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Definitions

• VEGF Vascular endothelial growth factor
• DME diabetic macular edema
• wAMD wet age-related macular degeneration
• RVO retinal vein occlusion
• Intravitreal antiangiogenic therapy is currently the primary treatment for DME, wAMD, and macular edema due to RVO.
• standard treatment of these eye disorders with therapeutic VEGF-A inhibitors such as intravitreal aflibercept and intravitreal ranibizumab involve dosing every month or every 8 weeks (after initial monthly loading doses), depending on the eye disorder.
• the anti- VEGF antibody of the present disclosure may be an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate, that includes a polymeric moiety that extends the half-life (e.g., ocular half-life, etc.) of the antibody or protein when administered to a subject.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate that includes a polymeric moiety that extends the half-life (e.g., ocular half-life, etc.) of the antibody or protein when administered to a subject.
• Methods of the present disclosure may provide for a course of treatment for an eye disorder that includes fewer doses (e.g., less frequent administration) of the anti-VEGF antibody conjugates or anti-VEGF protein conjugates than conventional anti-VEGF therapies, to achieve a therapeutic effect of the anti-VEGF therapy on the subject.
• a method of treating an eye disorder comprises: administering an anti-VEGF antibody conjugate (e.g., KSI-301), or anti- VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder at a first loading dose; and repeating the loading dose at least once, but not more than twice, whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy for at least 12 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the eye disorder is at least one of diabetic macular edema (DME), retinal vein occlusion (RVO), wet age-related macular degeneration (AMD), and diabetic retinopathy (DR).
• DME diabetic macular edema
• RVO retinal vein occlusion
• AMD wet age-related macular degeneration
• DR diabetic retinopathy
• the eye disorder is either DME or RVO.
• RVO retinal vein occlusion
• the method comprises: administering anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject with RVO at a first loading dose; and repeating the loading dose once; whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy for at least 8 weeks after a final loading dose.
• anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy lasts for at least 12, at least 14, including at least 16 weeks past a final loading dose. In some embodiments, the therapeutic result of the anti-VEGF antibody conjugate therapy lasts for at least 20 weeks past a final loading dose.
• no further administration of the anti-VEGF antibody conjugate e.g., KSI-301 is provided to the subject within four weeks of a final loading dose. In some embodiments, no further administration of the anti-VEGF antibody conjugate, e.g., KSI-301, is provided to the subject within ten, within 12, or within 16 weeks of a final loading dose.
• no further administration of the anti-VEGF antibody conjugate, e.g., KSI-301 is provided to the subject within 14 weeks of a final loading dose. In some embodiments, no further administration of the anti-VEGF antibody conjugate, e.g., KSI-301, is provided to the subject within twenty weeks of a final loading dose.
• the loading doses are administered with one month between each loading dose. In some embodiments, the loading doses are administered with about one to two months between each loading dose. In some embodiments, the loading doses are administered with about two months between each loading dose.
• a method of the present disclosure includes administering one or more subsequent doses of the anti-VEGF antibody conjugate (e.g., KSI-301) to the subject after the final loading dose.
• any subsequent dose of the anti-VEGF antibody conjugate, e.g., KSI-301 is administered no more frequently than once every 12 weeks.
• any subsequent dose of the anti-VEGF antibody conjugate, e.g., KSI-301 is administered no more frequently than once every 20 weeks.
• the one or more subsequent doses of the anti-VEGF antibody conjugate is administered on average no more frequently than once every 24 weeks.
• the method includes administering a first subsequent dose of the anti-VEGF antibody conjugate, e.g., KSI-301, at a first time period after the final loading dose; and administering a second subsequent dose at a second time period after the first subsequent dose, wherein anti-VEGF antibody conjugate, e.g., KSI-301, is not administered between the first subsequent dose and the second subsequent dose, wherein the first time period is shorter than the second time period.
• the first time period is 8 weeks or more.
• the second time interval is longer than the first time period by at least 4 weeks.
• antibody per loading dose is administered to the subject in the form of the anti-VEGF antibody conjugate, e.g., KSI-301. In some embodiments, about 5 mg of antibody per loading dose is administered to the subject in the form of the anti-VEGF antibody conjugate, e.g., KSI-301. [0014] In some embodiments, no dose following the loading dose is administered until at least 20 weeks following the last loading dose.
• the therapeutic result comprises one or more of improved visual acuity, reduced retinal thickness, improved perfusion in at least one eye (e.g., at least one eye to which anti-VEGF antibody conjugate, e.g., KSI-301, has been administered), improved diabetic retinopathy severity score (DRSS), or reduced disease activity of the eye disorder, compared to a pre-treatment level.
• improved visual acuity e.g., reduced retinal thickness
• improved perfusion in at least one eye e.g., at least one eye to which anti-VEGF antibody conjugate, e.g., KSI-301, has been administered
• DRSS diabetic retinopathy severity score
• reduced disease activity of the eye disorder compared to a pre-treatment level.
• Also provided herein is a method of improving perfusion of an eye comprising: identifying a subject with DME, DR or RVO; and administering at least 2 loading doses of the anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject; providing one or more further doses of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), to the subject, until the subject displays improved perfusion in at least one eye.
• the anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• each of the loading dose of the anti- VEGF antibody conjugate comprises at least 1.25 mg of antibody protein.
• no dose following the loading doses is administered until at least 20 weeks following a last loading dose. In some embodiments, no dose following the loading dose is administered until at least 24 weeks following the last loading dose.
• the present disclosure also provides a method of improving perfusion of an eye, the method comprising: identifying a subject with non-proliferative DR; and administering an initial dose of the anti-VEGF antibody conjugate (e.g., KSI-301), or anti- VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject, to provide improved perfusion in at least one eye.
• the method comprises providing one or more further doses of the anti-VEGF antibody conjugate, e.g., KSI-301, to the subject after the initial dose. In some embodiments, no dose is administered until at least 20 weeks following the initial dose.
• no loading dose of the anti-VEGF antibody conjugate, e.g., KSI-301 is administered to the subject.
• each dose of the anti- VEGF antibody conjugate, e.g., KSI-301 comprises at least 1.25 mg of antibody protein.
• the improved perfusion comprises at least a reduction in the rate of progressive non-perfusion in the at least one eye. In some embodiments, the improved perfusion comprises a reduction in the area of non-perfusion of at least 10% over pre-treatment.
• Also provided herein is a method of treating a subject with DME, DR or RVO comprising: administering 1-3 loading doses of the anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject with DME, DR or RVO; not administering more than 3 loading doses to the subject; providing a follow-on application of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), at a point in time no sooner than 12 weeks after a last loading dose or a last follow-on application of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), wherein the loading doses are administered to the subject on 1-3 loading doses of the
• the subject has proliferative DR
• the method comprises administering 3 loading doses of the anti-VEGF antibody conjugate, e.g., KSI- 301, to the subject.
• a method of treating a subject with non-proliferative DR comprising: administering 1 or 2 loading doses of the anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject with non-proliferative DR; not administering more than 2 loading doses to the subject; and providing a follow-on administration of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), at a point in time no sooner than 12 weeks after a last loading dose, wherein the loading doses are administered to the subject on a monthly basis
• the present disclosure also provides a method of treating a subject with RVO, the method comprising: administering 1 or 2 loading doses of the anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject with RVO; not administering more than 2 loading doses to the subject; providing a follow-on administration of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), at a point in time no sooner than 8 weeks after a last loading dose, wherein the loading doses are administered to the subject on a monthly basis.
• the anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• each of the loading dose of the anti-VEGF antibody conjugate comprises at least 1.25 mg of antibody protein.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the anti-VEGF antibody conjugate, e.g., KSI-301 is administered at an amount of 5 mg.
• the anti-VEGF antibody conjugate e.g., KSI-301, comprises: an antibody conjugate comprising an anti-VEGF-A immunoglobulin G (IgG) bonded to a polymer, which polymer comprises MPC monomers, wherein the sequence of the anti- VEGF-A antibody heavy chain is SEQ ID NO: 1, and the sequence of the anti-VEGF-A antibody light chain is SEQ ID NO. 2, and wherein the antibody is bonded at C449 in SEQ ID NO. 1 to the polymer.
• IgG immunoglobulin G
• the anti-VEGF antibody conjugate comprises an antibody conjugate comprising a light chain and a heavy chain, wherein the anti-VEGF-A antibody heavy chain comprises CDR H 1: GYDFTHYGMN (SEQ ID NO: 9), CDRH2: WINTYTGEPTYAADFKR (SEQ ID NO: 10), and CDRH3: YPYYYGTSHWYFDV (SEQ ID NO: 11), and the anti-VEGF-A antibody light chain comprises CDRL1: SASQDISNYLN (SEQ ID NO: 12), CDRL2: FTSSLHS (SEQ ID NO: 13), and CDRL3: QQYSTVPWT (SEQ ID NO: 14).
• the antibody conjugate has the following structure:
• each heavy chain of the anti-VEGF-A antibody is denoted by the letter H, and each light chain of the anti-VEGF-A antibody is denoted by the letter L; the polymer is bonded to the anti-VEGF-A antibody through the sulfhydryl of C443 (EU numbering), which bond is depicted on one of the heavy chains;
• PC is , where the curvy line indicates the point of attachment to the rest of the polymer, where X is a) –OR where R is H, methyl, ethyl, propyl, or isopropyl, b) –H, c) any halogen, including –Br, –Cl, or –I, d) – SCN, or e) –NCS; and n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different such that the sum of n1, n2, n3, n4, n5, n
• a method of treating RVO comprises: administering an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating RVO at 1-3 loading doses; and whereby the subject retains a therapeutic result of the anti- VEGF antibody conjugate, e.g., KSI-301, therapy, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate) therapy, for RVO for at least 8 weeks after a final loading dose and/or for one or more subsequent dosing intervals of at least 8 weeks.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the subject is not retreated with the anti-VEGF antibody conjugate, e.g., KSI-301, more frequently than once every 10 weeks.
• the subject is not retreated with the anti- VEGF antibody conjugate, e.g., KSI-301, more frequently than once every 12 weeks.
• the present disclosure also provides a method of disease modification of an eye disorder, wherein the method comprises: administering anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject having an eye disorder at a first loading dose, whereby the eye disorder is thereby modified in a beneficial manner to the subject.
• anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• Also provided herein is a method of treating an eye disorder comprising: identifying a subject with DME, DR or RVO; and administering 1-6 loading doses of the anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject; providing a first retreatment dose of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate to the subject following a first amount of time from the last loading dose; and providing a second retreatment dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject, following a second amount of time from the first retreatment dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate),
• the method includes administering 1-3 loading doses of the anti-VEGF antibody conjugate to the subject.
• the second amount of time is at least 1 week more than the first amount of time. In some embodiments, the second amount of time is at least 2 weeks more than the first amount of time. In some embodiments, the second amount of time is at least 4 weeks more than the first amount of time.
• Also provided herein is a method of treating an eye disorder comprising: administering an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder at a first loading dose, wherein the eye disorder is diabetic macular edema (DME); and repeating the loading dose at least once, but not more than twice, whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate therapy, or anti-VEGF protein conjugate therpay for at least 8 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate
• DME diabetic macular edema
• the method further includes administering one or more subsequent doses of the anti-VEGF antibody conjugate to the subject after the final loading dose.
• the method includes administering the one or more subsequent doses of the anti-VEGF antibody conjugate at a dosing schedule of Q8W or longer.
• the dosing schedule is between Q8W and Q24W.
• no subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year after the first loading dose.
• Also provided herein is method of treating an eye disorder comprising: administering an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder at a first loading dose, wherein the eye disorder is wet age-related macular degeneration (wAMD); and repeating the loading dose at least once, but not more than twice, whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate therapy, or anti-VEGF protein conjugate therapy, for at least 12 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate
• wAMD wet age-related macular degeneration
• the method further includes administering one or more subsequent doses of the anti-VEGF antibody conjugate to the subject after the final loading dose at a dosing schedule of Q12W or longer.
• the dosing schedule is between Q12W and Q20W.
• no more than one subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within about one year of the first loading dose.
• Also provided herein is a method of treating an eye disorder comprising: administering an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder at a first loading dose, wherein the eye disorder is retinal vein occlusion (RVO); and repeating the loading dose at least once, but not more than twice, whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate therapy, or or anti-VEGF protein conjugate therapy, for at least 8 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate
• RVO retinal vein occlusion
• the method further includes administering one or more subsequent doses of the anti-VEGF antibody conjugate to the subject after the final loading dose.
• the method includes administering the one or more subsequent doses of the anti-VEGF antibody conjugate at a dosing schedule of Q8W or longer.
• a method of treating an eye disorder comprising administering to a subject in need of treating an eye disorder a therapeutically effective amount of an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), at dosing schedule of Q12W or longer, wherein the eye disorder is diabetic retinopathy (DR), thereby treating the eye disorder.
• the dosing schedule is between Q12W and Q24W.
• the method further comprises administering to the subject no more than two loading doses of the anti-VEGF antibody conjugate.
• the time between any two consecutive loading doses is about 8 weeks.
• a method of treating an eye disorder comprising administering to a subject in need of treating an eye disorder a first dose of a plurality of doses of an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), in a dosing schedule comprising: a loading dosing schedule comprising 1-3 loading doses of the anti-VEGF antibody conjugate or anti- VEGF protein conjugate, wherein the first dose is a loading dose; followed by a maintenance dosing schedule comprising one or more subsequent doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate after a final loading dose, wherein the maintenance dosing schedule comprises a predetermined dosing schedule of Q8W or longer.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• the method further comprises: evaluating a therapeutic result of the anti-VEGF antibody conjugate therapy in the subject at one or more time points after the first dose; and administering a subsequent dose of the anti-VEGF antibody conjugate to the subject at a subsequent time point specified by the predetermined dosing schedule, unless the therapeutic result is retained by the subject, in which case extending the time interval until administering the subsequent dose.
• the eye disorder is wAMD
• the predetermined dosing schedule is Q12W or longer.
• the eye disorder is DME, DR, or RVO.
• Also provided herein is a method of treating an eye disorder comprising: identifying a subject in need of treating an eye disorder, wherein the eye disorder is presumed ocular histoplasmosis syndrome; and intravitreally administering to the subject a therapeutically effective amount of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti- VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), thereby treating the eye disorder.
• the therapeutically effective amount comprises about 1 mg to about 5 mg of the anti-VEGF antibody conjugate.
• FIG.1 is a graph showing extended half-life of KSI-301 in vivo.
• FIG.2 is a graph showing in vivo retinal bioavailability of KSI-301.
• FIG. 3 is a graph showing rapid systemic clearance of intravenously administered KSI-301.
• FIG. 4 is a graph showing the therapeutic effect of a single intravitreal administration of KSI-301in patients with diabetic macular edema (DME), according to some embodiments of the present disclosure.
• DME diabetic macular edema
• FIG. 5 is a schematic diagram representing a KSI-301 intravitreal administration schedule in age-related macular degeneration (wAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 6 is a set of graphs showing sustained therapeutic effects of KSI-301 after intravitreal administration of loading doses of KSI-301 to patients with wet age-related macular degeneration (wAMD), according to some embodiments of the present disclosure.
• FIG. 7 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for wAMD, according to some embodiments of the present disclosure.
• FIG. 8 is a set of graphs showing sustained therapeutic effects of KSI-301 after intravitreal administration of loading doses of KSI-301 to patients with diabetic macular edema (DME), according to some embodiments of the present disclosure.
• FIG. 9 is a set of graphs showing the schedule of intravitreal administration of KSI-301received by individual patients treated for DME, according to some embodiments of the present disclosure.
• FIG. 10 is a set of graphs showing sustained therapeutic effects of KSI- 301after intravitreal administration of loading doses of KSI-301 to patients with retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 11 is a graph showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for RVO, according to some embodiments of the present disclosure.
• FIG. 12 is a collection of images showing sustained improvement in retinal health after intravitreal administration of loading doses of KSI-301 to patients with wAMD (left column), DME (middle column), and RVO (right column), according to some embodiments of the present disclosure.
• FIG. 10 is a set of graphs showing sustained therapeutic effects of KSI- 301after intravitreal administration of loading doses of KSI-301 to patients with retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 11 is a graph showing the schedule of intravitreal administration of KSI
• FIG. 13 is a schematic diagram of the structure of KSI-301, according to some embodiments of the present disclosure, where each heavy chain of the anti-VEGF-A antibody is denoted by the letter H, and each light chain of the anti-VEGF-A antibody is denoted by the letter L; the polymer is bonded to the anti-VEGF-A antibody through a sulfhydryl at C443 according to EU numbering, which bond is depicted on one of the heavy chains above; PC is , where the curvy line indicates the point of attachment to the rest of the polymer; and n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different such that the sum of n1, n2, n3, n4, n5, n6, n6, n7, n8 and n9 is 2500 plus or minus 15%.
• FIG. 14 depicts an amino acid sequence of the heavy and light chains of KSI-301, according to some embodiments of the present disclosures.
• FIG.15 is a set of amino acid sequences for various antibodies.
• FIG. 16 is a graph showing the proportion of patients with differing levels of diabetic retinopathy severity, measured on a standardized photographic reading scale.
• FIGs. 17A and 17B display the efficacy of KSI-301 in Wet AMD and the direct effect on the choroidal neovascularization.
• FIG. 17A displays the efficacy of KSI-301 in Wet AMD, and the change from baseline to week in median BCVA and OCT CST.
• FIG. 18A-18D show the results in a DME patient with disease modification post 3 loading doses, with significant DRSS improvement and reperfusion representing disease modification.
• FIG. 19 shows the results of an RVO patient that after 3 loading doses with no additional doses required for at least 5 months, representing possible disease modification.
• FIG. 20 displays a set of OCT images of a patient showing the effect of 3 loading doses lasting 8 weeks until diseases recurs and the patient receives retreatment.
• FIGs. 21A-21C depict the results from a single-dose bioactivity study.
• FIG. 22 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for wAMD, according to some embodiments of the present disclosure.
• FIG. 23 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with wet age- related macular degeneration (wAMD), according to some embodiments of the present disclosure.
• FIG. 24 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with wet age- related macular degeneration (wAMD), but without high pigment epithelial detachment, according to some embodiments of the present disclosure.
• FIG. 24 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with wet age- related macular degeneration (wAMD), but without high pigment epithelial detachment, according to some embodiments of the present disclosure.
• FIG. 25 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with wet age- related macular degeneration (wAMD), according to some embodiments of the present disclosure.
• FIG. 26 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with wet age- related macular degeneration (wAMD), but without high pigment epithelial detachment, according to some embodiments of the present disclosure.
• FIG. 27 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for DME, according to some embodiments of the present disclosure.
• FIG. 28 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with diabetic macular edema (DME), according to some embodiments of the present disclosure.
• FIG. 29 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with diabetic macular edema (DME), according to some embodiments of the present disclosure.
• FIG. 30 is a graph showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for RVO, according to some embodiments of the present disclosure.
• FIG. 29 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with diabetic macular edema (DME), according to some embodiments of the present disclosure.
• FIG. 30 is a graph showing the schedule of intravitreal administration of KSI-301 received by
• FIG. 31 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 32 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 33 is a schematic diagram representing an antibody binding construct A intravitreal administration schedule in age-related macular degeneration (wAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• wAMD age-related macular degeneration
• DME diabetic macular edema
• RVO retinal vein occlusion
• FIG. 34 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for wAMD, according to some embodiments of the present disclosure.
• FIG. 35 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with wAMD, according to some embodiments of the present disclosure.
• FIG. 36 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for DME, according to some embodiments of the present disclosure.
• FIG. 35 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with wAMD, according to some embodiments of the present disclosure.
• FIG. 36 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for DME, according to some embodiments of the present disclosure.
• FIG. 34 is
• FIG. 37 is a set of graphs showing sustained therapeutic effects of KSI- 301after intravitreal administration of loading doses of KSI-301 to patients with DME, according to some embodiments of the present disclosure.
• FIG. 38 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for RVO, according to some embodiments of the present disclosure.
• FIG. 39 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 38 is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for RVO, according to some embodiments of the present disclosure.
• FIG. 39 is a set of graphs showing sustained therapeutic effects of KSI- 301 after intravitreal administration of loading doses of KSI-301 to patients with retinal vein occlusion (R
• FIG. 40 is a schematic diagram representing a Phase 2 study design for KSI-301 treatment in treatment-na ⁇ ve wAMD patients and comparison with a standard of care treatment, according to some embodiments of the present disclosure.
• FIGS. 41A and 41B are a collection of graphs showing hypothetical schedule of treatment and probability of remaining on Q20W dosing, based on data from patients from the Phase 1b study but applying the Phase 2 retreatment criteria, according to some embodiments of the present disclosure.
• FIG. 42 is a flow chart depicting an embodiment of a method of the present disclosure.
• FIG. 41A and 41B are a collection of graphs showing hypothetical schedule of treatment and probability of remaining on Q20W dosing, based on data from patients from the Phase 1b study but applying the Phase 2 retreatment criteria, according to some embodiments of the present disclosure.
• FIG. 42 is a flow chart depicting an embodiment of a method of the present disclosure.
• FIG. 43 is a schematic diagram representing KSI-301 intravitreal administration schedule in age-related macular degeneration (wAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 44 is a set of graphs showing sustained therapeutic effects of KSI- 301 administered to patients with wet age-related macular degeneration (wAMD), according to some embodiments of the present disclosure.
• FIG. 45A is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for wAMD, according to some embodiments of the present disclosure.
• FIG. 44 is a set of graphs showing sustained therapeutic effects of KSI- 301 administered to patients with wet age-related macular degeneration (wAMD), according to some embodiments of the present disclosure.
• FIG. 45A is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for wAMD,
• FIG. 45B is a table summarizing the administration interval of KSI-301 in wAMD patients shown in FIG.45A.
• FIG. 46 is a collection of OCT images of a wAMD patient treated with KSI-301, according to some embodiments of the present disclosure.
• FIG. 47 is a graph showing benchmarking of KSI-301 in wAMD against a standard-of-care treatment, according to some embodiments of the present disclosure.
• FIG. 48 is a graph showing benchmarking of KSI-301 in wAMD against a standard-of-care treatment, according to some embodiments of the present disclosure.
• FIG. 46 is a collection of OCT images of a wAMD patient treated with KSI-301, according to some embodiments of the present disclosure.
• FIG. 47 is a graph showing benchmarking of KSI-301 in wAMD against a standard-of-care treatment, according to some embodiments of the present disclosure.
• FIG. 48 is a graph showing benchmarking of
• FIG. 49 is a set of graphs showing sustained therapeutic effects of KSI- 301 administered to patients with diabetic macular edema (DME), according to some embodiments of the present disclosure.
• FIG. 50A is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for DME, according to some embodiments of the present disclosure.
• FIG. 50B is a table summarizing the administration interval of KSI-301 in DME patients shown in FIG. 50A.
• FIG. 51 is a collection of OCT images of a DME patient treated with KSI- 301, according to embodiments of the present disclosure. [0086] FIG.
• FIG. 52 is a collection of OCT images of a DME patient treated with KSI- 301, according to some embodiments of the present disclosure.
• FIG. 53 is a set of graphs showing sustained therapeutic effects of KSI- 301 administered to patients with retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• FIG. 54A is a set of graphs showing the schedule of intravitreal administration of KSI-301 received by individual patients treated for RVO, according to some embodiments of the present disclosure.
• FIG. 54B is a table summarizing the administration interval of KSI-301 in RVO patients shown in FIG.54A.
• FIG. 54A is a table summarizing the administration interval of KSI-301 in RVO patients shown in FIG.54A.
• FIG. 55 is a graph showing benchmarking of KSI-301 in RVO against a standard-of-care treatment, according to some embodiments of the present disclosure.
