg)試験陽性、又は標準の局所的な実行の場合、HBVコア抗原試験陽性
・陽性(検出可能な)HCV RNA;
・膵損傷又は膵炎、又は他の膵疾患の病歴;
・スクリーニング又はベースライン時、ULNを超えるアミラーゼ又はリパーゼ;
・類似した生物学的クラスの、FGF21タンパク質類似体、又はFc融合タンパク質の薬剤に対する過敏症の病歴;
・限定はされないが、骨粗鬆症、骨減少症、骨軟化症、重度のビタミンD欠乏を含む骨障害の病歴;及び
・スクリーニング時、血漿25−ヒドロキシビタミンDレベルが正常範囲の下限を下回る。
FGF21に対する修飾により野生型FGF21よりも半減期及び/又は効力が改善されることで、臨床的に好ましい投与計画とともに、代謝若しくは心血管障害を治療若しくは管理する(例えば、障害の1つ以上の症状を軽減する)又は心血管リスクを減少させるためのFGF21治療薬が得られうる。
具体的態様では、代謝又は心血管障害、例えば高トリグリセリド血症及び心リスク、インスリン抵抗性、例えば、インスリン受容体の遺伝子突然変異及びリポジストロフィー、糖尿病、肥満、及び非アルコール性脂肪肝疾患(NAFLD)/非アルコール性脂肪性肝炎(NASH)を有する患者を治療、予防、及び/又は管理する方法における使用のための、FGF21タンパク質変異体、例えば表1に記載のFGF21タンパク質変異体、例えばV103(配列番号11)を含む医薬組成物が本明細書に提供される。
以下の実施例は、本発明を例示することが意図され、それに対する制限であるように解釈されるべきでない。当該技術分野で通常であるように、略称が用いられる。
Fc−FGF21変異体融合タンパク質、例えば配列番号11を含むV103について述べており、例えば、PCT公開番号の国際公開第2013/049247号パンフレットを参照されたし。例えば、V103は、ob/obマウス(2型糖尿病用のマウスモデルとしての機能的レプチン欠損マウス)において、マウス3T3L1脂肪細胞による2−デオキシグルコース取り込みを誘導し、細胞に基づくERKリン酸化アッセイにおいてERKシグナル伝達を誘導し、且つ総血漿グルコース、血漿インスリン、及び体重を減少させることが報告されている。V103はまた、より長い半減期を有し、また例えば融解温度による評価としてより熱力学的に安定であることが報告されている。
臨床試験の目的は、肥満対象における3か月にわたり皮下投与された複数回用量のV103の安全性及び耐容性を評価することである。さらに、試験では、トリグリセリド上昇及び/又は肥満に関連する様々な代謝疾患における早期の有効性シグナルや、V103が、高トリグリセリド血症、肥満、及び/又は非アルコール性脂肪性肝疾患といった代謝疾患の発生に適した治療薬として臨床的安全性及び有効性特性を示すか否かをも判定することになる。
一次目的は、12週にわたるV103の皮下(SC)注射による反復投与後の、肥満対象における安全性及び耐容性を評価することである。この目的に関するエンドポイントは、
・有害事象(AE)
・バイタルサイン
・アスパラギン酸トランスアミナーゼ(AST)、アラニントランスアミナーゼ(ALT)、総ビリルビン(Total Bili)及びアルカリホスファターゼ(ALP)の肝機能検査
・24時間尿中コルチゾール
・電解質
を含む。
・治療の12週目、トリグリセリド及び脂質特性に対するV103の効果を評価すること
・治療の12週目、再吸収、骨形成及び沈着に対する再吸収のバランスに関する骨バイオマーカーに対するV103の潜在的効果を評価すること
・12週目、体重、肥満度指数(BMI)及び腹囲により測定するとき、体重に対するV103の効果を評価すること
を含む。
・12週目の総コレステロール、LDL−C、HDL−C及びトリグリセリド(空腹時)
・12週目の骨再吸収のバイオマーカー(血清CTX−1、尿NTX−1)
・12週目の骨形成バイオマーカー(血清BSAP、PlNP、及びオステオカルシン)
・12週目の体重、肥満度指数(BMI)、腹囲、及びパーセント肝脂肪画分(MRIにより測定されるとき)
を含む。
・12週にわたる反復投与後の肥満対象におけるV103の薬物動態(PK)を評価すること
・V103の反復皮下投与後のV103の免疫原性を評価すること
・V103の潜在的な血糖代謝効果を評価すること
を含む。
・AUClast、Cmax、及びTmaxを含むPKパラメータの決定;
・最大12週までの、空腹時血糖、インスリン、グルカゴン、及びC−ペプチド、並びにインスリン感受性及び分泌(HOMA)について得られた推定値;
・HbAlc、糖化アルブミン;
・アディポネクチン;及び
・26週にわたる投与前及び投与後の抗薬剤抗体(ADA)
が挙げられる。
試験は、V103又はプラセボが3か月にわたる反復投与で皮下投与される、肥満対象における非確認、多施設、無作為化、治験責任医師及び対象盲検、プラセボ対照安全性試験として設計する。
試験集団は、18〜55歳(を含む)約60名の成人男性及び女性の肥満対象から構成されることになる。