• FIG. 56 is a collection of OCT images of a CRVO patient treated with KSI-301, according to some embodiments of the present disclosure.
• FIG. 57 is a schematic diagram representing an anti-VEGF antibody conjugate intravitreal administration schedule in age-related macular degeneration (wAMD), according to some embodiments of the present disclosure.
• FIG. 58 is a schematic diagram representing an anti-VEGF antibody conjugate intravitreal administration schedule in diabetic macular edema (DME), according to some embodiments of the present disclosure.
• DME diabetic macular edema
• FIG. 59 is a schematic diagram representing an anti-VEGF antibody conjugate intravitreal administration schedule in retinal vein occlusion (RVO), according to some embodiments of the present disclosure.
• RVO retinal vein occlusion
• DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT [0095]
• the anti-VEGF antibody of the present disclosure may be an anti-VEGF antibody conjugate (e.g., KSI-301) that includes a polymeric moiety that extends the half-life of the antibody when administered to a subject.
• the antibody conjugate may retain therapeutic efficacy after administration for a longer time period compared to an antibody without the polymeric moiety.
• the methods of the present disclosure may provide for a course of treatment for an eye disorder that includes fewer doses (e.g., less frequent administration) of the anti-VEGF antibody conjugates than conventional anti-VEGF antibody therapies, to achieve a therapeutic effect of the anti-VEGF therapy on the subject.
• the present methods may encourage better patient compliance with the treatment course especially when the eye disorder treatment involves intravitreal administration of the therapeutic agent.
• a “neovascular disorder” is a disorder or disease state characterized by altered, dysregulated or unregulated angiogenesis. Examples of neovascular disorders include neoplastic transformation (e.g. cancer) and ocular neovascular disorders including diabetic retinopathy and age-related macular degeneration.
• An “ocular neovascular” disorder is a disorder characterized by altered, dysregulated or unregulated angiogenesis in the eye of a patient.
• Such disorders include optic disc neovascularization, iris neovascularization, retinal neovascularization, choroidal neovascularization, corneal neovascularization, vitreal neovascularization, glaucoma, pannus, pterygium, macular edema, diabetic retinopathy, diabetic macular edema, vascular retinopathy, retinal degeneration, uveitis, inflammatory diseases of the retina, and proliferative vitreoretinopathy.
• the term antibody includes intact antibodies and binding fragments thereof.
• a binding fragment refers to a molecule other than an intact antibody that comprises a portion of an intact antibody that binds the antigen to which the intact antibody binds.
• binding fragments include Fv, Fab', Fab'-SH, F(ab')2; diabodies; linear antibodies; single-chain antibody molecules (e.g. scFv); and multispecific antibodies formed from antibody fragments.
• scFv antibodies are described in Houston JS. 1991. Methods in Enzymol. 203:46-96.
• antibody fragments comprise single chain polypeptides having the characteristics of a VH domain, namely being able to assemble together with a VL domain, or of a VL domain, namely being able to assemble together with a VH domain to a functional antigen binding site and thereby providing the antigen binding property of full length antibodies.
• Specific binding of an antibody to its target antigen(s) means an affinity of at least 10 6 , 10 7 , 10 8 , 10 9 , or 10 10 M -1 . Specific binding is detectably higher in magnitude and distinguishable from non-specific binding occurring to at least one unrelated target.
• a basic antibody structural unit is a tetramer of subunits. Each tetramer includes two identical pairs of polypeptide chains, each pair having one "light” (about 25 kDa) and one "heavy" chain (about 50-70 kDa). The amino-terminal portion of each chain includes a variable region of about 100 to 110 or more amino acids primarily responsible for antigen recognition. This variable region is initially expressed linked to a cleavable signal peptide.
• variable region without the signal peptide is sometimes referred to as a mature variable region.
• a light chain mature variable region means a light chain variable region without the light chain signal peptide.
• reference to a variable region does not mean that a signal sequence is necessarily present; and in fact signal sequences are cleaved once the antibodies or fusion proteins have been expressed and secreted.
• a pair of heavy and light chain variable regions defines a binding region of an antibody.
• the carboxy-terminal portion of the light and heavy chains respectively defines light and heavy chain constant regions.
• the heavy chain constant region is primarily responsible for effector function. In IgG antibodies, the heavy chain constant region is divided into CH1, hinge, CH2, and CH3 regions.
• the CH1 region binds to the light chain constant region by disulfide and noncovalent bonding.
• the hinge region provides flexibility between the binding and effector regions of an antibody and also provides sites for intermolecular disulfide bonding between the two heavy chain constant regions in a tetramer subunit.
• the CH2 and CH3 regions are the primary site of effector functions and FcR binding.
• Light chains are classified as either kappa or lambda.
• Heavy chains are classified as gamma, mu, alpha, delta, or epsilon, and define the antibody's isotype as IgG, IgM, IgA, IgD and IgE, respectively.
• variable and constant regions are joined by a "J" segment of about 12 or more amino acids, with the heavy chain also including a "D” segment of about 10 or more amino acids.
• J The mature variable regions of each light/heavy chain pair form the antibody binding site.
• an intact antibody has two binding sites, i.e., is divalent. In natural antibodies, the binding sites are the same. However, bispecific antibodies can be made in which the two binding sites are different (see, e.g., Songsivilai S, Lachmann PC. 1990.
• variable regions all exhibit the same general structure of relatively conserved framework regions (FR) joined by three hypervariable regions, also called complementarity determining regions or CDRs.
• FR relatively conserved framework regions
• CDRs complementarity determining regions
• variable heavy CDRs can be referred to as CDR H 1, CDR H 2 and CDR H 3; the variable light chain CDRs can be referred to as CDRL1, CDRL2 and CDRL3.
• the assignment of amino acids to each domain is in accordance with the definitions of Kabat EA, et al. 1987 and 1991. Sequences of Proteins of Immunological Interest (National Institutes of Health, Bethesda, MD) or Chothia C, Lesk AM. 1987. Canonical Structures for the Hypervariable Regions of Immunoglobulins. J Mol Biol 196:901-917; Chothia C, et al. 1989. Conformations of Immunoglobulin Hypervariable Regions. Nature 342:877-883.
• Kabat also provides a widely used numbering convention (Kabat numbering) in which corresponding residues between different heavy chain variable regions or between different light chain variable regions are assigned the same number. Although Kabat numbering can be used for antibody constant regions, EU numbering is more commonly used, as is the case in this application. Although specific sequences are provided for exemplary antibodies disclosed herein, it will be appreciated that after expression of protein chains one to several amino acids at the amino or carboxy terminus of the light and/or heavy chain, particularly a heavy chain C-terminal lysine residue, may be missing or derivatized in a proportion or all of the molecules. [0103] The term "epitope” refers to a site on an antigen to which an antibody or extracellular trap segment binds.
• An epitope on a protein can be formed from contiguous amino acids or noncontiguous amino acids juxtaposed by tertiary folding of one or more proteins.
• Epitopes formed from contiguous amino acids also known as linear epitopes
• epitopes formed by tertiary folding also known as conformational epitopes
• An epitope typically includes at least 3, and more usually, at least 5 or 8-10 amino acids in a unique spatial conformation. Methods of determining spatial conformation of epitopes include, for example, x-ray crystallography and 2-dimensional nuclear magnetic resonance.
• Antibodies that recognize the same or overlapping epitopes can be identified in a simple immunoassay showing the ability of one antibody to compete with the binding of another antibody to a target antigen.
• the epitope of an antibody can also be defined by X-ray crystallography of the antibody (or Fab fragment) bound to its antigen to identify contact residues.
• two antibodies have the same epitope if all amino acid mutations in the antigen that reduce or eliminate binding of one antibody reduce or eliminate binding of the other.
• Two antibodies have overlapping epitopes if some amino acid mutations that reduce or eliminate binding of one antibody reduce or eliminate binding of the other.
• Competition between antibodies is determined by an assay in which an antibody under test inhibits specific binding of a reference antibody to a common antigen (see, e.g., Junghans et al., Cancer Res. 50: 1495, 1990).
• a test antibody competes with a reference antibody if an excess of a test antibody (e.g., at least 2x, 5x, 10x, 20x or l00x) inhibits binding of the reference antibody by at least 50%.
• the test antibody inhibits binding of the reference antibody by 75%, 90%, or 99% as measured in a competitive binding assay.
• Antibodies identified by competition assay include antibodies binding to the same epitope as the reference antibody and antibodies binding to an adjacent epitope sufficiently proximal to the epitope bound by the reference antibody for steric hindrance to occur.
• the term "patient” includes human and other mammalian subjects that receive either prophylactic or therapeutic treatment.
• amino acids are grouped as follows: Group I (hydrophobic side chains): met, ala, val, leu, ile; Group II (neutral hydrophilic side chains): cys, ser, thr; Group III (acidic side chains): asp, glu; Group IV (basic side chains): asn, gin, his, lys, arg; Group V (residues influencing chain orientation): gly, pro; and Group VI (aromatic side chains): trp, tyr, phe. Conservative substitutions involve substitutions between amino acids in the same class.
• Non-conservative substitutions constitute exchanging a member of one of these classes for a member of another.
• Percentage sequence identities are determined with antibody sequences maximally aligned by the Kabat numbering convention for a variable region or EU numbering for a constant region. After alignment, if a subject antibody region (e.g., the entire mature variable region of a heavy or light chain) is being compared with the same region of a reference antibody, the percentage sequence identity between the subject and reference antibody regions is the number of positions occupied by the same amino acid in both the subject and reference antibody region divided by the total number of aligned positions of the two regions, with gaps not counted, multiplied by 100 to convert to percentage.
• Sequence identities of other sequences can be determined by aligning sequences using algorithms, such as BESTFIT, FASTA, and TFASTA in the Wisconsin Genetics Software Package Release 7.0, Genetics Computer Group, 575 Science Dr., Madison, WI, using default gap parameters, or by inspection, and the best alignment (i.e., resulting in the highest percentage of sequence similarity over a comparison window). Percentage of sequence identity is calculated by comparing two optimally aligned sequences over a window of comparison, determining the number of positions at which the identical residues occurs in both sequences to yield the number of matched positions, dividing the number of matched positions by the total number of positions in the window of comparison (i.e., the window size), and multiplying the result by 100 to yield the percentage of sequence identity.
• algorithms such as BESTFIT, FASTA, and TFASTA in the Wisconsin Genetics Software Package Release 7.0, Genetics Computer Group, 575 Science Dr., Madison, WI, using default gap parameters, or by inspection, and the best alignment (i.e., resulting in
• compositions or methods "comprising" one or more recited elements may include other elements not specifically recited.
• a composition that comprises antibody may contain the antibody alone or in combination with other ingredients.
• ADCC antibody-dependent cellular cytotoxicity
• effector cells include natural killer cells, monocytes/macrophages and neutrophils.
• ADCC is triggered by interactions between the Fc region of an antibody bound to a cell and Fcy receptors, particularly Fc ⁇ RI and Fc ⁇ RIII, on immune effector cells such as neutrophils, macrophages and natural killer cells.
• Fcy receptors particularly Fc ⁇ RI and Fc ⁇ RIII
• the target cell is eliminated by phagocytosis or lysis, depending on the type of mediating effector cell. Death of the antibody-coated target cell occurs as a result of effector cell activity.
• opsonization also known as "antibody-dependent cellular phagocytosis", or ADCP, refers to the process by which antibody-coated cells are internalized, either in whole or in part, by phagocytic immune cells (e.g., macrophages, neutrophils and dendritic cells) that bind to an immunoglobulin Fc region.
• phagocytic immune cells e.g., macrophages, neutrophils and dendritic cells
• CDC complement-dependent cytotoxicity refers to a mechanism for inducing cell death in which an Fc effector domain(s) of a target-bound antibody activates a series of enzymatic reactions culminating in the formation of holes in the target cell membrane.
• antigen-antibody complexes such as those on antibody- coated target cells bind and activate complement component Clq which in turn activates the complement cascade leading to target cell death.
• Activation of complement may also result in deposition of complement components on the target cell surface that facilitate ADCC by binding complement receptors (e.g., CR3) on leukocytes.
• complement receptors e.g., CR3
• a humanized antibody is a genetically engineered antibody in which the CDRs from a non-human "donor” antibody are grafted into human "acceptor” antibody sequences (see, e.g., Queen, US 5,530,101 and 5,585,089; Winter, US 5,225,539, Carter, US 6,407,213, Adair, US 5,859,205 6,881,557, Foote, US 6,881,557).
• the acceptor antibody sequences can be, for example, a mature human antibody sequence, a composite of such sequences, a consensus sequence of human antibody sequences, or a germline region sequence.
• a humanized antibody is an antibody having some or all CDRs entirely or substantially from a donor antibody and variable region framework sequences and constant regions, if present, entirely or substantially from human antibody sequences.
• a humanized heavy chain has at least one, two and usually all three CDRs entirely or substantially from a donor antibody heavy chain, and a heavy chain variable region framework sequence and heavy chain constant region, if present, substantially from human heavy chain variable region framework and constant region sequences.
• a humanized light chain has at least one, two and usually all three CDRs entirely or substantially from a donor antibody light chain, and a light chain variable region framework sequence and light chain constant region, if present, substantially from human light chain variable region framework and constant region sequences.
• a humanized antibody comprises a humanized heavy chain and a humanized light chain.
• a CDR in a humanized antibody is substantially from a corresponding CDR in a non-human antibody when at least 85%, 90%, 95% or 100% of corresponding residues (as defined by Kabat) are identical between the respective CDRs.
• the variable region framework sequences of an antibody chain or the constant region of an antibody chain are substantially from a human variable region framework sequence or human constant region respectively when at least 85, 90, 95 or 100% of corresponding residues defined by Kabat are identical.
• humanized antibodies often incorporate all six CDRs (which can be as defined by Kabat) from a mouse antibody, they can also be made with less than all CDRs (e.g., at least 3, 4, or 5 CDRs from a mouse antibody) (e.g., De Pascalis R, Iwahashi M, Tamura M, et al. 2002. Grafting “Abbreviated” Complementary-Determining Regions Containing Specificity-Determining Residues Essential for Ligand Contact to Engineer a Less Immunogenic Humanized Monoclonal Antibody. J Immunol. 169:3076-3084; Vajdos FF, Adams CW, Breece TN, Presta LG, de Vos AM, Sidhu, SS.
• CDRs which can be as defined by Kabat
• a chimeric antibody is an antibody in which the mature variable regions of light and heavy chains of a non-human antibody (e.g., a mouse) are combined with human light and heavy chain constant regions. Such antibodies substantially or entirely retain the binding specificity of the mouse antibody, and are about two-thirds human sequence.
• a veneered antibody is a type of humanized antibody that retains some and usually all of the CDRs and some of the non-human variable region framework residues of a non-human antibody but replaces other variable region framework residues that may contribute to B- or T-cell epitopes, for example exposed residues (Padlan EA. 1991.
• Polymer refers to a series of monomer groups linked together. A polymer is composed of multiple units of a single monomer (a homopolymer) or different monomers (a heteropolymer).
• High MW polymers are prepared from monomers that include, but are not limited to, acrylates, methacrylates, acrylamides, methacrylamides, styrenes, vinyl-pyridine, vinyl-pyrrolidone and vinyl esters such as vinyl acetate. Additional monomers are useful in high MW polymers . When two different monomers are used, the two monomers are called “comonomers,” meaning that the different monomers are copolymerized to form a single polymer.
• the polymer can be linear or branched.
• each polymer chain is referred to as a “polymer arm.”
• the end of the polymer arm linked to the initiator moiety is the proximal end, and the growing-chain end of the polymer arm is the distal end.
• the polymer arm end group can be the radical scavenger, or another group.
• “Initiator” refers to a compound capable of initiating a polymerization using monomers or comonomers.
• the polymerization can be a conventional free radical polymerization or a controlled/”living” radical polymerization, such as Atom Transfer Radical Polymerization (ATRP), Reversible Addition-Fragmentation-Termination (RAFT) polymerization or nitroxide mediated polymerization (NMP).
• ATRP Atom Transfer Radical Polymerization
• RAFT Reversible Addition-Fragmentation-Termination
• NMP nitroxide mediated polymerization
• the polymerization can be a “pseudo” controlled polymerization, such as degenerative transfer.
• the initiator is suitable for ATRP, it contains a labile bond which can be homolytically cleaved to form an initiator fragment, I, being a radical capable of initiating a radical polymerization, and a radical scavenger, I’, which reacts with the radical of the growing polymer chain to reversibly terminate the polymerization.
• the radical scavenger I’ is typically a halogen, but can also be an organic moiety, such as a nitrile.
• the initiator contains one of more 2-bromoisobutyrate groups as sites for polymerization via ATRP.
• a “chemical linker” refers to a chemical moiety that links two groups together, such as a half-life extending moiety and a protein.
• the linker can be cleavable or non-cleavable.
• Cleavable linkers can be hydrolyzable, enzymatically cleavable, pH sensitive, photolabile, or disulfide linkers, among others.
• Other linkers include homobifunctional and heterobifunctional linkers.
• a “linking group” is a functional group capable of forming a covalent linkage consisting of one or more bonds to a bioactive agent. Non-limiting examples include those illustrated in Table 1 of WO2013059137 (incorporated by reference).
• the term "reactive group” refers to a group that is capable of reacting with another chemical group to form a covalent bond, i.e. is covalently reactive under suitable reaction conditions, and generally represents a point of attachment for another substance.
• the reactive group is a moiety, such as maleimide or succinimidyl ester, is capable of chemically reacting with a functional group on a different moiety to form a covalent linkage.
• Reactive groups generally include nucleophiles, electrophiles and photoactivatable groups.
• Phosphorylcholine also denoted as “PC,” refers to the following: where * denotes the point of attachment.
• the phosphorylcholine is a zwitterionic group and includes salts (such as inner salts), and protonated and deprotonated forms thereof.
• Phosphorylcholine containing polymer is a polymer that contains phosphorylcholine.
• Zwitterion containing polymer refers to a polymer that contains a zwitterion.
• Poly(acryloyloxyethyl phosphorylcholine) containing polymer refers to a polymer containing 2-(acryloyloxy)ethyl-2-(trimethylammonium)ethyl phosphate (HEA-PC shown below in Example 6) as monomer.
• Poly(methacryloyloxyethyl phosphorylcholine) containing polymer refers to a polymer containing 2-(methacryloyloxy)ethyl-2-(trimethylammonium)ethyl phosphate (HEMA-PC or MPC) as monomer (see below): [0126] As used herein, “MPC” and “HEMA-PC” are interchangeable.
• Molecular weight in the context of the polymer can be expressed as either a number average molecular weight, or a weight average molecular weight or a peak molecular weight. Unless otherwise indicated, all references to molecular weight herein refer to the peak molecular weight. These molecular weight determinations, number average (Mn), weight average (Mw) and peak (Mp), can be measured using size exclusion chromatography or other liquid chromatography techniques.
• molecular weight values can also be used, such as the use of end-group analysis or the measurement of colligative properties (e.g., freezing-point depression, boiling-point elevation, or osmotic pressure) to determine number average molecular weight, or the use of light scattering techniques, ultracentrifugation or viscometry to determine weight average molecular weight.
• the molecular weight is measured by SEC-MALS (size exclusion chromatography – multi angle light scattering).
• the polymeric reagents are typically polydisperse (i.e., number average molecular weight and weight average molecular weight of the polymers are not equal), and can possess low polydispersity values of, for example, less than about 1.5, as judged, for example, by the PDI value derived from the SEC-MALS measurement.
• the polydispersities (PDI) are in the range of about 1.4 to about 1.2. In some embodiments the PDI is less than about 1.15, 1.10, 1.05, or 1.03.
• the phrase “a” or “an” entity refers to one or more of that entity; for example, a compound refers to one or more compounds or at least one compound.
• “a” or “an”), “one or more”, and “at least one” can be used interchangeably herein.
• “About” means variation one might see in measurements taken among different instruments, samples, and sample preparations.
• “Protected,” “protected form,” “protecting group” and “protective group” refer to the presence of a group (i.e., the protecting group) that prevents or blocks reaction of a particular chemically reactive functional group in a molecule under certain reaction conditions. Protecting groups vary depending upon the type of chemically reactive group being protected as well as the reaction conditions to be employed and the presence of additional reactive or protecting groups in the molecule, if any.
• Suitable protecting groups include those such as found in the treatise by Greene et al., “Protective Groups In Organic Synthesis,” 3 rd Edition, John Wiley and Sons, Inc., New York, 1999.
• Alkyl refers to a straight or branched, saturated, aliphatic radical having the number of carbon atoms indicated.
• C 1 -C 6 alkyl includes, but is not limited to, methyl, ethyl, propyl, isopropyl, butyl, isobutyl, sec-butyl, tert-butyl, pentyl, isopentyl, hexyl, etc.
• alkyl groups include, but are not limited to heptyl, octyl, nonyl, decyl, etc.
• Alkyl can include any number of carbons, such as 1-2, 1-3, 1-4, 1-5, 1-6, 1-7, 1-8, 1-9, 1-10, 2-3, 2-4, 2-5, 2-6, 3-4, 3-5, 3-6, 4-5, 4-6 and 5-6.
• the alkyl group is typically monovalent, but can be divalent, such as when the alkyl group links two moieties together.
• Alkylene refers to an alkyl group, as defined above, linking at least two other groups, i.e., a divalent hydrocarbon radical.
• the two moieties linked to the alkylene can be linked to the same atom or different atoms of the alkylene.
• a straight chain alkylene can be the bivalent radical of -(CH 2 ) n, where n is 1, 2, 3, 4, 5 or 6.
• Alkylene groups include, but are not limited to, methylene, ethylene, propylene, isopropylene, butylene, isobutylene, sec-butylene, pentylene and hexylene.
• R’, R” and R”’ each independently refer to hydrogen, unsubstituted (C1-C8)alkyl and heteroalkyl, unsubstituted aryl, aryl substituted with 1-3 halogens, unsubstituted alkyl, alkoxy or thioalkoxy groups, or aryl-(C1-C4)alkyl groups.
• R’ and R” are attached to the same nitrogen atom, they can be combined with the nitrogen atom to form a 5-, 6-, or 7-membered ring.
• -NR’R is meant to include 1-pyrrolidinyl and 4-morpholinyl.
• alkyl is include groups such as haloalkyl (e.g., -CF 3 and -CH 2 CF 3 ) and acyl (e.g., -C(O)CH 3 , -C(O)CF 3 , -C(O)CH 2 OCH 3 , and the like).
• the substituted alkyl and heteroalkyl groups have from 1 to 4 substituents.
• the substituted akyl and heteroalkyl groups have 1, 2 or 3 substituents. Exceptions are those perhalo alkyl groups (e.g., pentafluoroethyl and the like) .
• R’, R”, R”’ and R each independently refer to hydrogen, substituted or unsubstituted heteroalkyl, substituted or unsubstituted aryl, e.g., aryl substituted with 1-3 halogens, substituted or unsubstituted alkyl, alkoxy or thioalkoxy groups, or arylalkyl groups.
• each of the R groups is independently selected as are each R’, R”, R’” and R”” groups when more than one of these groups is present.
• R’ and R” are attached to the same nitrogen atom, they can be combined with the nitrogen atom to form a 5-, 6-, or 7-membered ring.
• -NR’R is meant to include, but not be limited to, 1-pyrrolidinyl and 4-morpholinyl.
• alkyl is meant to include groups including carbon atoms bound to groups other than hydrogen groups, such as haloalkyl (e.g., -CF 3 and –CH 2 CF 3 ) and acyl (e.g., -C(O)CH 3 , -C(O)CF 3 , -C(O)CH 2 OCH 3 , and the like).
• Alkoxy refers to alkyl group having an oxygen atom that either connects the alkoxy group to the point of attachment or is linked to two carbons of the alkoxy group.
• Alkoxy groups include, for example, methoxy, ethoxy, propoxy, iso-propoxy, butoxy, 2-butoxy, iso-butoxy, sec-butoxy, tert-butoxy, pentoxy, hexoxy, etc.
• the alkoxy groups can be further substituted with a variety of substituents described within. For example, the alkoxy groups can be substituted with halogens to form a “halo-alkoxy” group.
• Carboxyalkyl means an alkyl group (as defined herein) substituted with a carboxy group.
• carboxycycloalkyl means a cycloalkyl group (as defined herein) substituted with a carboxy group.
• alkoxyalkyl means an alkyl group (as defined herein) substituted with an alkoxy group.
• carboxy employed herein refers to carboxylic acids and their esters.
• Haloalkyl refers to alkyl as defined above where some or all of the hydrogen atoms are substituted with halogen atoms.
• Halogen represents chloro or fluoro, but may also be bromo or iodo.
• haloalkyl includes trifluoromethyl, fluoromethyl, 1,2,3,4,5-pentafluoro-phenyl, etc.
• perfluoro defines a compound or radical which has all available hydrogens that are replaced with fluorine.
• perfluorophenyl refers to 1,2,3,4,5-pentafluorophenyl
• perfluoromethyl refers to 1,1,1-trifluoromethyl
• perfluoromethoxy refers to 1,1,1-trifluoromethoxy.
• “Fluoro-substituted alkyl” refers to an alkyl group where one, some, or all hydrogen atoms have been replaced by fluorine.
• “Cytokine” is a member of a group of protein signaling molecules that may participate in cell-cell communication in immune and inflammatory responses. Cytokines are typically small, water-soluble glycoproteins that have a mass of about 8-35 kDa.
• Cycloalkyl refers to a cyclic hydrocarbon group that contains from about 3 to 12, from 3 to 10, or from 3 to 7 endocyclic carbon atoms. Cycloalkyl groups include fused, bridged and spiro ring structures.
• Endocyclic refers to an atom or group of atoms which comprise part of a cyclic ring structure.
• Exocyclic refers to an atom or group of atoms which are attached but do not define the cyclic ring structure.
• Cyclic alkyl ether refers to a 4 or 5 member cyclic alkyl group having 3 or 4 endocyclic carbon atoms and 1 endocyclic oxygen or sulfur atom (e.g., oxetane, thietane, tetrahydrofuran, tetrahydrothiophene); or a 6 to 7 member cyclic alkyl group having 1 or 2 endocyclic oxygen or sulfur atoms (e.g., tetrahydropyran, 1,3-dioxane, 1,4-dioxane, tetrahydrothiopyran, 1,3-dithiane, 1,4-dithiane, 1,4-oxathiane).
• alkenyl refers to either a straight chain or branched hydrocarbon of 2 to 6 carbon atoms, having at least one double bond.
• alkenyl groups include, but are not limited to, vinyl, propenyl, isopropenyl, 1-butenyl, 2-butenyl, isobutenyl, butadienyl, 1-pentenyl, 2-pentenyl, isopentenyl, 1,3-pentadienyl, 1,4-pentadienyl, 1-hexenyl, 2-hexenyl, 3-hexenyl, 1,3-hexadienyl, 1,4-hexadienyl, 1,5-hexadienyl, 2,4-hexadienyl, or 1,3,5-hexatrienyl.
• Alkenyl groups can also have from 2 to 3, 2 to 4, 2 to 5, 3 to 4, 3 to 5, 3 to 6, 4 to 5, 4 to 6 and 5 to 6 carbons.
• the alkenyl group is typically monovalent, but can be divalent, such as when the alkenyl group links two moieties together.
• Alkenylene refers to an alkenyl group, as defined above, linking at least two other groups, i.e., a divalent hydrocarbon radical.
• the two moieties linked to the alkenylene can be linked to the same atom or different atoms of the alkenylene.
• Alkenylene groups include, but are not limited to, ethenylene, propenylene, isopropenylene, butenylene, isobutenylene, sec-butenylene, pentenylene and hexenylene.
• Alkynyl refers to either a straight chain or branched hydrocarbon of 2 to 6 carbon atoms, having at least one triple bond.
• alkynyl groups include, but are not limited to, acetylenyl, propynyl, 1-butynyl, 2-butynyl, isobutynyl, sec-butynyl, butadiynyl, 1-pentynyl, 2-pentynyl, isopentynyl, 1,3-pentadiynyl, 1,4-pentadiynyl, 1-hexynyl, 2-hexynyl, 3-hexynyl, 1,3-hexadiynyl, 1,4-hexadiynyl, 1,5-hexadiynyl, 2,4-hexadiynyl, or 1,3,5-hexatriynyl.
• Alkynyl groups can also have from 2 to 3, 2 to 4, 2 to 5, 3 to 4, 3 to 5, 3 to 6, 4 to 5, 4 to 6 and 5 to 6 carbons.
• the alkynyl group is typically monovalent, but can be divalent, such as when the alkynyl group links two moieties together.
• Alkynylene refers to an alkynyl group, as defined above, linking at least two other groups, i.e., a divalent hydrocarbon radical.
• the two moieties linked to the alkynylene can be linked to the same atom or different atoms of the alkynylene.
• Alkynylene groups include, but are not limited to, ethynylene, propynylene, butynylene, sec-butynylene, pentynylene and hexynylene.
• “Cycloalkyl” refers to a saturated or partially unsaturated, monocyclic, fused bicyclic or bridged polycyclic ring assembly containing from 3 to 12 ring atoms, or the number of atoms indicated.
• Monocyclic rings include, for example, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, and cyclooctyl.
• Bicyclic and polycyclic rings include, for example, norbornane, decahydronaphthalene and adamantane.
• C 3-8 cycloalkyl includes cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cyclooctyl, and norbornane.
• Cycloalkylene refers to a cycloalkyl group, as defined above, linking at least two other groups, i.e., a divalent hydrocarbon radical. The two moieties linked to the cycloalkylene can be linked to the same atom or different atoms of the cycloalkylene.
• Cycloalkylene groups include, but are not limited to, cyclopropylene, cyclobutylene, cyclopentylene, cyclohexylene, and cyclooctylene.
• “Heterocycloalkyl” refers to a ring system having from 3 ring members to about 20 ring members and from 1 to about 5 heteroatoms such as N, O and S. Additional heteroatoms can also be useful, including, but not limited to, B, Al, Si and P. The heteroatoms can also be oxidized, such as, but not limited to, -S(O)- and -S(O) 2 -.
• heterocycle includes, but is not limited to, tetrahydrofuranyl, tetrahydrothiophenyl, morpholino, pyrrolidinyl, pyrrolinyl, imidazolidinyl, imidazolinyl, pyrazolidinyl, pyrazolinyl, piperazinyl, piperidinyl, indolinyl, quinuclidinyl and 1,4-dioxa-8-aza-spiro[4.5]dec-8-yl.
• “Heterocycloalkylene” refers to a heterocyclalkyl group, as defined above, linking at least two other groups.
• Aryl refers to a monocyclic or fused bicyclic, tricyclic or greater, aromatic ring assembly containing 6 to 16 ring carbon atoms.
• aryl may be phenyl, benzyl or naphthyl.
• Arylene means a divalent radical derived from an aryl group.
• Aryl groups can be mono-, di- or tri-substituted by one, two or three radicals selected from alkyl, alkoxy, aryl, hydroxy, halogen, cyano, amino, amino-alkyl, trifluoromethyl, alkylenedioxy and oxy-C 2 -C 3 -alkylene; all of which are optionally further substituted, for instance as hereinbefore defined; or 1- or 2-naphthyl; or 1- or 2-phenanthrenyl.
• Alkylenedioxy is a divalent substitute attached to two adjacent carbon atoms of phenyl, e.g. methylenedioxy or ethylenedioxy.
• Oxy-C 2 -C 3 -alkylene is also a divalent substituent attached to two adjacent carbon atoms of phenyl, e.g. oxyethylene or oxypropylene.
• An example for oxy- C2-C3-alkylene-phenyl is 2,3-dihydrobenzofuran-5-yl.
• the aryl is naphthyl, phenyl or phenyl mono- or disubstituted by alkoxy, phenyl, halogen, alkyl or trifluoromethyl, especially phenyl or phenyl-mono- or disubstituted by alkoxy, halogen or trifluoromethyl, and in particular phenyl.
• substituted phenyl groups as R are, e.g. 4-chlorophen-1-yl, 3,4-dichlorophen-1-yl, 4-methoxyphen-1-yl, 4-methylphen-1-yl, 4-aminomethylphen-1-yl, 4-methoxyethylaminomethylphen-1-yl, 4-hydroxyethylaminomethylphen-1-yl, 4-hydroxyethyl-(methyl)-aminomethylphen-1-yl, 3-aminomethylphen-1-yl, 4-N-acetylaminomethylphen-1-yl, 4-aminophen-1-yl, 3-aminophen-1-yl, 2-aminophen-1-yl, 4-phenyl-phen-1-yl, 4-(imidazol-1-yl)-phenyl, 4-(imidazol-1-ylmethyl)-phen-1-yl, 4-(morpholin-1-yl)-phen-1-yl, 4-(morpholin-1-ylmethyl)-phen-1-
• Arylene refers to an aryl group, as defined above, linking at least two other groups. The two moieties linked to the arylene are linked to different atoms of the arylene. Arylene groups include, but are not limited to, phenylene.
• Arylene-oxy refers to an arylene group, as defined above, where one of the moieties linked to the arylene is linked through an oxygen atom. Arylene-oxy groups include, but are not limited to, phenylene-oxy.
• Two of the substituents on adjacent atoms of the aryl or heteroaryl ring may optionally be replaced with a substituent of the formula -T-C(O)-(CH 2 ) q -U-, wherein T and U are independently -NH-, -O-, -CH 2 - or a single bond, and q is an integer of from 0 to 2.
• two of the substituents on adjacent atoms of the aryl or heteroaryl ring may optionally be replaced with a substituent of the formula -A-(CH 2 ) r -B-, wherein A and B are independently -CH2-, -O-, -NH-, -S-, -S(O)-, -S(O)2-, -S(O)2NR’- or a single bond, and r is an integer of from 1 to 3.
• One of the single bonds of the new ring so formed may optionally be replaced with a double bond.
• two of the substituents on adjacent atoms of the aryl or heteroaryl ring may optionally be replaced with a substituent of the formula -(CH 2 ) s -X-(CH 2 ) t -, where s and t are independently integers of from 0 to 3, and X is -O-, -NR’-, -S-, -S(O)-, -S(O) 2 -, or -S(O) 2 NR’-.
• the substituent R’ in -NR’- and -S(O) 2 NR’- is selected from hydrogen or unsubstituted (C 1 -C 6 )alkyl.
• Heteroaryl refers to a monocyclic or fused bicyclic or tricyclic aromatic ring assembly containing 5 to 16 ring atoms, where from 1 to 4 of the ring atoms are a heteroatom each N, O or S.
• heteroaryl includes pyridyl, indolyl, indazolyl, quinoxalinyl, quinolinyl, isoquinolinyl, benzothienyl, benzofuranyl, furanyl, pyrrolyl, thiazolyl, benzothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl, pyrazolyl, imidazolyl, thienyl, or any other radicals substituted, especially mono- or di-substituted, by e.g. alkyl, nitro or halogen.
• Pyridyl represents 2-, 3- or 4-pyridyl, advantageously 2- or 3-pyridyl.
• Thienyl represents 2- or 3-thienyl.
• quinolinyl represents 2-, 3- or 4-quinolinyl.
• isoquinolinyl represents 1-, 3- or 4-isoquinolinyl.
• benzopyranyl, benzothiopyranyl can represent 3-benzopyranyl or 3-benzothiopyranyl, respectively.
• thiazolyl can represent 2- or 4-thiazolyl.
• triazolyl can be 1-, 2- or 5-(1,2,4-triazolyl).
• tetrazolyl can be 5-tetrazolyl.
• heteroaryl is pyridyl, indolyl, quinolinyl, pyrrolyl, thiazolyl, isoxazolyl, triazolyl, tetrazolyl, pyrazolyl, imidazolyl, thienyl, furanyl, benzothiazolyl, benzofuranyl, isoquinolinyl, benzothienyl, oxazolyl, indazolyl, or any of the radicals substituted, especially mono- or di-substituted.
• heteroalkyl refers to an alkyl group having from 1 to 3 heteroatoms such as N, O and S.
• heteroalkyl can include ethers, thioethers, alkyl-amines and alkyl-thiols.
• heteroalkylene refers to a heteroalkyl group, as defined above, linking at least two other groups. The two moieties linked to the heteroalkylene can be linked to the same atom or different atoms of the heteroalkylene.
• Electrophile refers to an ion or atom or collection of atoms, which may be ionic, having an electrophilic center, i.e., a center that is electron seeking, capable of reacting with a nucleophile.
• An electrophile (or electrophilic reagent) is a reagent that forms a bond to its reaction partner (the nucleophile) by accepting both bonding electrons from that reaction partner.
• Nucleophile refers to an ion or atom or collection of atoms, which may be ionic, having a nucleophilic center, i.e., a center that is seeking an electrophilic center or capable of reacting with an electrophile.
• a nucleophile is a reagent that forms a bond to its reaction partner (the electrophile) by donating both bonding electrons.
• a “nucleophilic group” refers to a nucleophile after it has reacted with a reactive group. Non limiting examples include amino, hydroxyl, alkoxy, haloalkoxy and the like.
• Maleimido refers to a pyrrole-2,5-dione-1-yl group having the structure: , which upon reaction with a sulfhydryl (e.g., a thio alkyl) forms an -S-maleimido group having the structure , where “•” indicates the point of attachment for the maleimido group and “ “indicates the point of attachment of the sulfur atom the thiol to the remainder of the original sulfhydryl bearing group.
• a sulfhydryl e.g., a thio alkyl
• “naturally occurring amino acids” found in proteins and polypeptides are L-alanine, L-arginine, L-asparagine, L-aspartic acid, L-cysteine, L-glutamine, L-glutamic acid, L-glycine, L-histidine, L-isoleucine, L-leucine, L-lysine, L-methionine, L-phenylalanine, L-proline, L-serine, L-threonine, L-tryptophan, L-tyrosine, and or L-valine.
• “Non-naturally occurring amino acids” found in proteins are any amino acid other than those recited as naturally occurring amino acids.
• Non-naturally occurring amino acids include, without limitation, the D isomers of the naturally occurring amino acids, and mixtures of D and L isomers of the naturally occurring amino acids.
• Other amino acids such as N-alpha- methyl amino acids (e.g. sarcosine), 4-hydroxyproline, desmosine, isodesmosine, 5-hydroxylysine, epsilon-N-methyllysine, 3-methylhistidine, although found in naturally occurring proteins, are considered to be non-naturally occurring amino acids found in proteins for the purpose of this disclosure as they are generally introduced by means other than ribosomal translation of mRNA.
• Linear in reference to the geometry, architecture or overall structure of a polymer, refers to polymer having a single polymer arm.
• Branched in reference to the geometry, architecture or overall structure of a polymer, refers to a polymer having 2 or more polymer “arms” extending from a core structure contained within an initiator.
• the initiator may be employed in an atom transfer radical polymerization (ATRP) reaction.
• a branched polymer may possess 2 polymer chains (arms), 3 polymer arms, 4 polymer arms, 5 polymer arms, 6 polymer arms, 7 polymer arms, 8 polymer arms, 9 polymer arms or more. Each polymer arm extends from a polymer initiation site.
• Each polymer initiation site is capable of being a site for the growth of a polymer chain by the addition of monomers.
• the site of polymer initiation on an initiator is typically an organic halide undergoing a reversible redox process catalyzed by a transition metal compound such as cuprous halide.
• the halide is a bromine.
• “Pharmaceutically acceptable excipient” refers to an excipient that can be included in compositions and that causes no significant adverse toxicological effect on the patient and is approved or approvable by the FDA for therapeutic use, particularly in humans.
• Non-limiting examples of pharmaceutically acceptable excipients include water, NaCl, normal saline solutions, lactated Ringer’s, normal sucrose, normal glucose and the like.
• Therapeutic proteins are administered in an effective regime meaning a dosage, route of administration and frequency of administration that delays the onset, reduces the severity, inhibits further deterioration, and/or ameliorates at least one sign or symptom of a disorder. If a patient is already suffering from a disorder, the regime can be referred to as a therapeutically effective regime. If the patient is at elevated risk of the disorder relative to the general population but is not yet experiencing symptoms, the regime can be referred to as a prophylactically effective regime.
• therapeutic or prophylactic efficacy can be observed in an individual patient relative to historical controls or past experience in the same patient. In other instances, therapeutic or prophylactic efficacy can be demonstrated in a preclinical or clinical trial in a population of treated patients relative to a control population of untreated patients.
• the “biological half-life” of a substance is a pharmacokinetic parameter which specifies the time required for one half of the substance to be removed from a tissue or an organism following introduction of the substance.
• “OG1786” is a 9-arm initiator used for polymer synthesis, which depicts that salt form of OG1786 with trifluororacetic acid. OG1786 may be used as other salts are used or as the free base.
• “OG1801” is an approximately (+/- 15%) 750 kDa polymer (either by Mn or Mp) made using OG1786 as an initiator for ATRP synthesis using the monomer HEMA- PC.
• “OG1802” is OG1801 with a maleimide functionality added wherein each of n 1 , n 2 , n 3 , n 4 , n 5 , n 6 , n 7 , n 8 and n 9 is an integer (positive) (from 0 up to about 3000) such that the total molecular weight of the polymer is (Mw) 750,000 ⁇ 15% Daltons.
• “BCVA” denotes Best Corrected Visual Acuity.
• Multi-angle light scattering is a technique of analyzing macromolecules where the laser light impinges on the molecule, the oscillating electric field of the light induces an oscillating dipole within it. This oscillating dipole will re-radiate light and can be measured using a MALS detector such as Wyatt miniDawn TREOS.
• SEC also allows another average molecular weight determination of the peak molecular weight Mp which is defined as the molecular weight of the highest peak at the SEC.
• the PDI is used as a measure of the broadness of a molecular weight distribution of a polymer and bioconjugate which is derived from conjugation of a discrete protein (e.g. OG1950) to a polydisperse biopolymer (e.g., OG1802).
• SEC Size exclusion chromatography
• the resin is expected to be inert to the analyte when passing through the column and the analytes separate from each other based on their unique size and the pore size characteristics of the selected column.
• Coupling the SEC with MALS or SEC/MALS provides accurate distribution of molar mass and size (root mean square radius) as opposed to relying on a set of SEC calibration standards. This type of arrangement has many advantages over traditional column calibration methods. Since the light scattering and concentration are measured for each eluting fraction, the molar mass and size can be determined independently of the elution position.
• a SEC/MALS analysis includes a Waters HPLC system with Alliance 2695 solvent delivery module and Waters 2996 Photodiole Array Detector equipped with a Shodex SEC-HPLC column (7.8x300mm). This is connected online with a Wyatt miniDawn TREOS and Wyatt Optilab T-rEX differential refractometer.
• the Empower software from Waters can be used to control the Waters HPLC system and the ASTRA V 6.1.7.16 software from Wyatt can be used to acquire the MALS data from the Wyatt miniDawn TREOS, dn/dc data from the T-rEX detector and the mass recovery data using the A280 absorbance signal from the Waters 2996 Photodiole Array detector.
• SEC can be carried out at 1ml/min in 1xPBS pH 7.4, upon sample injection, the MALS and RI signals can be analyzed by the ASTRA software for determination of absolute molar mass (Mp, Mw, Mn) and polydisperse index (PDI).
• the calculation also involves the input dn/dc values for polymer and protein as 0.142 and 0.183, respectively.
• KSI-301 is a bioconjugate of a recombinant, mammalian cell expressed full-length humanized anti-VEGF monoclonal antibody which is covalently conjugated to a branched high molecular weight phosphorylcholine based biopolymer.
• KSI-301 is supplied as a preservative free, sterile, aqueous solution in a single- use glass vial at a concentration of 50 mg/mL (based on antibody mass).
• FIG. 14 displays the amino acid sequence of the antibody portion of KSI-301.
• KSI-301 is an anti-vascular endothelial growth factor (VEGF) biopharmaceutical with an extended ocular half-life.
• VEGF anti-vascular endothelial growth factor
• KSI- 301 is a bioconjugate of two intermediates: (1) OG1950 antibody intermediate, a recombinant, full-length humanized, anti-huVEGF A monoclonal antibody, and (2) OG1802 biopolymer intermediate, a phosphorylcholine biopolymer.
• OG1802 an inert biopolymer, increases the size of the biologic, thereby extending the ocular pharmacokinetics (PK) of KSI-301 beyond that of currently approved anti-huVEGF-A therapeutics.
• Nonclinical studies with KSI-301 indicate that it appropriately binds with high affinity to huVEGF-A whose binding to huVEGF Receptors 1 and 2 (huVEGFR) is then inhibited. This in turn abrogates huVEGF-A mediated function.
• Pharmacokinetic studies have been conducted in rabbit which demonstrate that KSI-301 has extended ocular half-life, penetrates ocular tissues well and is distributed to the retina and choroid.
• KSI-301 has an ocular half-life of approximately 11 days, which is significantly longer than the reported rabbit half-life measured for aflibercept and ranibizumab, which are 4 to 5 and 3 to 4 days, respectively (CovanceStudy 8376321, Park 2016).
• a series of non-clinical GLP repeat dose (4-week dosing intervals) toxicology studies in cynomolgus monkeys testing the ocular and systemic safety of KSI-301 have been conducted through 26 weeks (7 intravitreal doses) and 10 weeks (3 intravenous doses), respectively.
• KSI-301 was well tolerated up to the maximum dose tested of 5 mg/eye (intravitreal) and 5 mg/kg (intravenous) in the ocular and systemic studies, respectively. Together, data extrapolated from non-clinical PK and toxicology studies indicate that KSI-301 can be safely and effectively dosed in human subjects.
• the route of administration is via an intravitreal injection.
• an anti-VEGF antibody conjugate e.g., KSI-301
• the molecule to be administered in any one or more of the methods provided herein is any one of the molecules disclosed in U.S. Pat. Pub.
• a method of the present disclosure includes administering one or more doses of an anti-VEGF antibody conjugate (e.g., KSI-301, or the embodiment in FIG. 14 conjugated to a phosphorylcholine polymer, as provided herein, or the construct depicted in FIG. 13), or an anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate) to a subject (e.g., human or other mammalian patient) in need of treating an eye disorder, to thereby treat the eye disorder.
• an anti-VEGF antibody conjugate e.g., KSI-301, or the embodiment in FIG. 14 conjugated to a phosphorylcholine polymer, as provided herein, or the construct depicted in FIG. 13
• an anti-VEGF protein conjugate e.g., aflibercept biopolymer conjugate
• the anti-VEGF antibody conjugate or anti-VEGF protein conjugate when administered to the subject, may provide a long- lasting therapeutic effect that allows for a dosing schedule with longer intervals between dosing than has been previously used with anti-VEGF therapies.
• a therapeutic result of the anti-VEGF antibody conjugate therapy or anti-VEGF protein conjugate therapy once achieved by administration of one or more doses (e.g., loading dose and/or maintenance dose) of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate, is retained by the subject without requiring any additional dose thereafter, e.g., retained for the rest of the subject’s life.
• the method 4200 can include administering 4210 an anti-VEGF antibody conjugate (e.g., KSI-301) to a subject in need of treating an eye disorder (e.g., wAMD, DME, or RVO) at a first loading dose. Then, the loading dose can be repeated 4220 at least once (e.g., repeated once, twice, three times, etc.). After administration of the loading doses, the therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy can be retained by the subject for at least 8 weeks, e.g., at least 12 weeks, at least 16 weeks, at least 20 weeks, at least 24 weeks or longer, after the final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301
• an eye disorder e.g., wAMD, DME, or RVO
• the loading dose can be repeated 4220 at least once (e.g., repeated once, twice, three times, etc.).