・18〜55歳を含む男性及び女性対象;
・30〜45kg/m2の範囲内を含む肥満度指数(BMI)(民族調整としてアジア人については≧27.5)(WHO Expert Consultation,2004,Lancet,363(9403):157−63);BMI=体重(kg)/[身長(m)]2を含む;及び
・スクリーニング時、150〜500mg/dL(1.69〜5.65ミリモル/L)を含むトリグリセリド。
・肝性脳症、食道静脈瘤、若しくは門脈大静脈シャントの病歴による又は超音波スクリーニング時の肝胆道疾患、胆石症、又は胆泥の病歴;
・スクリーニング又はベースライン時、正常上限を超える異常な肝機能試験(ALT、AST、GGT、アルカリホスファターゼ、又は血清ビリルビン)によって示されるときの肝疾患又は肝損傷;
・ヒト免疫不全ウイルス(HIV)、B型肝炎(HBV)又はC型肝炎(HCV)による慢性感染。HBV表面抗原(HBsAg)試験陽性、又は標準の局所的な実行の場合、HBVコア抗原試験陽性における対象を除外する。HCV抗体試験が陽性である対象は、HCV RNAレベルの測定を行う必要がある。陽性(検出可能な)HCV RNAを有する対象は除外される必要がある;
・500mg/dL[5.65ミリモル/L]以上の空腹時トリグリセリド、又は高トリグリセリド血症に対する薬物治療の併用(フィブラート、ω−3脂肪酸、ニコチン酸);
・膵損傷又は膵炎、又は他の膵疾患の病歴。スクリーニング又はベースライン時、ULNを超えるアミラーゼ又はリパーゼ;
・類似した生物学的クラスの、FGF21タンパク質類似体、又はFc融合タンパク質の薬剤に対する過敏症の病歴;
・限定はされないが、骨粗鬆症、骨減少症、骨軟化症、重度のビタミンD欠乏を含む骨障害の病歴;
・スクリーニング時、血漿25−ヒドロキシビタミンDレベルが正常範囲の下限を下回る;
・MRIに対する禁忌;
・体重の変化(過去3か月間の、5%超の自己報告変化又は5kgの自己報告変化);
・体重減少薬:オルリスタット(Xenical、Alli)、ロルカセリン(Belviq)、フェンテルミン・トピラマート(Qsymia)、ナルトレキソン・ブプロピオン(Contrave)、又はリラグルチド(Victoza又はSaxenda)又は他のグルカゴン様ペプチド1(GLP1)受容体作動薬(エキセナチド(Byetta/Bydureon)、リキシセナチド(Luxumia)、アルビグルチド(Tanzeum)又はデュラグルチド(Trulicity)又はその他)の使用;及び
・無作為化前3か月以内の体重減少への具体的意図を伴う食事、体重減少又は運動プログラムへの登録、又は任意の摂食障害の臨床診断もまた除外である。
・空腹時トリグリセリド
・体重
・主要な安全性評価
・有害事象及び重篤な有害事象の監視
・骨バイオマーカー
・肝機能
・超音波
・膵機能
・下垂体−副腎機能
・他の下垂体−内分泌の安全性の監視
・身体検査及びバイタルサイン
・血中及び尿中の日常の実験室マーカーの監視
・心電図
・コロンビア自殺重症度評価尺度(C−SSRS)
・炎症の機構的バイオマーカー及びバイオマーカー
一態様では、代謝障害又は心血管障害を治療、予防、又は管理する方法であって、それを必要とする対象にヒトFGF21タンパク質変異体を100mg〜600mgの範囲内の用量で投与することを含む方法が本明細書に提供される。
Claims (20)
- ヒト対象における代謝障害又は心血管障害を治療、予防、又は管理する方法における使用のためのヒトFGF21タンパク質変異体であって、100mg〜600mgの範囲内の用量での投与用に提供される、ヒトFGF21タンパク質変異体。
- 前記代謝障害又は心血管障害が、高コレステロール血症、脂質異常症、高トリグリセリド血症、非アルコール性脂肪肝疾患(NAFLD)、非アルコール性脂肪性肝炎(NASH)、2型糖尿病、及び肥満から選択される、請求項1に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記代謝障害又は心血管障害を治療、予防、又は管理することが、前記対象における体重、肝脂肪含量、増加したLDL−C、総コレステロール、トリグリセリド、及びアポリポタンパク質Bレベルの1つ以上を減少させることを含むか又はそれによって特徴づけられる、請求項1又は2に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記代謝障害又は心血管障害を治療、予防、又は管理することが、前記対象におけるHDL−Cレベルを増加させることを含むか又はそれによって特徴づけられる、請求項1〜3のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記代謝障害又は心血管障害を治療、予防、又は管理することが、前記対象におけるトリグリセリドレベルを少なくとも約40%又は少なくとも約50%低下させることを含むか又はそれによって特徴づけられる、請求項3に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記代謝障害又は心血管障害を治療、予防、又は管理することが、前記対象における心血管リスクを減少させることを含むか又はそれによって特徴づけられる、請求項1又は2に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記代謝障害又は心血管障害が、脂質異常症、任意選択的には混合型脂質異常症、高トリグリセリド血症、任意選択的には重度の高トリグリセリド血症、又は高コレステロール血症、任意選択的には原発性高コレステロール血症である、請求項2〜6のいずれか一項に記載の使用のためのFGF21タンパク質変異体。