• the method includes administering 4230 one or more subsequent doses (e.g., maintenance doses) of the anti-VEGF antibody conjugate, e.g., KSI-301, to the subject at least 8 weeks, e.g., at least 12 weeks, at least 16 weeks, at least 20 weeks, at least 24 weeks, after administering the final loading dose.
• the method includes administering an anti-VEGF protein, e.g., aflibercept, conjugate (in lieu of the anti-VEGF antibody conjugate) to a subject in need of treating an eye disorder, according to any of the methods disclosed herein.
• the method includes administering a first loading dose of an anti-VEGF antibody conjugate (e.g., KSI-301) or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate) to a subject (e.g., human or other mammalian patient) in need of treating an eye disorder, and subsequently administering at least one more, but no more than two more of the loading doses to achieve a therapeutic result (e.g., improved vision, slowing disease progression, reduced symptoms, improved retinal health, etc.) of the anti-VEGF therapy that lasts for an extended period of time.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the patient may not require re-treatment of the eye disorder for an extended period of time upon receiving the final loading dose.
• administration of the anti-VEGF antibody conjugate may provide for a therapeutic result of the anti-VEGF therapy without any loading doses, to treat a subject having an eye disorder (e.g., non-proliferative diabetic retinopathy).
• an anti-VEGF protein such as an anti-VEGF fusion protein, e.g., aflibercept, is also contemplated.
• an anti-VEGF protein e.g., aflibercept
• a phosphorylcholine containing biopolymer e.g., OG1802
• any reference to an anti-VEGF antibody conjugate therapy also contemplates an anti-VEGF protein, e.g., aflibercept, conjugate therapy.
• any reference to an anti-VEGF antibody conjugate also contemplates an aflibercept biopolymer conjugate.
• a “loading dose” has its ordinary and customary meaning as understood by a person of ordinary skill in the art, in view of the present disclosure.
• a loading dose may refer to an amount of a therapeutic agent administered to a subject, either before a therapeutic effect of the agent is observed in the subject, or before a desired level of therapeutic effect of the agent is achieved in the subject.
• a loading dose is typically administered at the beginning of a course of treatment with the therapy. In some embodiments, the loading dose is administered more frequently or at shorter intervals compared to later doses that are for maintenance of a therapeutic result. The time period during which a subject receives one or more loading doses may be referred to as a loading phase.
• a subject is not monitored for disease progression or status (e.g., not assessed for visual acuity, retinal thickness, etc.) during the loading phase.
• a therapeutic result (as disclosed herein) of the anti-VEGF antibody conjugate therapy e.g., KSI-301 therapy
• the loading dose may be one of a series of loading doses administered to the subject, e.g., during the loading phase.
• a “final loading dose” may refer to the last loading dose in a series of loading doses administered to the subject, at and/or after which a desired level of therapeutic effect of the agent is achieved. Thus, where the subject is given one loading dose, the final loading dose is the first loading dose.
• the final loading dose is the second loading dose.
• the final loading dose is the third loading dose, and so on.
• a dose of the therapeutic agent administered to a subject after the loading phase may be referred to as a maintenance dose or a retreatment dose. “Maintenance dose” and “retreatment dose” are used herein interchangeably.
• the loading doses can be adequate without as frequent need for, or any need for, subsequent retreatment or maintenance doses.
• a series of loading doses is administered to a subject at a higher frequency than a series of maintenance (or retreatment) doses administered to the subject.
• the loading dose(s) given may be sufficient to keep disease activity under control in the subject, without requiring a maintenance (or retreatment) dose.
• the therapeutic result of the anti-VEGF therapy achieved by the methods disclosed herein is sufficiently retained so as not to require a maintenance dose at the scheduled time point in a predetermined dosing schedule.
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of an anti- VEGF antibody conjugate (e.g. KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), until about 2 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• an anti- VEGF antibody conjugate e.g. KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 3 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti- VEGF antibody conjugate until about 4 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 5 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 6 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 7 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 8 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti- VEGF antibody conjugate until about 9 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 10 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 12 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 14 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti-VEGF antibody conjugate until about 16 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• a subject has at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, or higher chance, or percentage between any two of the preceding values, of not requiring a subsequent dose, e.g., a maintenance dose, of the anti- VEGF antibody conjugate until about 18 months or longer after receiving the last loading dose or the last maintenance dose.
• a subsequent dose e.g., a maintenance dose
• the subject may retain a therapeutic result of the anti-VEGF therapy for a sustained period of time without the subject receiving a subsequent dose (e.g., a maintenance dose) of the antibody conjugate.
• a therapeutic result of the anti-VEGF therapy may include an improvement in one or more of visual acuity or retinal health (e.g., retinal thickness, extent of retinal perfusion, etc.) at or around the time of the final loading dose compared to before or at the time of the first loading dose. Any suitable therapeutic result of an anti- VEGF therapy may be used according to methods of the present disclosure.
• Suitable measures for determining therapeutic results include, e.g., visual acuity, retinal thickness, perfusion in at least one eye, diabetic retinopathy severity score (DRSS), disease activity of the eye disorder, or any combination thereof.
• DRSS diabetic retinopathy severity score
• wAMD, DME, RVO, or DR disease activity includes one or more of increased intraretinal fluid, increased subretinal fluid, new intraretinal hemorrhage, new exudates.
• the therapeutic result includes an improvement, or at least a slowed decline, in visual acuity. Visual acuity may be monitored using any suitable method.
• the visual acuity is measured by best corrected visual acuity (BCVA) using e.g., ETDRS letters or Snellen chart, etc.
• the therapeutic result may include an improvement in BCVA measured by ETDRS letters of 3 letters or more, e.g., 4 letters or more, 5 letters or more, 6 letters or more, 7 letters or more, 8 letters or more, 9 letters or more, 10 letters or more, 12 letters or more, 15 letters or more, 18 letters or more, 20 letters or more, 22 letters, or more, including 25 letters or more, or by a number within a range defined by any two of the preceding values, compared to pre- treatment.
• the therapeutic result may include a reduction in the rate of deterioration of BCVA by at least 10%, e.g., at least 15%, at least 25%, at least 50%, at least 75%, at least 90%, including about 100%, or any percentage in a range defined by any two of the preceding values, over pre-treatment.
• the therapeutic result includes a reduction, or at least a slowed increase, in retinal thickness (e.g., central subfield thickness).
• the retinal thickness may be measured using any suitable method, including, but not limited to, optical coherence tomography (OCT).
• the therapeutic result may include a reduction in retinal thickness of about 25 ⁇ m or more, e.g., about 50 ⁇ m or more, about 75 ⁇ m or more, about 100 ⁇ m or more, about 125 ⁇ m or more, about 150 ⁇ m or more, about 175 ⁇ m or more, about 200 ⁇ m or more, about 225 ⁇ m or more, about 250 ⁇ m or more, about 275 ⁇ m or more, about 300 ⁇ m or more, about 325 ⁇ m or more, about 350 ⁇ m or more, about 375 ⁇ m or more, about 400 ⁇ m or more, or a reduction within a range defined by any two of the preceding values, compared to pre-treatment.
• the therapeutic result may include a reduction in the rate of increase in retinal thickness by at least 10%, e.g., at least 15%, at least 25%, at least 50%, at least 75%, at least 90%, including about 100%, or any percentage in a range defined by any two of the preceding values, over pre-treatment.
• the therapeutic result includes improved perfusion, or at least a reduction in the rate of expansion of non-perfusion, of the retina. Perfusion may be monitored using any suitable method. Suitable methods include, without limitation, OCT- angiography (OCT-A), fluorescein angiogram or ultrawide-field fluorescein angiogram. The degree of perfusion, or non-perfusion, may be measured using any suitable measure.
• non-perfusion area or area of capillary non-perfusion is measured.
• an ischemic index is calculated by dividing the non-perfusion area by the total retinal area.
• the presence or absence of retinal non-perfusion in retinal quadrants on the angiogram is measured.
• the therapeutic result may include a reduction in the area of non-perfusion of at least 10%, e.g., at least 15%, at least 25%, at least 50%, at least 75%, at least 90%, including about 100%, or any percentage in a range defined by any two of the preceding values, over pre-treatment.
• the therapeutic result may include a reduction in the rate of progressive non- perfusion of at least 10%, e.g., at least 15%, at least 25%, at least 50%, at least 75%, at least 90%, including about 100%, or any percentage in a range defined by any two of the preceding values, over pre-treatment.
• the therapeutic result includes improved, or prevented worsening of, diabetic retinopathy severity score (DRSS).
• DRSS diabetic retinopathy severity score
• the therapeutic result may include an improved DRSS of 2 steps or more, or 3 steps or more compared to pre-treatment.
• the therapeutic result may include preventing worsening of DRSS by 2 steps or more, or 3 steps or more compared to pre- treatment.
• the therapeutic result is retained if the level of visual acuity or retinal health (e.g., retinal thickness, degree of non-perfusion, etc.) does not worsen by more than a predetermined amount compared to the improved level. In some embodiments, the therapeutic result is retained if the level of visual acuity or retinal health does not revert by 30% or more, e.g., 50% or more, 75% or more, 90% or more, including 100% or more to the pretreatment level of visual acuity or retinal health after the last dose (e.g., final loading dose).
• the last dose e.g., final loading dose
• the therapeutic result is retained if the rate of change of visual acuity or retinal health does not revert by 30% or more, e.g., 50% or more, 75% or more, 90% or more, including 100% or more to the pretreatment level of the rate of change of visual acuity or retinal health after the last dose (e.g., final loading dose).
• the therapeutic result includes an improvement in visual acuity.
• the therapeutic result may be retained if BCVA does not fall by 3 letters or more, 4 letters or more, 5 letters or more, 6 letters or more, 7 letters or more, 8 letters or more, 9 letters or more, or 10 letters or more from the BCVA score at the time of the final loading dose (e.g., at Week 12 after three monthly loading doses). In some embodiments the therapeutic result may be retained if BCVA does not fall by 3 letters or more, 4 letters or more, 5 letters or more, 6 letters or more, 7 letters or more, 8 letters or more, 9 letters or more, or 10 letters or more from the BCVA score measured at the last assessment (e.g., 4 weeks ago).
• the therapeutic result may be retained if BCVA does not fall by 3 letters or more, 4 letters or more, 5 letters or more, 6 letters or more, 7 letters or more, 8 letters or more, 9 letters or more, or 10 letters or more from the best measured BCVA score, or the average of the 2 best measured BCVA scores, of the subject.
• the therapeutic result includes a reduction in retinal thickness (e.g., central subfield thickness).
• the therapeutic result may be retained if retinal thickness (e.g., central subfield thickness) does not increase by 25 ⁇ m or more, 50 ⁇ m or more, 75 ⁇ m or more, 100 ⁇ m or more, 125 ⁇ m or more, or 150 ⁇ m or more from the retinal thickness at the time of the last dose (e.g., final loading dose) (e.g., at Week 12 after three monthly loading doses).
• retinal thickness e.g., central subfield thickness
• the therapeutic result may be retained if retinal thickness (e.g., central subfield thickness) does not increase by 25 ⁇ m or more, 50 ⁇ m or more, 75 ⁇ m or more, 100 ⁇ m or more, 125 ⁇ m or more, or 150 ⁇ m or more from the retinal thickness measured at the last assessment (e.g., 4 weeks ago).
• a retained therapeutic result includes retinal thickness that is not greater than 150 ⁇ m, 125 ⁇ m, 100 ⁇ m, 75 ⁇ m, 50 ⁇ m, 40 ⁇ m, or 30 ⁇ m, compared to the lowest measured retinal thickness of the subject.
• the therapeutic result includes improved perfusion of the retina.
• the retina can have an area of non- perfusion, or absence of blood flow.
• non-perfusion is visualized on angiograms.
• a therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, administration, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate) administration includes regression of non-perfusion, or re-perfusion of the retina.
• the therapeutic result may be retained if the area of non-perfusion is reduced by 10% or more, e.g., 15% or more, 25% or more, 50% or more, 75% or more, 90% or more, or about 100% relative to the area of non-perfusion at the time of the last dose (e.g., final loading dose). In some embodiments, the therapeutic result may be retained if the area of non-perfusion is not increased by 10% or more, e.g., 15% or more, 25% or more, 50% or more, 75% or more, 90% or more, or about 100% relative to the area of non-perfusion at the time of the last dose (e.g., final loading dose).
• the therapeutic result may be retained if the area of non-perfusion is not increased by 10% or more, e.g., 15% or more, 25% or more, 50% or more, 75% or more, 90% or more, or about 100% relative to the area of non- perfusion measured at the last assessment (e.g., 4 weeks ago). In some embodiments, the therapeutic result may be retained if the area of non-perfusion is not increased by 10% or more, e.g., 15% or more, 25% or more, 50% or more, 75% or more, 90% or more, or about 100% relative to the smallest area of non-perfusion measured in the subject.
• a therapeutic result of the anti-VEGF therapy after the last dose may be retained for at least 8 weeks or more, e.g., at least 10 weeks or more, at least 12 weeks or more, at least 14 weeks or more, at least 16 weeks or more, at least 20 weeks or more, at least 24 weeks or more, at least 28 weeks or more, at least 32 weeks or more, at least 36 weeks or more, at least 40 weeks or more, at least 44 weeks or more, at least 48 weeks or more, including at least 52 weeks or more, after the last dose (e.g., final loading dose) was administered.
• the last dose e.g., final loading dose
• the therapeutic result may be retained for a time period of between 8 weeks to 1 year, e.g., between 8 weeks to 40 weeks, between 8 weeks to 32 weeks, including between 12 weeks to 28 weeks, after the final loading dose was administered.
• This can be for any one or more of the eye disorders provided herein, including, for example, RVO, DME, DR, and/or wAMD.
• the method includes administering one, two, or three loading doses of the anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject, and administering one or more subsequent doses (e.g., maintenance doses) of the anti-VEGF antibody conjugate, e.g., KSI-301, (or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)) after the final loading dose.
• the anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the subsequent doses may be administered to the subject no more frequently than once every 8 weeks, e.g., every 10 weeks, every 12 weeks, every 14 weeks, every 16 weeks, every 18 weeks, every 20 weeks, every 24 weeks, every 28 weeks, every 32 weeks, every 40 weeks, including every 52 weeks. Whether to administer a subsequent dose of the anti-VEGF antibody conjugate may be determined based on any convenient reason. In some embodiments, the subsequent dose may be administered based on a predetermined schedule (e.g., a schedule determined before the subject is administered any of the one or more of the loading doses).
• a predetermined schedule e.g., a schedule determined before the subject is administered any of the one or more of the loading doses.
• the subsequent dose may be administered based on a predetermined schedule based on the severity of the eye disorder, the subject’s previous response, or lack thereof, to other therapies for the eye disorder, or any other clinically relevant factors associated with the subject. In some embodiments, the subsequent dose may be administered based on the outcome of one or more assessment tests for ocular health and/or function carried out on the subject during the course of treatment with the anti-VEGF antibody conjugate.
• the subsequent dose may be administered based on the outcome of one or more assessment tests carried out on the subject every 4 or more weeks, e.g., every 6 or more weeks, every 8 or more weeks, every 10 or more weeks, every 12 or more weeks, every 16 or more weeks, every 20 or more weeks, every 24 or more weeks, every 28 or more weeks, every 32 or more weeks, every 36 or more weeks, including every 40 or more weeks.
• the subsequent dose may be administered if one or more assessment tests indicates a diminishment of the therapeutic result of the anti-VEGF therapy that is greater than a predetermined threshold.
• Q4W refers to a dosing schedule, and have the ordinary and customary meaning to one of ordinary skill in the art.
• the number may indicate the number of the unit of time specified by the subsequent letter.
• W indicates a unit of a week;
• M specifies an interval of a month.
• Q4W refers to a dosing interval of 4 weeks, which also includes a dosing interval of one month;
• Q8W refers to a dosing interval of 8 weeks, which also includes a dosing interval of two months; and so on.
• specification of a dosing schedule does not necessarily imply a number of doses beyond two, unless indicated otherwise.
• a dosing schedule refers to the dosing schedule for maintenance doses (including the interval between the last loading dose, and the first maintenance dose).
• a reference to a dosing schedule being “longer” or “shorter” refers to the time interval between doses being longer than that specified (e.g., a dosing interval of 12 weeks or longer).
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject in the first year of treatment is 10 times or less, 9 times or less, 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject in the first two years of treatment is 10 times or less, 9 times or less, 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject in the first three years of treatment is 10 times or less, 9 times or less, 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the total number of maintenance doses of the anti- VEGF antibody conjugate (e.g., KSI-301) administered to the subject in a one-year period for treatment is 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti- VEGF antibody conjugate e.g., KSI-301
• the total number of maintenance doses of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject in a two-year period for treatment is 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of maintenance doses of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject in a three-year period for treatment is 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with wAMD in the first year of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with wAMD in the first two years of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with wAMD in the first three years of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti- VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of maintenance doses of the anti- VEGF antibody conjugate (e.g., KSI-301) administered to the subject with wAMD in a one- year period for treatment is 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the total number of maintenance doses of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with wAMD in a two-year period for treatment is 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the total number of maintenance doses of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with wAMD in a three-year period for treatment is 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in the first year of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in the first two years of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in the first three years of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti- VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of maintenance doses of the anti- VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in a one- year period during treatment is 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the total number of maintenance doses of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in a two-year period during treatment is 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the total number of maintenance doses of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in a three-year period during treatment is 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with RVO in the first year of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with RVO in the first two years of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of injections (including loading and maintenance doses) of the anti-VEGF antibody conjugate (e.g., KSI-301) administered to the subject with RVO in the first three years of treatment is 8 times or less, 7 times or less, 6 times or less, 5 times or less, 4 times or less, 3 times or less, 2 times or less, or once, in order to retain the therapeutic result of the anti- VEGF antibody conjugate therapy.
• the anti-VEGF antibody conjugate e.g., KSI-301
• the total number of maintenance doses of the anti- VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in a one- year period during treatment is 5 times or less, 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the anti- VEGF antibody conjugate e.g., KSI-301
• the total number of maintenance doses of the anti- VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in a two- year period during treatment is 5 times or less, 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• the total number of maintenance doses of the anti- VEGF antibody conjugate (e.g., KSI-301) administered to the subject with DME in a three- year period during treatment is 5 times or less, 4 times or less, 3 times or less, 2 times or less, once or less, or zero, in order to retain the therapeutic result of the anti-VEGF antibody conjugate therapy.
• a first subsequent dose is administered at a first time after the last loading dose
• a second subsequent dose is administered at a second period of time after the first subsequent dose, where no other dose is administered between the last loading dose and the first subsequent dose, or between the first subsequent dose and the second subsequent dose.
• the second period of time between the first and second subsequent doses may be the same or different from the first period of time between the last loading dose and the first subsequent dose.
• the first time period is 8 weeks or more, e.g., 10 weeks or more, 12 weeks or more, 14 weeks or more, 16 weeks or more, 18 weeks or more, 20 weeks or more, 24 weeks or more, 28 weeks or more, 32 weeks or more, 36 weeks or more, 40 weeks or more, at least 44 weeks or more, at least 48 weeks or more, including 52 weeks or more.
• the second period of time is longer than the first period of time by 0 weeks or more, e.g., by 4 weeks or more, by 6 weeks or more, by 8 weeks or more, by 10 weeks or more, by 12 weeks or more, by 16 weeks or more, by 20 weeks or more, including by 24 weeks or more.
• the timing for administering the second subsequent dose may depend on the outcome of one or more assessments for ocular health and/or function of the subject.
• Any suitable amount of the anti-VEGF antibody conjugate, or anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• a subsequent dose e.g., maintenance dose
• the subsequent dose includes about 1 mg or more, e.g., about 1.25 mg or more, about 1.5 mg or more, about 1.75 mg or more, about 2 mg or more, about 2.5 mg or more, about 3 mg or more, about 3.5 mg or more, about 4 mg or more, about 4.5 mg of more, including about 5 mg or more (by weight of the anti-VEGF antibody portion) of the anti-VEGF antibody conjugate.
• the subsequent dose includes from about 1 mg to about 10 mg, e.g., about 1 mg to about 7.5 mg, about 1.25 mg to about 5 mg, including about 2 mg to about 5 mg (by weight of the anti-VEGF antibody portion) of the anti-VEGF antibody conjugate.
• the subject may not need to receive a dose of the anti-VEGF antibody conjugate, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), while the therapeutic effect lasts.
• the last dose e.g., final loading dose
• the subject may not need to receive a dose of the anti-VEGF antibody conjugate, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), while the therapeutic effect lasts.
• no further administration of the anti-VEGF antibody conjugate, or anti-VEGF protein conjugate is made to the subject within 4 weeks or more, e.g., within 6 weeks or more, within 8 weeks or more, within 10 weeks or more, within 12 weeks or more, within 14 weeks or more, within 16 weeks or more, within 20 weeks or more, within 24 weeks or more, within 28 weeks or more, within 32 weeks or more, within 36 weeks or more, within 40 weeks or more, within 44 weeks or more, within 48 weeks or more, including within 52 weeks or more, after the last dose (e.g., final loading dose).
• the last dose e.g., final loading dose
• a method of the present disclosure can include administering a fewer number of injections (of the anti-VEGF antibody conjugate, such as KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)) after the last loading dose compared to the number of injections in a standard of care treatment, to maintain a therapeutic result.
• the anti-VEGF antibody conjugate such as KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• the average number of injections (e.g., of the anti- VEGF antibody conjugate) administered after the last loading dose is about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about 0.25 or less, about 0.2 or less, about 0.18 or less, about 0.17 or less, or a number within a range defined by any two of the preceding values, over 16 weeks.
• the average number of injections (e.g., of the anti-VEGF antibody conjugate) administered after the last loading dose is about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about 0.25 or less, about 0.2 or less, about 0.18 or less, about 0.17 or less, or a number within a range defined by any two of the preceding values, over 12 weeks.
• the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about 0.25 or less, about 0.2 or less, about 0.18 or less, about 0.17 or less, or a number within a range defined by any two of the preceding values, over 8 weeks.
• the subject has DME, and the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about 0.25 or less, about 0.2 or less, or a number within a range defined by any two of the preceding values, over 16 weeks.
• the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about
• the subject has DME, and the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about 0.25 or less, about 0.2 or less, or a number within a range defined by any two of the preceding values, over 12 weeks.
• the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about
• the subject has DME, and the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI- 301) administered after the last loading dose is about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less, about 0.25 or less, about 0.2 or less, or a number within a range defined by any two of the preceding values, over 8 weeks.
• the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI- 301) administered after the last loading dose is about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, about 0.4 or less, about 0.35 or less, about 0.3 or less
• the subject has RVO, and the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 2.75 or less, about 2.5 or less, about 2.25 or less, about 2 or less, about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, or a number within a range defined by any two of the preceding values, over 16 weeks.
• the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 2.75 or less, about 2.5 or less, about 2.25 or less, about 2 or less, about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, or a number within
• the subject has RVO, and the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 2.75 or less, about 2.5 or less, about 2.25 or less, about 2 or less, about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, or a number within a range defined by any two of the preceding values, over 12 weeks.
• the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 2.75 or less, about 2.5 or less, about 2.25 or less, about 2 or less, about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, or a number within
• the subject has RVO, and the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 2.75 or less, about 2.5 or less, about 2.25 or less, about 2 or less, about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, or a number within a range defined by any two of the preceding values, over 8 weeks.
• the average number of injections (of the anti-VEGF antibody conjugate, e.g., KSI-301) administered after the last loading dose is about 2.75 or less, about 2.5 or less, about 2.25 or less, about 2 or less, about 1.75 or less, about 1.5 or less, about 1.25 or less, about 1 or less, about 0.9 or less, about 0.8 or less, about 0.7 or less, about 0.5 or less, about 0.45 or less, or a number within
• the eye disorder treated by the present methods include one or more of age-related macular degeneration (AMD), diabetic macular edema (DME), retinal vein occlusion (RVO) (e.g., central retinal vein occlusion (CRVO) and branched central retinal vein occlusion (BRVO)), diabetic retinopathy (DR) (e.g., non- proliferative DR and proliferative DR) and presumed ocular histoplasmosis syndrome.
• AMD age-related macular degeneration
• DME diabetic macular edema
• RVO retinal vein occlusion
• CRVO central retinal vein occlusion
• BRVO branched central retinal vein occlusion
• DR diabetic retinopathy
• a subject to be treated by methods of the present disclosure has wet AMD.
• the subject has wet AMD without a high pigment epithelial detachment (PED).
• a subject has high PED when the baseline central subfield retinal thickness (CST) in an eye of the subject is 500 microns or greater.
• CST central subfield retinal thickness
• a subject with the eye disorder has, before receiving a treatment according to methods of the present disclosure, a CST of about 200 microns or more, about 250 microns or more, about 275 microns or more, about 300 microns or more, about 325 microns or more, about 350 microns or more, about 375 microns or more, about 400 microns or more, about 425 microns or more, about 450 microns or more, about 475 microns or more, about 500 microns or more, about 525 microns or more, about 550 microns or more, about 575 microns or more, about 600 microns or more, about 625 microns or more, about 650 microns or more, about 675 microns or more, about 700 microns or more, about 725 microns or more
• a subject with the eye disorder has, before receiving a treatment according to methods of the present disclosure, a BCVA, in ETDRS letters, of about 80 or less, about 75 or less, about 70 or less, about 68 or less, about 66 or less, about 64 or less, about 62 or less, about 60 or less, about 58 or less, about 56 or less, about 54 or less, about 52 or less, about 50 or less, about 48 or less, about 46 or less, about 44 or less, about 42 or less, about 40 or less, or value within a range defined by any two of the preceding values.
• a BCVA in ETDRS letters, of about 80 or less, about 75 or less, about 70 or less, about 68 or less, about 66 or less, about 64 or less, about 62 or less, about 60 or less, about 58 or less, about 56 or less, about 54 or less, about 52 or less, about 50 or less, about 48 or less, about 46 or less, about 44 or less, about 42 or less, about 40 or less, or value within
• a method of the present disclosure includes administering a first loading dose of an anti-VEGF antibody conjugate (e.g., KSI-301) (or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)) to a subject (e.g., human or other mammalian patient) in need of treating wAMD or DME, and subsequently administering at least one more, but no more than two more of the loading doses to achieve a therapeutic result (e.g., improved vision, reduced symptoms, etc.) of the anti-VEGF therapy, where the therapeutic result is retained for at least 12 weeks after the final loading dose was administered.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the therapeutic result is retained for at least 14 weeks, e.g., at least 16 weeks, at least 20 weeks, at least 24 weeks, at least 28 weeks, at least 32 weeks, at least 36 weeks, at least 40 weeks, at least 44 weeks, at least 48 weeks, including at least 52 weeks after the final loading dose was administered.
• the eye disorder is wAMD and the method includes administering a subsequent dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti- VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), after about 24 months of the final loading dose.
• the eye disorder is wet AMD without a high pigment epithelial detachment (PED).
• PED pigment epithelial detachment
• a subject has high PED when the baseline central subfield retinal thickness (CST) in an eye of the subject is 500 microns or greater.
• CST central subfield retinal thickness
• a subject treated by the present methods has RVO.
• a method of the present disclosure includes administering a first loading dose of an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject (e.g., human patient) in need of treating RVO, and subsequently administering one more loading dose to achieve a therapeutic result (e.g., improved vision, reduced symptoms, etc.) of the anti-VEGF therapy, where the therapeutic result is retained for at least 8 weeks after the final loading dose was administered.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the therapeutic result is retained for at least 10 weeks, e.g., at least 12 weeks, at least 14 weeks, at least 16 weeks, at least 20 weeks, at least 24 weeks, at least 28 weeks, at least 32 weeks, at least 36 weeks, at least 40 weeks, including at least 52 weeks after the final loading dose was administered.
• the method further includes administering one or more subsequent doses (e.g., maintenance doses) of the anti-VEGF antibody conjugate, e.g., KSI-301, after the final loading dose.
• the subsequent doses may be administered to the subject no more frequently than once every 8 weeks, e.g., every 10 weeks, every 12 weeks, every 14 weeks, every 16 weeks, every 18 weeks, every 20 weeks, every 24 weeks, every 28 weeks, every 32 weeks, every 36 weeks, every 40 weeks, every 44 weeks, every 48 weeks, including every 52 weeks.
• Also provided herein are methods of treating a subject with an eye disorder where the method includes administering between 1 to 3 loading doses, but no more than 3 loading doses, of an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject, and providing a follow-on application of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate no sooner than 14 weeks after the last loading dose was administered.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the follow-on application of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is provided no sooner than 16 weeks, e.g., no sooner than 18 weeks, no sooner than 20 weeks, no sooner than 24 weeks, no sooner than 28 weeks, no sooner than 32 weeks, no sooner than 36 weeks, including no sooner than 40 weeks after the last loading dose was administered.
• the eye disorder treated is DME.
• Also provided are methods of treating a subject for an eye disorder where the method includes administering to a subject in need of treating an eye disorder a monthly loading dose of an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), over one, two or three months, and administering one or more subsequent doses of the anti-VEGF antibody conjugate no less than every 8 weeks after the final loading dose.
• the eye disorder is AMD (e.g., wAMD), DME, RVO or DR.
• the eye disorder is RVO.
• the eye disorder is wAMD, DME or DR, and the subsequent doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is administered no less than every 12 weeks, e.g., every 16 weeks, every 20 weeks, every 24 weeks, every 28 weeks, every 32 weeks, every 36 weeks, every 40 weeks, including every 52 weeks after the final loading dose.
• the eye disorder is wAMD, and the subsequent doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is administered no less than every 12 weeks.
• the eye disorder is wet AMD without a high pigment epithelial detachment (PED).
• a subject has high PED when the baseline central subfield retinal thickness (CST) in an eye of the subject is 500 microns or greater.
• a method of the present disclosure includes administering at least one and up to three loading doses of an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder, to thereby achieve a therapeutic result of the anti-VEGF therapy, assessing the ocular health of the subject after the final loading dose to determine whether the therapeutic result of the anti-VEGF therapy is retained, and not administering any subsequent doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate for at least 8 weeks after the final loading dose until upon a determination that the anti-VEGF therapy is no longer retained.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an a
• the eye disorder is AMD (e.g., wAMD), DME or RVO. In some embodiments, the eye disorder is RVO. In some embodiments, the eye disorder is wAMD or DME, and the subsequent doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is administered at least 12 weeks after the final loading dose. In some embodiments, the eye disorder is wAMD and the method includes administering a subsequent dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), after about 24 months of the final loading dose.
• KSI-301 anti-VEGF protein conjugate
• the eye disorder is wet AMD without a high pigment epithelial detachment (PED).
• PED pigment epithelial detachment
• a subject has high PED when the baseline central subfield retinal thickness (CST) in an eye of the subject is 500 microns or greater.
• a method of the present disclosure includes administering at least one and up to three loading doses of an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder, to achieve a therapeutic result (e.g., improved vision, reduced symptoms, etc.) of the anti-VEGF therapy, and administering one or more subsequent doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate no less than every 8 weeks after the final loading dose, where the therapeutic result of the anti- VEGF therapy is retained as effectively as administering the one or more subsequent doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate every 4 weeks after the final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the eye disorder is AMD (e.g., wAMD), DME or RVO. In some embodiments, the eye disorder is RVO. In some embodiments, the eye disorder is wAMD or DME, and the subsequent doses of the anti-VEGF antibody conjugate is administered no less than every 12 weeks after the final loading dose, where the therapeutic result of the anti-VEGF therapy is retained as effectively as administering the one or more subsequent doses of the anti-VEGF antibody conjugate every 4 weeks after the final loading dose.
• the eye disorder is wAMD and the method includes administering a subsequent dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti- VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), after about 24 months of the final loading dose.
• the eye disorder is wet AMD without a high pigment epithelial detachment (PED).
• PED pigment epithelial detachment
• a subject has high PED when the baseline central subfield retinal thickness (CST) in an eye of the subject is 500 microns or greater.
• a method of the present disclosure includes administering at least one and up to three loading doses of an anti-VEGF antibody conjugate (e.g., KSI-301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder, to achieve a therapeutic result (e.g., improved vision, reduced symptoms, etc.) of the anti-VEGF therapy, and administering one or more subsequent doses of the anti-VEGF antibody conjugate no less than every 12 weeks after the final loading dose, where the therapeutic result of the anti-VEGF therapy is retained as effectively as the therapeutic result a standard or care treatment for the eye disorder, where the standard of care treatment includes administering three monthly loading doses of a standard of care therapeutic, and administering one or more subsequent doses of the standard of care therapeutic every 8 weeks, or every 4 weeks, after the final loading dose of the standard of care therapeutic.
• an anti-VEGF antibody conjugate e.g., KSI-301
• the eye disorder is wAMD. In some embodiment, the eye disorder is wet AMD without a high pigment epithelial detachment (PED). In some embodiments, a subject has high PED when the baseline central subfield retinal thickness (CST) in an eye of the subject is 500 microns or greater. In some embodiments, the standard of care therapeutic is aflibercept. In some embodiments, the subsequent doses of the anti-VEGF antibody conjugate is administered no less than every 16 weeks, e.g., no less than every 20 weeks, no less than every 24 weeks, no less than every 28 weeks, including no less than every 32 weeks, after the final loading dose of the anti-VEGF antibody conjugate.
• Also provided herein are methods of reperfusion of an eye in a subject suffering from DME where the method includes identifying the subject with DME, DR or RVO, administering at least 2 loading doses of an anti-VEGF antibody conjugate (e.g., KSI- 301), or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject, and providing one or more further doses of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate to the subject until the subject displays reperfusion in at least one eye.
• Reperfusion of an eye may be monitored using any suitable measure.
• reperfusion of the eye is determined by an increase in blood vessel count, e.g., in retinal tissue, compared to a pretreatment state.
• the reperfusion of the eye may be monitored using any suitable method, including, but not limited to, OCT-angiography (OCT- A), fluorescein angiogram or ultrawide-field fluorescein angiogram.
• OCT- A OCT-angiography
• fluorescein angiogram or ultrawide-field fluorescein angiogram.
• the method provides for improved perfusion of an eye as measured by reduction in the area of non-perfusion of at least 10%, e.g., at least 20%, at least 30%, at least 50%, at least 75%, at least 90%, including about 100%, over a pre-treatment area of non-perfusion.
• the method provides for reperfusion of an eye as measured by a reduction in the area of non-perfusion of between 10% and 100%, e.g., between 10% and 75%, between 10% and 50%, including between 10% and 30%, over a pre-treatment area of non-perfusion.
• the improved perfusion provides at least 10% recovery, e.g., at least 20% recovery, at least 30% recovery, at least 50% recovery, at least 75% recovery, at least 90% recovery, including approximately 100% recovery of visual acuity in the subject over the pretreatment level.
• the improved perfusion provides between 10% and 100% recovery, e.g., between 10% and 90% recovery, between 10% and 75% recovery, between 10% and 50% recovery, including between 10% and 30% recovery of visual acuity in the subject over the pretreatment level.
• the loading doses may be administered to the subject at any suitable time interval to achieve the desired therapeutic result.
• the loading doses are administered with 3 weeks or more, e.g., 4 weeks or more, one month or more, 5 weeks or more, 6 weeks or more, 8 weeks or more, 12 weeks or more, including 16 weeks or more between each loading dose. Where there are more than two loading doses, the time period between each loading dose may be the same or may be different.
• the loading doses may be administered at the same interval, and some other loading doses may be administered at a different interval.
• Any suitable amount of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate may be administered to the subject in a loading dose.
• the loading dose includes about 1 mg or more, e.g., about 1.25 mg or more, about 1.5 mg or more, about 1.75 mg or more, about 2 mg or more, about 2.5 mg or more, about 3 mg or more, about 3.5 mg or more, about 4 mg or more, about 4.5 mg of more, including about 5 mg or more (by weight of the anti-VEGF antibody portion) of the anti- VEGF antibody conjugate.
• the loading dose includes from about 1 mg to about 10 mg, e.g., about 1 mg to about 7.5 mg, about 1.25 mg to about 5 mg, including about 2 mg to about 5 mg (by weight of the anti-VEGF antibody portion) of the anti-VEGF antibody conjugate.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• a lasting therapeutic effect is obtained by a single dose of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate, without administering any loading dose (e.g., without having a loading phase with monthly loading doses in the treatment schedule).
• the eye disorder is non-proliferative DR.
• the VEGF antibody conjugate or anti-VEGF protein is administered to a patient having non- proliferative DR to improve perfusion in at least one eye of the subject. [0235] Any suitable amount of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate may be administered to the subject in a dose.
• the dose includes 1 mg or more, e.g., 1.25 mg or more, 1.5 mg or more, 1.75 mg or more, 2 mg or more, 2.5 mg or more, 3 mg or more, 3.5 mg or more, 4 mg or more, 4.5 mg of more, including 5 mg or more (by weight of the anti-VEGF antibody portion) of the anti-VEGF antibody conjugate.
• the dose includes from 1 mg to 10 mg, e.g., 1 mg to 7.5 mg, 1.25 mg to 5 mg, including 2 mg to 5 mg (by weight of the anti-VEGF antibody portion) of the anti-VEGF antibody conjugate.
• methods of the present disclosure provide for an anti-VEGF therapy for an eye disorder, where there is reduced risk of intraocular inflammation (e.g., blepharitis, infectious conjunctivitis, keratitis, scleritis, endophthalmitis).
• intraocular inflammation e.g., blepharitis, infectious conjunctivitis, keratitis, scleritis, endophthalmitis.
• intravitreal administration of the anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• intravitreal administration of the anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• retreating wAMD involves one or more of: – [0238] Increase in CST ⁇ 75 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12, OR – [0239] Decrease in BCVA of > 5 letters compared to Day 1, due to worsening wAMD activity, OR – [0240] Decrease in BCVA of ⁇ 10 letters compared to the best prior BCVA, due to worsening wAMD activity.
• retreating wAMD involves one or more of: – [0242] Increase in CST ⁇ 50 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12, OR – [0243] Decrease in BCVA of > 10 letters compared to the best prior BCVA, due to worsening wAMD activity, OR – [0244] Increase of ⁇ 75 microns compared to Week 12, OR – [0245] New Macular Hemorrhage [0246]
• retreating DME and RVO involves one or more of: – [0247] Increase in CST ⁇ 75 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12 or the prior visit, OR – [0248] Decrease in BCVA of ⁇ 10 letters compared to the best prior BCVA, due to worsening DME/RVO disease activity [0249] In some embodiments, no more than 0, 1, 2, 3, 4, 5, or 6 retreatment events is required for a one year duration for
• retreatment occurs when one or more of the above criteria occurs.
• a retreatment is a treatment that follows the last loading dose or treatment for a subject.
• a loading dose is a dose that is provided initially to bring the amount of drug in the patient or subject up to a desired level to have an initial therapeutic effect.
• a retreatment dose, or maintenance dose is a dose that is provided to return the therapeutic effect of the drug to the subject, after a prior dose (last loading dose or retreatment/maintenance dose) has degraded in effectiveness, or on a pre- determined interval.
• the method involves administering a re-treatment with intravitreal injection of an antibody or conjugate thereof (e.g., KSI-301) if at least one of the following re-treatment criteria is met.
• the criteria are related to signs of disease recurrence and/or vision loss due to disease recurrence.
• the subject has wAMD and the criteria is one or more of: increase in OCT central subfield retinal thickness (CST) ⁇ 75 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12; decrease in BCVA of ⁇ 10 letters compared to Day 1, due to worsening wAMD disease activity (e.g.
• the subject has DME or RVO, and the criteria is one or more of: increase in OCT central subfield retinal thickness (CST) ⁇ 75 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12 or the prior visit (4-week span between visits); and/or decrease in BCVA of ⁇ 10 letters compared to the best prior BCVA, due to worsening DME/RVO disease activity (e.g.
• the method involves administering a re-treatment with intravitreal injection of an antibody or conjugate thereof (e.g., KSI-301) if at least one of the following re-treatment criteria is met.
• the criteria are related to signs of disease recurrence and/or vision loss due to disease recurrence.
• the subject has wAMD
• the criteria is one or more of: increase in OCT central subfield retinal thickness (CST) ⁇ 50 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12; decrease in BCVA of ⁇ 10 letters compared to the best prior BCVA, due to worsening wAMD disease activity (e.g. increased intraretinal fluid, increased subretinal fluid, new intraretinal hemorrhage, new subretinal hemorrhage); increase in OCT central subfield retinal thickness (CST) ⁇ 75 ⁇ m; and/or new macular hemorrhage.
• CST OCT central subfield retinal thickness
• no retreatment dose is given to a subject for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 or more weeks following the last loading dose.
• 1 loading dose is administered and no retreatment dose is given to a subject for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 or more weeks following the loading dose.
• 2 loading doses are given to a subject and no retreatment dose is given for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 or more weeks following the last loading dose.
• 3 loading doses are given to a subject and no retreatment dose is given for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 or more weeks following the last loading dose.
• 1-2 loading doses are given to a subject and no retreatment dose is given for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 or more weeks following the last loading dose.
• 1-3 loading doses are given to a subject and 1, 2, 3, or 4 retreatment dose are given for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 or more weeks following the last loading dose.
• no more than 2, 3, 4, or 5 loading doses are administered to a subject.
• no 4 th loading dose is provided to the subject.
• the above treatment approaches allow for the subject’s vision to stay improved at or close to the level achieved following the 1 st 2 nd or 3 rd loading dose.
• the above treatment approaches allow for the subject’s vision to stay improved to the point of not requiring a retreatment of the subject.
• the methods of the present disclosure can provide a long dosing interval and still sustain a therapeutic result of the anti-VEGF antibody conjugate (e.g., KSI-301) therapy, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate) therapy.
• at least 75% of patients treated according to methods of the present disclosure can be on a Q4M dosing interval.
• at least 90% of patients treated according to methods of the present disclosure can be on a Q4M dosing interval.
• At least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90% of patients treated according to methods of the present disclosure can be on a Q4M dosing interval.
• between about 40 to about 95%, e.g., between about 45 to about 90%, between about 50 to about 85%, between about 55 to about 85%, between about 60 to about 85%, between about 65 to about 85%, including between about 70 to about 80% of patients treated according to methods of the present disclosure can be on a Q4M dosing interval.
• at least 75% of patients treated according to methods of the present disclosure can be on a Q5M dosing interval.
• At least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90% of patients treated according to methods of the present disclosure can be on a Q5M dosing interval.
• between about 40 to about 95%, e.g., between about 45 to about 90%, between about 50 to about 85%, between about 55 to about 85%, between about 60 to about 85%, between about 65 to about 85%, including between about 70 to about 80% of patients treated according to methods of the present disclosure can be on a Q5M dosing interval.
• at least 55% of patients treated according to methods of the present disclosure can be on a Q6M dosing interval.
• At least 70% of patients treated according to methods of the present disclosure can be on a Q6M dosing interval. In some embodiments, at least 75% of patients treated according to methods of the present disclosure can be on a Q6M dosing interval. In some embodiments, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, or at least 80% of patients treated according to methods of the present disclosure can be on a Q6M dosing interval.
• between about 30 to about 85%, e.g., between about 30 to about 80%, between about 35 to about 75%, between about 40 to about 70%, between about 45 to about 65%, between about 50 to about 65%, including between about 50 to about 60% of patients treated according to methods of the present disclosure can be on a Q6M dosing interval.
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient treated according to methods of the present disclosure has at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, or at least 80% chance of maintaining a therapeutic result of anti-VEGF therapy on a Q5M dosing interval.
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient treated according to methods of the present disclosure has between about 40 to about 95%, e.g., between about 45 to about 90%, between about 50 to about 85%, between about 55 to about 85%, between about 60 to about 85%, between about 65 to about 85%, including between about 70 to about 80% chance of maintaining a therapeutic result of anti-VEGF therapy on a Q5M dosing interval.
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient e.g., patient having an eye disorder, such as, but not limited to wAMD, RVO or DME
• a patient having an eye disorder such as, but not limited to wAMD, RVO or DME
• a patient having RVO treated according to methods of the present disclosure has at least 75% chance of maintaining a therapeutic result of anti- VEGF therapy on a Q4M dosing interval.
• a patient having RVO treated according to methods of the present disclosure has at least 80% chance of maintaining a therapeutic result of anti-VEGF therapy on a Q5M dosing interval. In some embodiments, a patient having RVO treated according to methods of the present disclosure has at least 90% chance of maintaining a therapeutic result of anti-VEGF therapy on a Q5M dosing interval. In some embodiments, a patient having RVO treated according to methods of the present disclosure has at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80% or at least 900% chance of maintaining a therapeutic result of anti-VEGF therapy on a Q4M dosing interval.
• a patient having RVO treated according to methods of the present disclosure has between about 40 to about 95%, e.g., between about 45 to about 95%, between about 50 to about 95%, between about 55 to about 95%, between about 60 to about 95%, between about 65 to about 95%, including between about 70 to about 90% chance of maintaining a therapeutic result of anti-VEGF therapy on a Q4M dosing interval.
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 1, 2, 3, 4, 5, or 6 loading doses of the anti-VEGF antibody conjugate, e.g., KSI-301
• KSI-301 has a chance of 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, 95% or more, or about 100%, or a percentage within a range defined by any two of the preceding values, of not receiving a retreatment dose (e.g., due to disease activity meeting one or more retreatment criteria) for at least about 28 weeks after the last loading dose, or after the last retreatment dose (and in the alternative, for at least 0.5, 0.6, 0.7, 0.8, 0.9.
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject having wAMD who has been administered 3 loading doses (of the anti-VEGF antibody conjugate, e.g., KSI-301), according to some methods of the present disclosure, has a chance of about 70% or higher of not receiving a retreatment dose (e.g., due to disease activity meeting one or more retreatment criteria) for at least about 28 weeks after the last loading dose, or after the last retreatment dose.
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 3 loading doses of the anti-VEGF antibody conjugate, e.g., KSI-301
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 1, 2, 3, 4, 5, or 6 loading doses of the anti-VEGF antibody conjugate, e.g., KSI-301
• KSI-301 has a chance of 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, 95% or more, or about 100%, or a percentage within a range defined by any two of the preceding values, of not receiving a retreatment dose (e.g., due to disease activity meeting one or more retreatment criteria) for at least about 24 weeks after the last loading dose, or after the last retreatment dose.
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 3 loading doses e.g., of KSI-301
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 1, 2, 3, 4, 5, or 6 loading doses of the anti-VEGF antibody conjugate, e.g., KSI-301
• KSI-301 has a chance of 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, 95% or more, or about 100%, or a percentage within a range defined by any two of the preceding values, of not receiving a retreatment dose (e.g., due to disease activity meeting one or more retreatment criteria) for at least about 20 weeks after the last loading dose, or after the last retreatment dose.
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 3 loading doses of the anti-VEGF antibody conjugate, e.g., KSI-301
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 1, 2, 3, 4, 5, or 6 loading doses of the anti-VEGF antibody conjugate, e.g., KSI-301
• KSI-301 has a chance of 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, 95% or more, or about 100%, or a percentage within a range defined by any two of the preceding values, of not receiving a retreatment dose (e.g., due to disease activity meeting one or more retreatment criteria) for at least about 16 weeks after the last loading dose, or after the last retreatment dose.