- 前記代謝障害又は心血管障害が、非アルコール性脂肪肝疾患(NAFLD)又は非アルコール性脂肪性肝炎(NASH)である、請求項2〜6のいずれか一項に記載の使用のためのFGF21タンパク質変異体。
- 前記対象が、18〜55歳である、請求項1〜8のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記対象が、30〜45kg/m2の範囲内を含む肥満度指数(BMI)を有し、民族調整としてアジア家系又はアジア祖先の対象については≧27.5である、請求項1〜9のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記対象が、前記ヒトFGF21タンパク質変異体の投与前に測定されるとき、150〜500mg/dL(1.69〜5.65ミリモル/L)の範囲内のトリグリセリドレベルを有する、請求項1〜10のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 配列番号1の付番に基づくQ55C、R105K、G148C、K150R、P158S、S195A、P199G、及びG202Aから選択される1つ以上の突然変異を含む成熟ヒトFGF21タンパク質又はその断片に融合されたヒトFc領域を含む融合タンパク質である、請求項1〜11のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 配列番号11のアミノ酸配列を含む、請求項12に記載の使用のためのヒトFGF21タンパク質変異体。
- 少なくとも100mg、150mg、200mg、250mg、300mg、350mg、又は400mgの用量での投与用に提供される、請求項1〜13のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 約200mg、210mg、220mg、230mg、240mg、250mg、260mg、270mg、280mg、290mg、300mg、310mg、320mg、330mg、340mg、又は350mgの用量での投与用に提供され、任意選択的には、約250mg又は300mgの用量で提供される、請求項1〜14のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 1つ以上の追加的な治療活性剤と組み合わせて提供される、請求項1〜15のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記1つ以上の追加的な治療活性剤が、肥満治療に有用な化合物、利尿薬、β遮断薬、α−遮断薬、ACE阻害剤、アンジオテンシンII受容体遮断薬(ARB)、直接レニン阻害剤、カルシウムチャネルブロッカー、中枢作動薬、末梢アドレナリン遮断薬、血管拡張薬、インスリン、α−グルコシダーゼ阻害剤、ビグアナイド、ドーパミン作動薬、DPP−4阻害剤、グルカゴン様ペプチド、メグリチニド、ナトリウムグルコーストランスポーター(SGLT)阻害剤、スルホニル尿素、チアゾリジンジオン、アミリノミメティックス(amylinomimetics)、スタチン、フィブラート、アスピリン、及び抗凝固剤からなる群から選択される、請求項16に記載の使用のためのヒトFGF21タンパク質変異体。
- 前記ナトリウムグルコーストランスポーター(SGLT)阻害剤が、ダパグリフロジン、エンパグリフロジン、カナグリフロジン、エルツグリフロジン、ソタグリフロジン、トホグリフロジン、レモグリフロジン、ルセオグリフロジン、イプラグリフロジン、アチグリフロジン、ベキサグリフロジン、ヘナグリフロジン、リコグリフロジン、及びこれらのいずれかの薬学的に許容できる塩から選択される、請求項17に記載の使用のためのヒトFGF21タンパク質変異体。
- 皮下投与の形態で提供される、請求項1〜18のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
- 1月に1回若しくは4週ごとに1回、3週ごとに1回、2週ごとに1回、又は1週ごとに1回の投与用に提供される、請求項1〜19のいずれか一項に記載の使用のためのヒトFGF21タンパク質変異体。
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