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• a subject e.g., a subject having an eye disorder, such as, but not limited to wAMD, RVO or DME
• 3 loading doses e.g., of KSI-301
• a retreatment dose e.g., due to disease activity meeting one or more retreatment criteria
• any of the above dosing schedules is from any ocular disorder.
• wAMD patients achieve 3 to 6 months of durability via the use of an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• DME patients achieve 3 to 5+ months of durability with only 3 loading doses via the use of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• DME patients achieve 3 to 6+ months of durability with only 3 loading doses via the use of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• RVO patients achieving 2 to 4+ months of durability with only 3 loading doses via the use of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• RVO patients achieve 2 to 5+ months of durability with only 3 loading doses via the use of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• sustained improvement in PDR with 3 loading doses via the use of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• a reduced number of loading doses in DME and RVO is achieved via the use of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti- VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• a dosing schedule for wet AMD is: every 3 to 5 months (although some wAMD patients may benefit from dosing every 8 weeks).
• a dosing schedule for DME is every 3 to 6 months. In some embodiments, a dosing schedule for RVO is every 8 weeks or longer (e.g., 6 months). In some embodiments, a dosing schedule for diabetic retinopathy (without diabetic macular edema) is every 3 months or longer (e.g., every 4 months or every 6 months). In some embodiments, the dosing schedule can be applied to treat diabetic retinopathy (non-proiliferative diabetic retinopathy and proliferative diabetic retinopathy). [0272] In some embodiments, an RVO patient that has received more than one retreatment after the loading dose, the time to the second retreatment is longer than the time to the first retreatment.
• the amount of the antibody administered to the subject will be between 1 and 5 mg, e.g., 1.25 (25 microliters), 2.5 (50 microliters) or 5 mg (100 microliters).
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• KSI-301 an anti-VEGF antibody conjugate
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• the outcome measures there are 1) improvement in 2 or more steps of diabetic retinopathy severity status on standard color photos of the retina or 2) prevention of 2 or more steps worsening of DRSS using photo.
• retreatment is done less frequently than once every 8 weeks.
• the dosing schedule can be applied to non- proliferative DR with 1 to 2 loading doses, or just 1 loading dose and not more than that. The retreatment can occur no sooner than 12 or 16 or 24 weeks thereafter.
• a method of administering an anti-VEGF antibody conjugate or anti-VEGF protein conjugate in which the patient gets a loading phase (for example, 2 loading doses q4 weeks), then a retreatment at 8 weeks, then the time to a second retreatment is longer that the time to the first retreatment (for example, 16+ weeks). In some embodiments, this reflects a ‘disease modification’.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• a method of disease modification of an eye disorder is provided.
• the method comprises: administering an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject having an eye disorder at a first loading dose, whereby the eye disorder is thereby modified in a beneficial manner to the subject.
• an anti-VEGF antibody conjugate e.g., KSI-301
• anti-VEGF protein conjugate e.g., an aflibercept biopolymer conjugate
• a method of treating an eye disorder is provided.
• the method comprises identifying a subject with DME, DR or RVO; administering 1-6 loading doses of an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject; providing a first retreatment dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), to the subject following a first amount of time from the last loading dose; and providing a second retreatment dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), to the subject, following a second amount of time from the first retreatment dose of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e
• the second amount of time is 10, 20, 30, 40, 50, 60, 70, 80, 90, 100% or greater than the first amount of time. In some embodiments, the second amount of time is 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 or more weeks longer than the first amount of time.
• the loading doses include 3 doses of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), administered to the subject.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• reperfusion of ischemic tissue
• each subsequent retreatment injection will be less frequent than the first retreatment injection. That is, the amount of time between retreatment injections can be increased, give the properties of the present method.
• the amount of time can increase by 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or more weeks for each subsequent retreatment injection.
• the amount of time increases by 1, 2, 3, 4, 5, 6, 7, 8, 90, 10, 15, 20, 25, 30, 35, 40, 45, 50, 100, 500, 1000, 5000, 10,000 percent or more between each retreatment.
• a method of treating an eye disorder can include: administering an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder at a first loading dose, wherein the eye disorder is diabetic macular edema (DME); and repeating the loading dose at least once, but not more than twice, whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti- VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), therapy for at least 8 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• DME diabetic macular edema
• the subject retains the therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate) therapy, for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 44, 48, 52, 56, or 60 or more weeks after the final loading dose.
• the loading dose is administered twice, or three times.
• the loading dose is administered monthly or every other month.
• the method further includes administering one or more subsequent doses of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to the subject after the final loading dose.
• the subsequent doses of the anti-VEGF antibody conjugate is administered at a dosing schedule of Q8W, Q12W, Q16W, Q20W, or Q24W, or longer. In some embodiments, the dosing schedule is between Q8W and Q24W.
• no subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose. In some embodiments, no more than one subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose. In some embodiments, no more than two subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose. In some embodiments, no more than three subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose.
• a method of treating an eye disorder includes: administering an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder at a first loading dose, wherein the eye disorder is wet age-related macular degeneration (wAMD); and repeating the loading dose at least once, but not more than twice, whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate therapy, or anti-VEGF protein conjugate therapy for at least 12 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate
• wAMD wet age-related macular degeneration
• the subject retains the therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy for at least 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 44, 48, 52, 56, or 60 or more weeks after the final loading dose.
• the loading dose is administered twice, or three times.
• the loading dose is administered monthly or every other month.
• the method further includes administering one or more subsequent doses of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), to the subject after the final loading dose.
• the subsequent doses of the anti-VEGF antibody conjugate or anti- VEGF protein conjugate is administered at a dosing schedule of Q2W, Q4W, Q8W, Q12W, Q16W, Q20W, or Q24W, or longer. In some embodiments, the dosing schedule is between Q12W and Q20W.
• no more than one, two, three, or four subsequent doses, or no subsequent dose of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is administered to the subject within about one year of the first loading dose. In some embodiments, the dosing schedule is between Q12W and Q20W. In some embodiments, no more than one, two, three, or four subsequent doses, or no subsequent dose of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is administered to the subject within about two years of the first loading dose. In some embodiments, no more than one, two, three, or four subsequent doses, or no subsequent dose of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is administered to the subject within about three years of the first loading dose.
• a method of treating an eye disorder includes: administering an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), to a subject in need of treating an eye disorder at a first loading dose, wherein the eye disorder is retinal vein occlusion (RVO), e.g., CRVO or BRVO; and repeating the loading dose at least once, but not more than twice, whereby the subject retains a therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate) therapy, for at least 8 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• RVO retinal
• the subject retains the therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate) therapy, for at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 44, 48, 52, 56, or 60 or more weeks after the final loading dose.
• the loading dose is administered twice, or three times.
• the loading dose is administered monthly or every other month.
• the method further includes administering one or more subsequent doses of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., aflibercept biopolymer conjugate), to the subject after the final loading dose.
• the subsequent doses of the anti-VEGF antibody conjugate is administered at a dosing schedule of Q8W, Q12W, Q16W, Q20W, or Q24W, or longer.
• the dosing schedule is Q8W or longer.
• no subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose.
• no more than one subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose. In some embodiments, no more than two subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose. In some embodiments, no more than three subsequent dose of the anti-VEGF antibody conjugate is administered to the subject within at least about one year, about two years, or about three years, after the first loading dose.
• a method of treating an eye disorder includes administering to a subject in need of treating an eye disorder a therapeutically effective amount of an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), wherein the eye disorder is diabetic retinopathy (DR), thereby treating the eye disorder.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• the anti-VEGF antibody conjugate is administered according to a dosing schedule of Q12W, Q16W, Q20W, or Q24W, or longer.
• the dosing schedule is between Q12W and Q24W.
• the method further comprises administering to the subject at least one loading dose, but no more than two loading doses, of the anti-VEGF antibody conjugate.
• the time between any two consecutive loading doses is about 4 or 8 weeks (once a month or once every other month).
• a method of treating an eye disorder includes administering to a subject in need of treating an eye disorder a first dose of a plurality of doses of an anti-VEGF antibody conjugate, e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), in a dosing schedule comprising: a loading dosing schedule comprising 1-3 loading doses of the anti-VEGF antibody conjugate, wherein the first dose is a loading dose; followed by a maintenance dosing schedule comprising one or more subsequent doses of the anti-VEGF antibody conjugate after a final loading dose, wherein the maintenance dosing schedule comprises a predetermined dosing schedule of Q8W or longer.
• an anti-VEGF antibody conjugate e.g., KSI-301, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate)
• a dosing schedule comprising: a loading dosing schedule comprising
• the predetermined dosing schedule is Q8W, Q12W, Q16W, Q20W, or Q24W, or longer.
• the eye disorder is wAMD, and the predetermined dosing schedule is Q12W or longer, e.g., Q16W, Q20W, or Q24W, or longer.
• the eye disorder is DME, DR, or RVO.
• the method includes an individualized dosing schedule.
• a method of treating an eye disorder with an individualized dosing schedule can include: evaluating a therapeutic result of the anti-VEGF antibody conjugate, e.g., KSI-301, therapy, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate) therapy, in the subject at one or more time points after the first dose (e.g., a loading dose or a maintenance dose); and administering a subsequent dose of the anti-VEGF antibody conjugate, or anti-VEGF protein conjugate, to the subject at a subsequent time point specified by the predetermined dosing schedule, unless the therapeutic result is retained by the subject, in which case extending the time interval until administering the subsequent dose.
• a therapeutic result of the anti-VEGF antibody conjugate e.g., KSI-301, therapy, or anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate) therapy
• the first dose e.g., a loading dose or a maintenance dose
• a subject’s eye health e.g. retinal health
• eye health may be evaluated or assessed at a follow-up visit 4, 8, or 12 weeks, or any time point within a range defined by the above values, after the last dose, e.g., last loading dose, or last maintenance dose.
• the therapeutic result of the anti-VEGF antibody conjugate therapy or anti-VEGF protein conjugate therapy may be assessed by any suitable option as disclose herein (e.g., visual acuity, retinal thickness, etc.).
• the therapeutic result of the anti-VEGF antibody conjugate therapy or anti-VEGF protein conjugate therapy is retained, as disclosed herein, no subsequent dose, e.g., maintenance dose, is needed, and the actual dosing schedule may deviate from the predetermined dosing schedule.
• the next subsequent dose e.g., maintenance dose, is postponed as long as the therapeutic result of the anti-VEGF antibody conjugate therapy or anti-VEGF protein conjugate therapy is retained.
• an actual dosing schedule may deviate from a predetermined Q8W dosing schedule if at 8 weeks after the last loading dose or the last maintenance dose, the subject’s treated eye retains the therapeutic result of the anti-VEGF antibody conjugate therapy, the anti-VEGF antibody conjugate is not administered at the scheduled time.
• the next maintenance dose may be postponed indefinitely as long as the therapeutic result of the anti-VEGF antibody conjugate therapy is retained.
• a method of treating an eye disorder includes: identifying a subject in need of treating an eye disorder, wherein the eye disorder is presumed ocular histoplasmosis syndrome; and intravitreally administering to the subject a therapeutically effective amount of the anti-VEGF antibody conjugate, e.g., KSI-301, or anti- VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate), thereby treating the eye disorder.
• the therapeutically effective amount comprises about 1 mg to about 5 mg, about 1.25 mg to about 5 mg, or about 2.5 mg to about 5 mg (by weight of the anti-VEGF antibody portion) of the anti-VEGF antibody conjugate.
• no more than one injection of the anti-VEGF antibody conjugate or anti-VEGF protein conjugate is required to treat the eye disorder.
• administering to the subject in need of treating an eye disorder no more than three loading doses of the anti-VEGF antibody conjugate (e.g., KSI-301) provides a therapeutic result that lasts at least 24 weeks or longer.
• administering to the subject in need of treating an eye disorder no more than two doses of the anti-VEGF antibody conjugate (e.g., KSI-301) provides a therapeutic result that lasts at least 24 weeks or longer.
• administering to the subject in need of treating an eye disorder no more than one dose of the anti-VEGF antibody conjugate (e.g., KSI-301) provides a therapeutic result that lasts at least 24 weeks or longer.
• no additional dose e.g., maintenance dose
• no additional dose e.g., maintenance dose
• no additional dose e.g., maintenance dose
• no additional dose of the anti-VEGF antibody conjugate is administered to the subject for at least 24 weeks.
• no additional dose (e.g., maintenance dose) of the anti-VEGF antibody conjugate is administered to the subject for at least 24 weeks. In some embodiments, after administering three loading dose, no additional dose (e.g., maintenance dose) of the anti- VEGF antibody conjugate is administered to the subject for at least 24 weeks. In some embodiments, an interval between loading doses is about one month to about two months. In some embodiments, an interval between loading doses is about one month or about two months. In some embodiments, the anti-VEGF antibody conjugate (e.g., KSI-301) is administered to the subject at a dosing schedule (e.g., maintenance dosing schedule) of Q24W or longer.
• a dosing schedule e.g., maintenance dosing schedule
• the eye disorder is wAMD. In some embodiments, the eye disorder is RVO. In some embodiments, the eye disorder is DME. In some embodiments, the eye disorder is DR. ANTIBODY CONJUGATES [0296]
• anti-VEGF antibodies including anti-VEGF proteins, e.g., afliberccept
• the antibodies themselves are different from other anti-VEGF agents and provide superior results over other anti-VEGF agents.
• the anti-VEGF antibody conjugate displays a surprising superiority over other antibodies and/or the expectation of the activity other antibody conjugates.
• the anti-VEGF antibody conjugate is KSI-301, which is an antibody conjugate comprising: (1) an anti-VEGF-A antibody; and (2) a phosphorylcholine containing polymer, wherein the polymer is covalently bonded to the anti-VEGF-A antibody at a cysteine outside a variable region of the anti-VEGF-A antibody, and wherein said cysteine replaces a non-cysteine amino acid that occurs in a same position in sequence, wherein the anti-VEGF-A antibody comprises a light chain and heavy chain, said heavy chain comprising an Fc region, wherein the cysteine is in the Fc region of the heavy chain, wherein the sequence of a heavy chain comprises SEQ ID NO 1, and wherein the sequence of a light chain comprises SEQ ID NO.2, wherein the antibody conjugate has the following structure:
• each heavy chain of the anti-VEGF-A antibody is denoted by the letter H, and each light chain of the anti-VEGF-A antibody is denoted by the letter L;
• the polymer is bonded to the anti-VEGF-A antibody through a sulfhydryl at C443 according to EU numbering, which bond is depicted on one of the heavy chains above;
• PC is , where the curvy line indicates the point of attachment to the rest of the polymer; and n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different such that the sum of n1, n2, n3, n4, n5, n6, n6, n7, n8 and n9 is 2500 plus or minus 15%.
• conjugating a molecule to a protein often resulted in a decrease in the protein’s binding interaction to its intended target.
• the same level of decrease as might have been expected is not necessarily observed.
• the evidence provided herein shows the opposite effect as to what may have been expected.
• the conjugate can be superior to the antibody alone.
• the interaction of a ligand and its specific receptor is often driven through the stereospecific interaction of the ligand and the receptor, as directed by the interactions of the hydrophilic amino acids on the ligand with the hydrophilic amino acids on the receptor, and water molecules are front and center in those interactions.
• an anti-VEGF antibody conjugate is provided that is capable of blocking at least 90% of an interaction between a VEGF ligand (“VEGFL”) and a VEGF-receptor (“VEGFR”).
• VEGFL VEGF ligand
• VEGFR VEGF-receptor
• the noted blocking occurs at saturating concentrations.
• an anti-VEGF antibody conjugate that blocks at least 95% of an interaction between a VEGF ligand and a VEGF-receptor.
• An example of such superiority of blocking is the ability of the anti-VEGF antibody bioconjugate (an antibody conjugate provided herein, e.g., KSI-301) to block to a higher degree than Lucentis®(ranibizumab) or Avastin®(bevacizumab) or even the antibody OG1950 (unconjugated).
• the antibodies or conjugates thereof inhibit at least 70, 80, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% of the activity and/or interaction between VEGFR and VEGFL.
• the IC50 value can be 0.1, 1, 2, 3, 4, 5, 6, 7 , 8, 9, 10, 20, 30, 40, 50, 100 nM or less than any one or more of the preceding values.
• the KD can be 2*10 ⁇ -13, 1*10 ⁇ -13, 1*10 ⁇ -12, 1*10 ⁇ -11, 1*10 ⁇ -10M or less than any one of the preceding values.
• the IC50 value can be 1, 5, 10, 20, 30, 40, 50, 60, 7080, 90, 100, 200, 300, 400, 500, 600, 700, 800, 900, 1,000, 1,100, 1,200, 1,300, or less than any one of the preceding values.
• an anti-VEGF antibody that blocks at least 90% of an interaction between a VEGF ligand and a VEGF-receptor. For example, it can block at least 91, 92, 93, 94, 95, 96, 97, 98, 99, or effectively all of the interaction between VEGFR and VEGFL.
• superiority of blocking is the ability of of OG1950 (and antibody provided herein) to block to a higher degree than Lucentis®(ranibizumab) or Avastin®(bevacizumab).
• antibodies such as Lucentis®(ranibizumab) or Avastin®(bevacizumab) can be conjugated to one or more of the polymers as described herein, by one or more of the processes described herein.
• any antibody, or fragment thereof can be conjugated to one or more of the polymers as described herein, by one or more of the processes described herein.
• the antibody comprises a heavy chain amino acid variable region that comprises SEQ ID NO 1 and a light chain amino acid variable region that comprises SEQ ID NO. 2.
• the antibody is conjugated to one or more of the polymers provided herein.
• the conjugated antibody is at least 90% identical to SEQ ID NO: 1 and/or 2.
• the antibody contains the 6 CDRs within SEQ ID NO:1 and SEQ ID NO: 2, as well as a point mutation of L443C (EU numbering, or 449C in SEQ ID NO: 1).
• the conjugated antibody is at least 90% identical to SEQ ID NO: 1 and/or 2 and includes the following mutations: L234A, L235A, and G237A (EU numbering), and at least one of the following mutations: Q347C (EU numbering)or L443C (EU numbering).
• an antibody that binds to VEGF-A is provided.
• the antibody comprises: a CDRH1 that is the CDRH1 in SEQ ID NO: 1, a CDRH2 that is the CDR H 2 in SEQ ID NO: 1, a CDR H 3 that is the CDR H 3 in SEQ ID NO: 1, a CDR L 1 that is the CDR L 1 in SEQ ID NO: 2, a CDR L 2 that is the CDR L 2 in SEQ ID NO: 2, a CDR L 3 that is the CDR L 3 in SEQ ID NO: 2, at least one of the following mutations: L234A, L235A, and G237A (EU numbering), and at least one of the following mutations: Q347C (EU numbering) or L443C (EU numbering).
• any of the antibodies provided herein can be conjugated to any of the polymers provided herein and/or any antibody provided herein can have a cysteine added such that it allows for site specific conjugation to a polymer.
• VEGF or “vascular endothelial growth factor” is a human vascular endothelial growth factor that affects angiogenesis or an angiogenic process.
• VEGF means any member of the class of growth factors that (i) bind to a VEGF receptor such as VEGFR-1 (Flt-1), VEGFR-2 (KDR/Flk-1), or VEGFR-3 (FLT-4); (ii) activates a tyrosine kinase activity associated with the VEGF receptor; and (iii) thereby affects angiogenesis or an angiogenic process.
• VEGF-A also known as VPE
• -B, -C, -D and PGF placental growth factor
• VEGF-A exists as a number of different isotypes which are generated both by alternative splicing and proteolysis: VEGF-A206, VEGF-A189, VEGF-A165, and VEGF-A121.
• the isoforms differ in their ability to bind heparin and non-signaling binding proteins called neuropilins.
• the isoforms are all biologically active as dimers.
• VEGF-A VEGF-A
• -B P49766
• -C P49767
• –D receptor tyrosine kinases
• RTKs receptor tyrosine kinases
• the VEGF family receptors belong to class V RTKs and each carry seven Ig-like domains in the extracellular domain (ECD).
• ECD extracellular domain
• VEGF binds to three types of RTKs: VEGFR-1 (Flt-1) (P17948), VEGFR-2 (KDR, Flk-1) (P935968) and VEGFR-3 (Flt-4) (P35916).
• VEGF vascular endothelial growth factor
• VEGF antagonist therapies have been approved for the treatment of certain cancers and wet AMD.
• Bevacizumab (AVASTIN, Genentech/Roche) is a humanized mouse monoclonal antibody that binds to and neutralizes human VEGF, in particular to all isoforms of VEGF-A and to bioactive proteolytic fragments of VEGF-A. See, e.g., Ferrara N, Hillan KJ, Gerber HP, Novotny W. 2004. Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nat Rev Drug Discov. 3(5):391-400. Bevacizumab has been approved for the treatment of certain cancers.
• the protein sequence of the heavy and light chains of bevacizumab (DrugBank DB00112) are set forth in SEQ ID NO.
• Bevacizumab variable light chain CDRs are CDRL1: SASQDISNYLN (SEQ ID NO: 12), CDRL2: FTSSLHS (SEQ ID NO: 13) and CDRL3: QQYSTVPWT (SEQ ID NO: 14).
• Bevacizumab variable heavy chain CDRs are CDRH1: GYTFTNYGMN, CDRH2: WINTYTGEPTYAADFKR (SEQ ID NO: 10), and CDRH3: YPHYYGSSHWYFDV.
• CDRs are defined by Kabat except CDRH1 uses the composite Kabat/Chothia definition.
• a cysteine can be added to the Bevacizumab sequence and the antibody (and/or a variant that includes the 6 CDRs of Bevacizumab) can be conjugated to any one or more of the polymers provided herein.
• Another anti-VEGF molecule derived from the same mouse monoclonal antibody as bevacizumab has been approved as a treatment for wet AMD: ranibizumab (LUCENTIS®(ranibizumab), Genentech/Roche).
• Ranibizumab is an antibody fragment or Fab. Ranibizumab was produced by affinity maturation of the variable heavy and light chains of bevacizumab.
• ranibizumab The sequence of the heavy and light chains of ranibizumab (as published by Novartis) is set forth in SEQ ID NO. 5 and 6 respectively.
• a cysteine can be added to the ranibizumab sequence and the antibody (and/or a variant that includes the 6 CDRs of ranibizumab) can be conjugated to any one or more of the polymers provided herein.
• the Ranibizumab CDRS are the same as Bevacizumab except where an improvement was added after affinity maturation:
• Ranibizumab variable light chain CDRs are CDRL1: SASQDISNYLN (SEQ ID NO: 12), CDRL2: FTSSLHS (SEQ ID NO: 13) and CDR L 3: QQYSTVPWT (SEQ ID NO: 14).
• Ranibizumab variable heavy chain CDRs are CDR H 1: GYDFTHYGMN (SEQ ID NO: 9), CDR H 2: WINTYTGEPTYAADFKR (SEQ ID NO: 10), and CDRH3: YPYYYGTSHWYFDV (SEQ ID NO: 11).
• an antibody conjugate having an anti- VEGF-A antibody bonded at a cysteine outside a variable region of the antibody to a phosphorylcholine containing polymer, wherein the cysteine has been added via recombinant DNA technology.
• the polymer is bonded to a single cysteine.
• “added by recombinant DNA technology” means that the cysteine residue replaces a non-cysteine amino acid that occurs in the same position in a known or existing antibody or in a consensus antibody sequence.
• the anti-VEGF-A antibody comprises a light chain and a heavy chain where the heavy chain has an Fc region.
• the cysteine is in the Fc region and the anti-VEGF-A antibody is an immunoglobulin G (IgG).
• the anti-VEGF-A heavy chain has CDRH1: GYDFTHYGMN (SEQ ID NO: 9), CDRH2: WINTYTGEPTYAADFKR (SEQ ID NO: 10), and CDRH3: YPYYYGTSHWYFDV (SEQ ID NO: 11), and position 221 (via sequential counting as in SEQ ID NO. 3) is T, and the anti-VEGF-A light chain has CDRL1: SASQDISNYLN (SEQ ID NO: 12), CDR L 2: FTSSLHS (SEQ ID NO: 13), and CDR L 3: QQYSTVPWT (SEQ ID NO: 14), and Kabat position 4 is L.
• the anti-VEGF-A heavy chain isotype is IgG1.
• the IgG1 constant domain has one or more mutations relative to an IgG1 constant domain (e.g. constant region of SEQ ID NO. 3) to modulate effector function.
• the effector function mutations are one or more of the following: (EU numbering) E233X, L234X, L235X, G236X, G237X, A327X, A330X, and P331X wherein X is any natural or unnatural amino acid.
• the mutations are selected from the group consisting of (EU numbering): E233P, L234V, L234A, L235A, G237A, A327G, A330S, and P331S.
• the antibody conjugate has the following mutations (EU numbering): L234A, L235A, and G237A.
• the cysteine residue is in the anti-VEGF-A heavy chain and is Q347C (EU numbering) or L443C (EU numbering). In some embodiments, the cysteine residue is L443C (EU numbering, or 449C in SEQ ID NO: 1).
• the sequence of the anti-VEGF-A heavy chain is SEQ ID NO. 1 and the sequence of the anti-VEGF-A light chain is SEQ ID NO. 2.
• the phosphorylcholine containing polymer comprises 2-(methacryloyloxyethyl)-2'-(trimethylammonium)ethyl phosphate (MPC) monomers as set forth below: .
• MPC 2-(methacryloyloxyethyl)-2'-(trimethylammonium)ethyl phosphate
• the polymer has three or more arms, or is synthesized with an initiator comprising 3 or more polymer initiation sites.
• the polymer has 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 arms, or is synthesized with an initiator comprising 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 polymer initiation sites. More preferably, the polymer has 3, 6, or 9 arms, or is synthesized with an initiator comprising 3, 6, or 9 polymer initiation sites. In some embodiments, the polymer has 9 arms, or is synthesized with an initiator comprising 9 polymer initiation sites.
• the polymer that is added has a molecular weight between about 300,000 and about 1,750,000 Da (SEC-MALs). In some embodiments, the polymer has a molecular weight between about 500,000 and about 1,000,000 Da. In some embodiments, the polymer has a molecular weight of between about 600,000 to about 900,000 Da. In some embodiments, the polymer has a molecular weight of between about 750,000 to about 850,000 Da. In some embodiments, the polymer has a molecular weight of between about 800,000 to about 850,000 Da. In some embodiments, the polymer has a molecular weight of between about 750,000 to about 800,000 Da.
• any of the antibodies described herein can be further conjugated to a polymer to form a bioconjugate.
• the molecular weight of the bioconjugate (in total, SEC-MALs) can be between about 350,000 and 2,000,000 Daltons, for example, between about 450,000 and 1,900,000 Daltons, between about 550,000 and 1,800,000 Daltons, between about 650,000 and 1,700,000 Daltons, between about 750,000 and 1,600,000 Daltons, between about 850,000 and 1,500,000 Daltons, between about 900,000 and 1,400,000 Daltons, between about 950,000 and 1,300,000 Daltons, between about 900,000 and 1,000,000 Daltons, between about 1,000,000 and 1,300,000 Daltons, between about 850,000 and 1,300,000 Daltons, between about 850,000 and 1,000,000 Daltons, and between about 1,000,000 and 1,200,000 Daltons.
• the antibody conjugate is purified.
• the polymer is aspect of the antibody conjugate is polydisperse, i.e. the polymer PDI is not 1.0.
• the PDI is less than 1.5.
• the PDI is less than 1.4.
• the PDI is less than 1.3.
• the PDI is less than 1.2.
• the PDI is less than 1.1.
• the antibody conjugate has an anti-VEGF-A immunoglobulin G (IgG) bonded to a polymer, which polymer comprises MPC monomers, wherein the sequence of the anti-VEGF-A heavy chain is SEQ ID NO.1, and the sequence of the anti-VEGF-A light chain is SEQ ID NO. 2, and wherein the antibody is bonded only at C449 in SEQ ID NO. 1 to the polymer.
• the polymer has 9 arms and has a molecular weight of between about 600,000 to about 1,000,000 Da.
• the antibody conjugate has an anti-VEGF-A immunoglobulin G (IgG) bonded to a polymer, which polymer comprises MPC monomers, wherein the sequence of the anti-VEGF-A heavy chain is SEQ ID NO.1, and the sequence of the anti-VEGF-A light chain is SEQ ID NO. 2, and wherein the antibody is bonded only at C443 (EU numbering, or 449C in SEQ ID NO: 1) to the polymer.
• the polymer has 9 arms and has a molecular weight of between about 600,000 to about 1,000,000 Da.
• the antibody conjugate has the following structure:
• each heavy chain of the anti-VEGF-A antibody is denoted by the letter H, and each light chain of the anti-VEGF-A antibody is denoted by the letter L; the polymer is bonded to the anti-VEGF-A antibody through the sulfhydryl of C449 of SEQ ID NO: 1, which bond is depicted on one of the heavy chains;
• PC is, where the curvy line indicates the point of attachment to the rest of the polymer;
• X is a) –OR where R is H, methyl, ethyl, propyl, or isopropyl, b) –H, c) any halogen, including –Br, –Cl, or –I, d) –SCN, or e) –NCS; and n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different such that the sum of n1, n2, n3, n4, n5,
• n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different and are integers from 0 to 3000. In some embodiments, n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different and are integers from 0 to 500.
• X is –OR, where R is a sugar, an aminoalkyl, mono-substituted, poly- substituted or unsubstituted variants of the following residues: saturated C1 -C24 alkyl, unsaturated C2 -C24 alkenyl or C2 -C24 alkynyl, acyl, acyloxy, alkyloxycarbonyloxy, aryloxycarbonyloxy, cycloalkyl, cycloalkenyl, alkoxy, cycloalkoxy, aryl, heteroaryl, arylalkoxy carbonyl, alkoxy carbonylacyl, amino, aminocarbonyl, aminocarboyloxy, nitro, azido, phenyl, hydroxy, alkylthio, arylthio, oxysulfonyl, carboxy, cyano, and halogenated alkyl including polyhalogenated alkyl, --CO--O--R 7 , carbonyl, alky
• each heavy chain of the anti-VEGF-A antibody is denoted by the letter H, and each light chain of the anti-VEGF-A antibody is denoted by the letter L;
• the polymer is bonded to the anti-VEGF-A antbiody through the sulfhydryl of C443 (EU numbering, or 449C in SEQ ID NO: 1), which bond is depicted on one of the heavy chains;
• PC is, where the curvy line indicates the point of attachment to the rest of the polymer;
• X is a) –OR where R is H, methyl, ethyl, propyl, or isopropyl, b) –H, c) any halogen, including Br, –Cl, or –I, d) –SCN, or e) –NCS; and n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different such that the sum of n
• n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different and are integers from 0 to 3000. In some embodiments, n1, n2, n3, n4, n5, n6, n7, n8 and n9 are the same or different and are integers from 0 to 500.
• X is -OR, where R is a sugar, an aminoalkyl, mono-substituted, poly- substituted or unsubstituted variants of the following residues: saturated C1 -C24 alkyl, unsaturated C2 -C24 alkenyl or C2 -C24 alkynyl, acyl, acyloxy, alkyloxycarbonyloxy, aryloxycarbonyloxy, cycloalkyl, cycloalkenyl, alkoxy, cycloalkoxy, aryl, heteroaryl, arylalkoxy carbonyl, alkoxy carbonylacyl, amino, aminocarbonyl, aminocarboyloxy, nitro, azido, phenyl, hydroxy, alkylthio, arylthio, oxysulfonyl, carboxy, cyano, and halogenated alkyl including polyhalogenated alkyl, --CO--O--R 7 , carbonyl, alky
• this construct is designated as KSI-301.
• the antibody conjugate is present in a liquid formulation. In some embodiments, the antibody conjugate is combined with a pharmaceutically acceptable carrier.
• an anti-VEGF-A antibody is presented.
• the anti- VEGF-A antibody heavy chain has at least the following CDR sequences: CDR H 1: GYDFTHYGMN (SEQ ID NO: 9), CDR H 2: WINTYTGEPTYAADFKR (SEQ ID NO: 10), and CDR H 3: YPYYYGTSHWYFDV (SEQ ID NO: 11).
• the anti-VEGF-A heavy chain has those CDRs and in addition has threonine (T) at position 221 (via sequential counting as in SEQ ID NO. 3).
• the anti-VEGF-A light chain has at least the following CDRs: CDRL1: SASQDISNYLN (SEQ ID NO: 12), CDRL2: FTSSLHS (SEQ ID NO: 13) and CDRL3: QQYSTVPWT (SEQ ID NO: 14).
• the anti-VEGF-A antibody has those CDRs and in addition has leucine (L) at Kabat position 4.
• the isotype of the anti-VEGF-A antibody heavy chain is IgG1 and has a CH 1 , hinge, CH 2 and CH 3 domains.
• the light chain isotype is kappa.
• the anti-VEGF antibody conjugate (e.g., KSI- 301) construct will have one or more of these CDRs.
• the IgG1 domain of the anti-VEGF-A antibody has one or more mutations to modulate effector function, such as ADCC, ADCP, and CDC. In some embodiments, the IgG1 mutations reduce effector function.
• the amino acids to use for effector function mutations include (EU numbering) E233X, L234X, L235X, G236X, G237X, G236X, D270X, K322X, A327X, P329X, A330X, A330X, P331X, and P331X, in which X is any natural or non-natural amino acid.
• the mutations include one or more of the following: E233P, L234V, L234A, L235A, G237A, A327G, A330S and P331S (EU numbering).
• the anti-VEGF-A heavy chain has the following mutations (EU numbering): L234A, L235A and G237A.
• the number of effector function mutations relative to a natural human IgG1 sequence is no more than 10.
• the number of effector function mutations relatative to a natural human IgG1 sequence is no more than 5, 4, 3, 2 or 1.
• the antibody has decreased Fc gamma binding and/or complement C1q binding, such that the antibody’s ability to result in an effector function is decreased. This can be especially advantageous for ophthalmic indications/disorders.
• the anti-VEGF-A antibody comprises one or more of the following amino acid mutations: L234A, L235A, G237A (EU numbering), and L443C (EU numbering, or 449C in SEQ ID NO: 1). [0331] In some embodiments, the anti-VEGF-A antibody is or is part of a human immunoglobulin G (IgG1). [0332] In some embodiments, the VEGF-A antibody comprises a heavy chain constant domain that comprises one or more mutations that reduce an immune-mediated effector function. [0333] In some embodiments an anti-VEGF-A antibody is provided.
• the anti- VEGF-antibody comprises a heavy chain that comprises a CDRH1 comprising the sequence GYDFTHYGMN (SEQ ID NO: 9), a CDRH2 comprising the sequence WINTYTGEPTYAADFKR (SEQ ID NO: 10), a CDR H 3 comprising the sequence YPYYYGTSHWYFDV (SEQ ID NO: 11), a CDR L 1 comprising the sequence SASQDISNYLN (SEQ ID NO: 12), a CDR L 2 comprising the sequence FTSSLHS (SEQ ID NO: 13), and a CDRL3 comprising the sequence QQYSTVPWT (SEQ ID NO: 14).
• the IgG domain can be IgG2, IgG3 or IgG4 or a composite in which a constant regions is formed from more than one of these isotypes (e.g., CH1 region from IgG2 or IgG4, hinge, CH2 and CH3 regions from IgG1).
• Such domains can contain mutations to reduce and/or modulate effector function at one or more of the EU position mentioned for IgG1.
• Human IgG2 and IgG4 have reduced effector functions relative to human IgG1 and IgG3.
• the anti-VEGF-A heavy chain has a cysteine residue added as a mutation by recombinant DNA technology which can be used to conjugate a half-life extending moiety.
• the mutation is (EU numbering) Q347C (EU numbering) and/or L443C (EU numbering, or 449C in SEQ ID NO: 1). In some embodiments, the mutation is L443C (EU numbering, or 449C in SEQ ID NO: 1). In some embodiments, the stoichiometry of antibody to polymer is 1:1; in other words, a conjugate has one molecule of antibody conjugated to one molecule of polymer. [0336] The half-life of the anti-VEGF-A antibodies can be extended by attachment of a “half-life (“half life”) extending moieties” or “half-life (“half life”) extending groups”.
• Half-life extending moieties include peptides and proteins which can be expressed in frame with the biological drug of issue (or conjugated chemically depending on the situation) and various polymers which can be attached or conjugated to one or more amino acid side chain or end functionalities such as -SH, -OH, -COOH, -CONH2, -NH2, or one or more N- and/or O-glycan structures.
• Half-life extending moieties generally act to increase the in vivo circulatory half-life of biologic drugs.
• Examples of peptide/protein half-life extending moieties include Fc fusion (Capon DJ, Chamow SM, Mordenti J, et al. Designing CD4 immunoadhesions for AIDS therapy. Nature. 1989.
• HAS human serum albumin
• CTP carboxy terminal peptide
• polymer half-life extending moieties include polyethylene glycol (PEG), branched PEG, PolyPEG® (Warwick Effect Polymers; Coventry, UK), polysialic acid (PSA), starch, hydroxylethyl starch (HES), hydroxyalkyl starch (HAS), carbohydrate, polysaccharides, pullulane, chitosan, hyaluronic acid, chondroitin sulfate, dermatan sulfate, dextran, carboxymethyl-dextran, polyalkylene oxide (PAO), polyalkylene glycol (PAG), polypropylene glycol (PPG), polyoxazoline, polyacryloylmorpholine, polyvinyl alcohol (PVA), polycarboxylate, polyvinylpyrrolidone, polyphosphazene, polyoxazoline, polyethylene-co-maleic acid anyhydride, polystyrene-co-maleic acid anhydride, poly(
• a half-life extending moiety can be conjugated to an antibody via free amino groups of the protein using N-hydroxysuccinimide (NHS) esters.
• NHS N-hydroxysuccinimide
• Reagents targeting conjugation to amine groups can randomly react to ⁇ -amine group of lysines, ⁇ -amine group of N-terminal amino acids, and ⁇ -amine group of histidines.
• the anti-VEGF-A antibodies disclosed herein have many amine groups available for polymer conjugation. Conjugation of polymers to free amino groups, thus, might negatively impact the ability of the antibody proteins to bind to VEGF.
• a half-life extending moiety is coupled to one or more free SH groups using any appropriate thiol-reactive chemistry including, without limitation, maleimide chemistry, or the coupling of polymer hydrazides or polymer amines to carbohydrate moieties of the antibody after prior oxidation.
• maleimide coupling is used.
• coupling occurs at cysteines naturally present or introduced via genetic engineering.
• polymers are covalently attached to cysteine residues introduced into anti-VEGF-A antibodies by site directed mutagenesis. In some embodiments, the cysteine residues are employed in the Fc portion of the antibody.
• the sites to introduce cysteine residues into an Fc region are provided in WO 2013/093809, US 7,521,541, WO 2008/020827, US 8,008,453, US 8,455,622 and US2012/0213705, incorporated herein by reference for all purposes.
• the cysteine mutations are Q347C (EU numbering) and L443C referring to the human IgG heavy chain by EU numbering.
• conjugates of antibody and high MW polymers serving as half-life extenders are provided.
• a conjugate comprises an antibody that is coupled to a zwitterionic polymer wherein the polymer is formed from one or more monomer units and wherein at least one monomer unit has a zwitterionic group is provided.
• the zwitterionic group is phosphorylcholine.
• one of the monomer units is HEMA-PC.
• a polymer is synthesized from a single monomer which is HEMA-PC.
• some antibody conjugates have 2, 3, or more polymer arms wherein the monomer is HEMA-PC.
• the conjugates have 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 polymer arms wherein the monomer is HEMA-PC. In some embodiments, the conjugates have 3, 6 or 9 arms. In some embodiments, the conjugate has 9 arms. [0346] In some embodiments, polymer-antibody conjugates have a polymer portion with a molecular weight of between 100,000 and 1,500,000 Da. In some embodiments, the conjugate has a polymer portion with a molecular weight between 500,000 and 1,000,000 Da. In some embodiments, the conjugate has a polymer portion with a molecular weight between 600,000 to 800,000 Da.
• the conjugate has a polymer portion with a molecular weight between 600,000 and 850,000 Da and has 9 arms.
• the molecular weight will be the addition of the molecular weight of the protein, including any carbohydrate moieties associated therewith, and the molecular weight of the polymer.
• an anti-VEGF-A antibody has a HEMA-PC polymer which has a molecular weight measured by Mw of between about 100 kDa and 1650 kDa is provided.
• the molecular weight of the polymer as measured by Mw is between about 500 kDa and 1000 kDa.
• the molecular weight of the polymer as measured by Mw is between about 600 kDa to about 900 kDa. In some embodiments, the polymer molecular weight as measured by Mw is 750 kDa plus or minus 15%.
• the polymer is made from an initiator suitable for ATRP having one or more polymer initiation sites. In some embodiments, the polymer initiation site has a 2-bromoisobutyrate site. In some embodiments, the initiator has 3 or more polymer initiation sites. In some embodiments, the initiator has 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 polymer initiation sites. In some embodiments, the initiator has 3, 6 or 9 polymer initiation sites.
• the initiator has 9 polymer initiation sites. In some embodiments, the initiator is OG1786.
• the anti-VEGF-A antibodies can be produced by recombinant expression including (i) the production of recombinant DNA by genetic engineering, (ii) introducing recombinant DNA into prokaryotic or eukaryotic cells by, for example and without limitation, transfection, electroporation or microinjection, (iii) cultivating the transformed cells, (iv) expressing antibody, e.g. constitutively or on induction, and (v) isolating the antibody, e.g. from the culture medium or by harvesting the transformed cells, in order to (vi) obtain purified antibody.
• the anti-VEGF-A antibodies can be produced by expression in a suitable prokaryotic or eukaryotic host system characterized by producing a pharmacologically acceptable antibody molecule.
• eukaryotic cells are mammalian cells, such as CHO, COS, HEK 293, BHK, SK-Hip, and HepG2.
• Other suitable expression systems are prokaryotic (e.g., E. coli with pET/BL21 expression system), yeast (Saccharomyces cerevisiae and/or Pichia pastoris systems), and insect cells.
• a wide variety of vectors can be used for the preparation of the antibodies disclosed herein and are selected from eukaryotic and prokaryotic expression vectors.
• vectors for prokaryotic expression include plasmids such as, and without limitation, preset, pet, and pad, wherein the promoters used in prokaryotic expression vectors include one or more of, and without limitation, lac, trc, trp, recA, or araBAD.
• vectors for eukaryotic expression include: (i) for expression in yeast, vectors such as, and without limitation, pAO, pPIC, pYES, or pMET, using promoters such as, and without limitation, AOX1, GAP, GAL1, or AUG1; (ii) for expression in insect cells, vectors such as and without limitation, pMT, pAc5, pIB, pMIB, or pBAC, using promoters such as and without limitation PH, p10, MT, Ac5, OpIE2, gp64, or polh, and (iii) for expression in mammalian cells, vectors such as, and without limitation, pSVL, pCMV, pRc/RSV, pcDNA3, or pBPV, and vectors derived from, in one aspect, viral systems such as and without limitation vaccinia virus, adeno-associated viruses, herpes viruses, or retroviruses, using promoters such as and without limitation
• a method is presented of preparing a therapeutic protein-half life extending moiety conjugate having the step of conjugating a therapeutic protein which has a cysteine residue added via recombinant DNA technology to a half-life extending moiety having a sulfhydryl specific reacting group selected from the group consisting of maleimide, vinylsulfones, orthopyridyl-disulfides, and iodoacetamides to provide the therapeutic protein-half life extending moiety conjugate.
• a method of preparing the anti-VEGF antibody conjugate e.g., KSI-301, from OG1950 is provided.
• the method comprises reducing the OG1950 protein with a 50x molar excess of the TCEP reducing agent.
• the antiobody is oxidized to produce a decapped OG1950 antibody where the inter- and intra- light and heavy chain disulfide bonds naturally occurring in the antibody are formed, but the engineered Cysteine on the heavy chain position L443C (EU numbering, or 449C in SEQ ID NO: 1) remains to be decapped.
• the OG1950 is then conjugated by adding an excipient and adding 5-10x molar excess of a maleimide biopolymer.
• the biopolymer links to the OG1950 antibody through a covalent thiolether linkage.
• the anti-VEGF antibody conjugate e.g., KSI-301
• KSI-301 is purified with both unconjugated antibody and polymer removed.
• the protein and process described above can be varied as well.
• a process for preparing a conjugated protein (which need not be an antibody or an anti-VEGF antibody) is provided.
• the process includes reducing one or more cysteines in a protein to form a decapped protein in a solution.
• the decapped protein is reoxidized to restore at least one disulfide linkage in the reduced protein while ensuring that an engineered cysteine residue in the protein remains in a free thiol form to form a reoxidized decapped protein in the solution.
• At least one excipient is then added to the solution. The excipient reduces a polymer induced protein precipitation. After the excipient is added, a polymer is added to the solution, which is conjugated to the reoxidized decapped protein at the engineered cysteine residue to form a conjugated protein.
• the molar excess of the reducing agent can be altered to any amount that functions.
• 10, 20, 30, 40, 50, 60, 70, 80, 90x molar excess of the reducing agent (which need not be TCEP in all embodiments) can be employed.
• any antibody (therapeutic or otherwise) can be employed.
• 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15x molar excess of a maleimide biopolymer can be employed.
• the amount of the reduced protein is less than the amount of the polymer.
• the amount of the reduced protein is 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, 5%, 4%, 3%, 2%, 1% of the amount of the polymer.
• the method of making an antibody conjugate comprises conjugating an anti-VEGF-A antibody to a phosphorylcholine containing polymer. In some embodiments the method comprises the steps of conjugating an anti-VEGF-A antibody to a phosphorylcholine containing polymer.
• the anti-VEGF-A antibody comprises an amino residue added via recombinant DNA technology. In some embodiments, the added amino acid residue is a cysteine residue.
• the cysteine residue is added outside a variable region of the antibody.
• the cysteine residue can be added to either the heavy chain or light chain of the antibody.
• the polymer comprises or consists of a phosphorylcholine containing polymer.
• the phosphorylcholine containing polymer comprises a sulfhydryl specific reacting group selected from the group consisting of a maleimide, a vinylsulfone, an orthopyridyl-disulfide, and an iodoacetamide.
• the sulfhydryl specific reacting group on the phosphorylcholine containing polymer reacts with the cysteine residue on the anti-VEGF-A antibody to make the antibody conjugate.
• the protein to be conjugated can be an antibody, an antibody protein fusion, or a binding fragment thereof.
• the protein is not an antibody but is an enzyme, a ligand, a receptor, or other protein or mutants or variants thereof.
• the native protein contains at least one disulfide bond and at least one non-native cysteine.
• the excipient can be an acid or a base.
• the excipient is a detergent, a sugar, or a charged amino acid. In some embodiments, the excipient assists in keeping the protein in solution during the conjugation to the polymer. In some embodiments, the excipient is added to the solution containing the protein, prior to the addition of the polymer to the solution that contains the protein. [0361] In some embodiments, the reaction occurs under aqueous conditions between about pH 5 to about pH 9. In some embodiments, the reaction occurs between 6.0 and 8.5, between 6.5 and 8.0 or between 7.0 and 7.5. [0362] In some embodiments, the polymer is conjugated to the protein at 2-37 degrees Celsius.
• the conjugation occurs at 0-40 degrees Celsius, 5-35 degrees Celsius, 10-30 degrees Celsius, and 15-25 degrees Celsius.
• the conjugated proteins described herein can be contacted to an ion exchange medium or hydrophobic interaction chromatography or affinity chromatography medium for purification (to remove the conjugated from the unconjugated).
• the ion exchange medium, hydrophobic interaction chromatography, and/or affinity chromatography medium separates the conjugated protein from the free polymer and from the reoxidized decapped protein.
• the processes described herein and outlined in FIG. 18 involves an excipient that is capable of facilitating and/or maintaining a solubility system.
• the process allows the solution to maintain the solubility of the two components meant to interact. This can include the solubility of the protein and the polymer and then the end conjugate as well.
• the issue can be that while the protein is soluble, when the biopolymer is added, the solubility of the solution (e.g., protein) drops and it crashes/precipitates out of solution. Of course, when the protein crashes out, it is not available to conjugate efficiently with the biopolymer.
• an excipient can be employed to maintain the solubility of the protein in the presence of the biopolymer so the two can couple to form the protein conjugate (or as depicted in FIG. 18, an antibody conjugate).
• the polymers disclosed herein can comprise one or more of the following: a zwitterion, a phosphorylcholine, or a PEG linker bridging a center of a polymer branching point to the maleimide functional group.
• any of the polymers provided herein can be added to a protein via the methods provided herein.
• any of the proteins provided herein can be conjugated to any of the polymers provided herein via one or more of the methods provided herein.
• the process(es) provided herein allow(s) for larger scale processing to make and purify protein and/or antibody conjugates.
• the volume employed is at least 1 liter, for example 1, 10, 100, 1,000, 5,000, 10,000, liters or more.
• the amount of the antibody conjugate produced and/or purified can be 0.1, 1, 10, 100, 1000, or more grams.
• the therapeutic protein may be any of the anti- VEGF-A antibodies described herein having a cysteine residue added via recombinant DNA technology.
• the anti-VEGF antibody heavy chain has the following CDRs: CDR H 1: GYDFTHYGMN (SEQ ID NO: 9), CDR H 2: WINTYTGEPTYAADFKR (SEQ ID NO: 10), and CDRH3: YPYYYGTSHWYFDV (SEQ ID NO: 11).
• the heavy chain can also have threonine (T) at position 221 (via sequential counting as in SEQ ID NO. 3).
• the anti-VEGF light chain has the following CDRs: CDRL1: SASQDISNYLN (SEQ ID NO: 12), CDRL2: FTSSLHS (SEQ ID NO: 13), and CDRL3: QQYSTVPWT (SEQ ID NO: 14).
• the anti-VEGF-A light chain can also have leucine (L) at Kabat position 4.
• the anti-VEGF-A antibody is IgG1.
• the heavy chain has one or more mutations to modulate effector function.
• the mutations are to one or more of the following amino acid positions (EU numbering): E233, L234, L235, G236, G237, A327, A330, and P331.
• the mutations are selected from the group consisting of: E233P, L234V, L234A, L235A, G237A, A327G, A330S and P331S (EU numbering). In some embodiments, the mutations are (EU numbering) L234A, L235A and G237A.
• the cysteine residue added to the therapeutic protein via recombinant DNA technology should not be involved in Cys-Cys disulfide bond pairing.
• therapeutic proteins may be dimeric. So for example, an intact anti- VEGF-A antibody has two light chains and two heavy chains.
• Cys residue is introduced into the heavy chain for instance, the intact antibody will have two such introduced cysteines at identical positions and the possibility exists that these cysteine residues will form intra- chain disulfide bonds. If the introduced cysteine residues form Cys-Cys disulfide bonds or have a propensity to do so, that introduced Cys residue will not be useful for conjugation. It is known in the art how to avoid positions in the heavy and light chains that will give rise to intra-chain disulfide pairing. See, e.g., U.S. Patent Application No. 2015/0158952.
• the cysteine residue introduced via recombinant DNA technology is selected from the group consisting of (EU numbering) Q347C and L443C.
• the cysteine residue is L443C (EU numbering, or 449C in SEQ ID NO: 1).
• the heavy chain the antibody has the amino acid sequence set forth in SEQ ID NO. 1 and the light chain has the amino acid sequence of SEQ ID NO. 2.
• the sulfhydral specific reacting group is maleimide.
• the half-life extending moiety is selected from the group consisting of polyethylene glycol (PEG), branched PEG, PolyPEG® (Warwick Effect Polymers; Coventry, UK), polysialic acid (PSA), starch, hydroxylethyl starch (HES), hydroxyalkyl starch (HAS), carbohydrate, polysaccharides, pullulane, chitosan, hyaluronic acid, chondroitin sulfate, dermatan sulfate, dextran, carboxymethyl-dextran, polyalkylene oxide (PAO), polyalkylene glycol (PAG), polypropylene glycol (PPG), polyoxazoline, polyacryloylmorpholine, polyvinyl alcohol (PVA), polycarboxylate, polyvinylpyrrolidone, polyphosphazene, polyoxazoline, polyethylene-co-maleic acid anyhydride, polystyrene-co- male
• the half-life extending moiety is a zwitterionic polymer.
• the zwitterion is phosphorylcholine, i.e. a phosphorylcholine containing polymer.
• the polymer is composed of MPC units.
• the MPC polymer has three or more arms. In some embodiments, the MPC polymer has 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 arms. In some embodiments, the MPC polymer has 3, 6, or 9 arms. In some embodiments, the MPC polymer has 9 arms.
• the polymer is synthesized with an initiator comprising 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, or more polymer initiation sites
• the MPC polymer has a molecular weight between about 300,000 and 1,750,000 Da. In some embodiments, the MPC polymer has a molecular weight between about 500,000 and 1,000,000 Da or between about 600,000 to 900,000 Da.
• the method of preparing a therapeutic protein-half life extending moiety conjugate has an additional step of contacting the therapeutic protein with a thiol reductant under conditions that produce a reduced cysteine sulfhydryl group.
• cysteine residue added via recombinant DNA technology are unpaired, i.e. are not involved in Cys-Cys intra chain disulfide bonds or are not substantially involved in such bonding.
• Cys residues which are not involved in such Cys-Cys disulfide bonding and are free for conjugation are known to react with with free cysteine in the culture media to form disulfide adducts. See, e.g., WO 2009/052249. A cysteine so derivatized will not be available for conjugation.
• the protein after purification is treated with a reducing agent, e.g., dithiothreitol.
• a reducing agent e.g., dithiothreitol
• such treatment with a reducing agent will reduce all of the cysteine residues in the therapeutic protein, including native cysteines many of which are involved in inter and intra chain Cys-Cys disulfides bonds.
• the native Cys-Cys disulfides are generally crucial to protein stability and activity and they should be reformed. In some embodiments, all native (e.g., inter and intra) Cys-Cys disulfides are reformed.
• the therapeutic protein is exposed to oxidizing conditions and/or oxidizing agents for a prescribed period of time, e.g., overnight. In some embodiments, ambient air exposure overnight can be used to achieve reformation of the native disulfide bonds.
• an oxidizing agent is employed to restore the native disulfides.
• the oxiding agent is selected from the group consisting of acqueous CuSO4 and dehydroascorbic acid (DHAA).
• the oxidizing agent is DHAA. In some embodiments, the range of DHAA used is in the range of 5-30 equivalents.
• the range is 10-20 equivalents. In some embodiments, the range is 15 equivalents.
• the thiol reductant is selected from the group consisting of: Tris[2-carboxyehtyl]phosphine hydrochloride (TCEP), dithiothreitol (DTT), dithioerythritol (DTE), sodium borohydride (NaBH4), sodium cyanoborohydride (NaCNBH3), ⁇ -mercaptoethanol (BME), cysteine hydrochloride and cysteine.
• the thiol reductant is TCEP.
• the thiol reductant concentration is between 1 and 100 fold molar excess relative to the therapeutic protein concentration. In some embodiments, the thiol reductant concentration is between 20 to 50 fold molar excess relative to the therapeutic protein concentration. In some embodiments, the thiol reductant is removed following incubation with the therapeutic protein prior to oxidation of the therapeutic protein. [0381] In some embodiments, the method for conjugating a therapeutic protein to a half-life extending moiety has a further step of purifying the therapeutic protein conjugate after conjugation.
• the therapeutic protein conjugate is purified using a technique selected from the group consisting of ion exchange chromatography, hydrophobic interaction chromatography, size exclusion chromatography, and affinity chromatography or combinations thereof. [0382] In some embodiments, the therapeutic protein conjugate retains at least 20% biological activity relative to unconjugated therapeutic protein. In some embodiments, the therapeutic protein conjugate retains at least 50% biological activity relative to unconjugated therapeutic protein. In some embodiments, the therapeutic protein conjugate retains at least 90% biological activity relative to native therapeutic protein. [0383] In some embodiments, the therapeutic protein conjugate has an increased half-life relative to unconjugated therapeutic protein.
• the therapeutic protein conjugate has at least a 1.5 fold increase in half-life relative to unconjugated therapeutic protein. In some embodiments, the therapeutic protein conjugate has at least a 5 fold increase in half-life relative to unconjugated therapeutic protein.
• the zwitterionic polymer of the method of conjugating a therapeutic protein to a half-life extending moiety is a radically polymerizable monomer having a zwitterionc group and the method has a further step of polymerizing the free radically polymerizable zwitterionic monomer in a polymerization medium to provide a polymer, the medium comprising: the radically polymerizable zwitterionic monomer; a transition metal catalyst Mt (q-1)+ wherein Mt is a transition metal, q is a higher oxidation state of the metal and q-1 is a lower oxidation state of the metal, wherein the metal catalyst is supplied as a salt of the form Mt (q-1)+ X’(q-1) wherein X’ is a counterion or group or the transition metal catalyst is supplied in situ by providing the inactive metal salt at its higher oxidation state M t q+ X’ q together with a reducing agent that is capable
• the transition metal should have at least two readily accessible oxidation states separated by one electron, a higher oxidation state and a lower oxidation state.
• ATRP a reversible redox reaction results in the transition metal catalyst cycling between the higher oxidation state and the lower oxidation state while the polymer chains cycle between having propagating chain ends and dormant chain ends. See, e.g., U.S. Patent No.7,893,173.
• the radically polymerizable zwitterionic monomer is selected from the group consisting of wherein R1 is H or C 1-6 alkyl, ZW is a zwitterion and n is an integer from 1-6.
• the radically polymerizable monomer is wherein R1 is H or C 1-6 alkyl, R2, R3, R4 are the same or different and are H or C 1-4 alkyl and X and Y are the same or different and are integers from 1-6. In some embodiments, R1, R2, R3 and R4 are each methyl and X and Y are each 2. [0388] In some embodiments, the radically polymerizable monomer is
• R1 is H or C1-6alkyl
• R2 and R3 are the same or different and are H or C 1-4 alkyl
• R4 is PO 4 -, SO 3 - or CO 2 - and X and Y are the same or different and are integers from 1-6.
• R1, R2 and R3 are methyl
• R4 is PO 4 - and X and Y are each 2.
• the monomer is wherein R1 is H or C 1-6 alkyl, R2, R3 and R4 are the same or different and are H or C 1-4 alkyl
• R5 is PO 4 -, SO 3 - or CO 2 - and X and Y are the same or different and are integers from 1-6.
• R1, R2, R3 and R4 are methyl
• R5 is PO 4 -
• X and Y are 2.
• the transition metal Mt is selected from the group consisting of Cu, Fe, Ru, Cr, Mo, W, Mn, Rh, Re, Co, V, Zn, Au, and Ag.
• the metal catalyst is supplied as a salt of the form Mt (q-1)+ X’(q-1).
• Mt (q-1)+ is selected from the group consisting of Cu 1+ , Fe 2+ , Ru 2+ , Cr 2+ , Mo 2+ , W 2+ , Mn 3+ , Rh 3+ , Re 2+ , Co + , V 2+ , Zn + , Au + , and Ag + and X’ is selected from the group consisting of halogen, C1-6 alkoxy, (SO 4 )1/2, (PO 4 )1/3, (R7PO 4 )1/2, (R72PO 4 ), triflate, hexaluorophosphate, methanesulfonate, arylsulfonate, CN and R7CO2, where R7 is H or a straight or branched C1- 6 alkyl group which may be substituted from 1 to 5 times with a halogen.
• M t (q-1)+ is Cu 1+ and X’ is Br. [0391] In some embodiments, M t (q-1)+ is supplied in situ. In some embodiments, M t q+ X q is CuBr 2 .
• the reducing agent is an inorganic compound. In some embodiments, the reducing agent is selected from the group consisting of a sulfur compound of a low oxidation level, sodium hydrogen sulfite, an inorganic salt comprising a metal ion, a metal, hydrazine hydrate and derivatives of such compounds. In some embodiments, the reducing agent is a metal. In some embodiments, the reducing agent is Cu 0 .
• the reducing agent is an organic compound.
• the organic compound is selected from the group consisting of alkylthiols, mercaptoethanol, or carbonyl compounds that can be easily enolized, ascorbic acid, acetyl acetonate, camphosulfonic acid, hydroxy acetone, reducing sugars, monosaccharides, glucose, aldehydes, and derivatives of such organic compounds.
• the ligand is selected from the group consisting of 2,2'-bipyridine, 4,4'-Di-5-nonyl-2,2'-bipyridine, 4,4-dinonyl-2,2'-dipyridyl, 4,4',4''-tris(5- nonyl)-2,2':6',2''-terpyridine, N,N,N',N',N'-Pentamethyldiethylenetriamine, 1,1,4,7,10,10- Hexamethyltriethylenetetramine, Tris(2-dimethylaminoethyl)amine, N,N-bis(2- pyridylmethyl)octadecylamine, N,N,N',N'-tetra[(2-pyridal)methyl]ethylenediamine, tris[(2- pyridyl)methyl]amine, tris(2-aminoethyl)amine, tris(2-bis(3-
• the ligand is 2,2’-bipyridine.
• the initiator has the structure: wherein R1 is a nucleophilic reactive group, R2 comprises a linker, and R3 comprises a polymer synthesis initiator moiety having the structure wherein R4 and R5 and are the same or different and are selected from the group consisting of alkyl, substituted alkyl, alkylene, alkoxy, carboxyalkyl, haloalkyl, cycloalkyl, cyclic alkyl ether, alkenyl, alkenylene, alkynyl, alkynylene, cycloalkylene, heterocycloalkyl, heterocycloalkylene, aryl, arylene, arylene-oxy, heteroaryl, amino, amido or any combination thereof; Z is a halogen, –OR (where R is –H, methyl, ethyl, propyl, or isopropyl), –SCN
• Z is Br and R4 and R5 are each methyl.
• R1 is selected from the group consisting of -NH 2 , -OH, and -SH.
• R2 is alkyl, substituted alkyl, alkylene, alkoxy, carboxyalkyl, haloalkyl, cycloalkyl, cyclic alkyl ether, alkenyl, alkenylene, alkynyl, alkynylene, cycloalkylene, heterocycloalkyl, heterocycloalkylene, aryl, arylene, arylene-oxy, heteroaryl, amino, amido or any combination thereof.
• R2 is wherein X and Y are the same or different and are integers from 1-20. In some embodiments, X and Y are each 4. [0397] In some embodiments, R3 is wherein R6, R7 and R8 are the same or different and are selected from the group consisting of
• Z is —OR (where R is –H, methyl, ethyl, propyl, or isopropyl), –SCN, –NCS, –F, – Cl, –Br or –I.
• R is –Br and R6, R7 and R8 are each
• the initiator has the structure: wherein A and B are the same or different and are integers from 2 to 12 and Z is any halide, for example Br. In some embodiments, A and B are each 4. [0399] In some embodiments, the method further has the step of reacting the polymer with a maleimide reagent to provide a polymer having a terminal maleimide. In some embodiments, the maleimide compound is .
• a method for the treatment or prophylaxis of an ocular disease having the step of administering a therapeutic protein selected from the group consisting of an anti-VEGF-A antibody (and conjugates thereof), and anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• a therapeutic protein selected from the group consisting of an anti-VEGF-A antibody (and conjugates thereof), and anti-VEGF protein conjugate (e.g., an aflibercept biopolymer conjugate).
• any one or more of the antibodies or antibody conjugates or protein conjugates provided herein can be used as treatment and/or prophylaxis for an ocular disease.
• the method includes administering to the subject any one or more of the antibodies or antibody conjugates provided herein.
• a method for treatment or prophylaxis of an ocular disease is provided.
• the method comprises administering an effective dose of any of the an antibody and/or antibody conjugates and/or protein conjugates described herein to a subject in need thereof.
• the disease can be age-related macular degeneration (AMD) or diabetic macular edema (DME).
• the disease can be wet AMD.
• the eye disorder is wet AMD without a high pigment epithelial detachment (PED).
• PED pigment epithelial detachment
• a subject has high PED when the baseline central subfield retinal thickness (CST) in an eye of the subject is 500 microns or greater.
• the ocular disease is selected from one or more of the group consisting of diabetic retinopathy, choroidal neovascularization (CNV), age-related macular degeneration (AMD), diabetic macular edema (DME), pathological myopia, von Hippel-Lindau disease, histoplasmosis of the eye, central retinal vein occlusion (CRVO), branched central retinal vein occlusion (BRVO), corneal neovascularization, retinal neovascularization, retinopathy of prematurity (ROP), subconjunctival hemorrhage, and hypertensive retinopathy.
• the ocular disease is diabetic retinopathy.
• the antibody or antibody conjugate or protein conjugate is administered no more frequently than once a month. In some embodiments, the antibody or conjugate thereof is administered two times per month or weekly. In some embodiments, the antibody or conjugate thereof is administered once every two months, once every three months, once every four months, once every five months, once every six months, once every seven months, once every eight months, once every nine months, once every ten months, once every eleven months, or once every twelve months. [0404] In some embodiments, one or more of the compositions provided herein can allow for a reduction in the consequences of high treatment burdens from the use of intravitreal injection of anti-VEGF agents for the treatment of the wet (proliferative) form of age related macular degeneration (AMD).
• AMD age related macular degeneration
• compounds, including antibody conjugates and anti-VEGF-A antibodies, and anti-VEGF protein conjugates (e.g., an aflibercept biopolymer conjugates), described herein are used to treat patients who have background or nonproliferative diabetic retinopathy but have little or no vision impairment.
• such patients are dosed less than once a month via intravitreal injection.
• such patients are dosed six times a year.
• such pateints are dosed no more than four times a year.
• the patients are dose no more than three times a year.
• the patients are dosed no more than twice a year.
• the patients are dosed no more than once a year.
• the subject receives the antibody or antibody conjugate or protein conjugate via intravitreal injection.
• the therapeutic proteins e.g., both antibodies and antibody conjugates
• the therapeutic proteins can be employed by expression of such polypeptides in vivo in a patient, i.e., gene therapy.
• the nucleic acid is injected directly into the patient, usually at the sites where the therapeutic protein is required, i.e., where biological activity of the therapeutic protein is needed.
• the patient's cells are removed, the nucleic acid is introduced into these isolated cells, and the modified cells are administered to the patient either directly or, for example, encapsulated within porous membranes that are implanted into the patient (see, e.g , U.S. Pat. Nos. 4,892,538 and 5,283,187).
• the techniques vary depending upon whether the nucleic acid is transferred into cultured cells in vitro, or transferred in vivo in the cells of the intended host.
• Techniques suitable for the transfer of nucleic acid into mammalian cells in vitro include the use of liposomes, electroporation, microinjection, transduction, cell fusion, DEAE-dextran, the calcium phosphate precipitation method, etc.
• Transduction involves the association of a replication-defective, recombinant viral (including retroviral) particle with a cellular receptor, followed by introduction of the nucleic acids contained by the particle into the cell.
• a commonly used vector for ex vivo delivery of the gene is a retrovirus.
• the in vivo nucleic acid transfer techniques include transfection with viral or non-viral vectors (such as adenovirus, lentivirus, Herpes simplex I virus, or adeno-associated virus (AAV)) and lipid-based systems (useful lipids for lipid- mediated transfer of the gene are, for example, DOTMA, DOPE, and DC-Chol; see, e.g., Tonkinison et al., Cancer Investigation, 14(1): 54-65 (1996)).
• the vectors for use in gene therapy are viruses, which include adenoviruses, AAV, lentiviruses, or retroviruses.
• a viral vector such as a retroviral vector includes at least one transcriptional promoter/enhancer or locus-defining element(s), or other elements that control gene expression by other means such as alternate splicing, nuclear RNA export, or post- translational modification of messenger.
• a viral vector such as a retroviral vector includes a nucleic acid molecule that, when transcribed in the presence of a gene encoding the therapeutic protein, is operably linked thereto and acts as a translation initiation sequence.
• Such vector constructs also include a packaging signal, long terminal repeats (LTRs) or portions thereof, and positive and negative strand primer binding sites appropriate to the virus used (if these are not already present in the viral vector).
• such vector typically includes a signal sequence for secretion of the PRO polypeptide from a host cell in which it is placed.
• the signal sequence for this purpose is a mammalian signal sequence.
• the signal is the native signal sequence for the therapeutic protein.
• the vector construct may also include a signal that directs polyadenylation, as well as one or more restriction sites and a translation termination sequence.
• such vectors will typically include a 5 ⁇ LTR, a tRNA binding site, a packaging signal, an origin of second-strand DNA synthesis, and a 3 ⁇ LTR or a portion thereof.
• vectors can be used that are non-viral, such as cationic lipids, polylysine, and dendrimers.
• agent that targets the target cells such as an antibody specific for a cell-surface membrane protein or the target cell, a ligand for a receptor on the target cell, etc.
• proteins that bind to a cell-surface membrane protein associated with endocytosis may be used for targeting and/or to facilitate uptake, e.g., capsid proteins or fragments thereof tropic for a particular cell type, antibodies for proteins that undergo internalization in cycling, and proteins that target intracellular localization and enhance intracellular half-life.
• a method for treatment or prophylaxis of an ocular disease in a mammal in which a nucleic acid molecule that encodes a therapeutic protein selected from the group consisting of an anti-VEGF-A antibody is administered.
• the heavy chain is that set forth in SEQ ID NO. 1 and the light chain is that set forth in SEQ ID NO.2.
• the nucleic acid molecule is administered via ex vivo gene therapy.
• compositions [0414] Therapeutic proteins can be incorporated into a pharmaceutical composition with a pharmaceutically acceptable excipient.
• Pharmaceutical compositions adapted for oral administration may be presented as discrete units such as capsules, as solutions, syrups or suspensions (in aqueous or non-aqueous liquids; or as edible foams or whips; or as emulsions).
• Suitable excipients for tablets or hard gelatine capsules include lactose, maize starch or derivatives thereof, stearic acid or salts thereof.
• Suitable excipients for use with soft gelatine capsules include for example vegetable oils, waxes, fats, semi-solid, or liquid polyols etc.
• excipients which may be used include for example water, polyols and sugars.
• suspensions oils e.g. vegetable oils
• Pharmaceutical compositions can be adapted for nasal administration wherein the excipient is a solid include a coarse powder having a particle size for example in the range 20 to 500 microns which is administered in the manner in which snuff is taken, i.e. by rapid inhalation through the nasal passage from a container of the powder held close up to the nose.
• Suitable compositions wherein the excipient is a liquid, for administration as a nasal spray or as nasal drops include aqueous or oil solutions of the active ingredient.
• compositions adapted for administration by inhalation include fine particle dusts or mists which may be generated by means of various types of metered dose pressurized aerosols, nebulizers or insufflators.
• Pharmaceutical compositions adapted for parenteral administration include aqueous and non-aqueous sterile injection solution which may contain anti-oxidants, buffers, bacteriostats and solutes which render the formulation substantially isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which may include suspending agents and thickening agents.
• Excipients which may be used for injectable solutions include water, alcohols, polyols, glycerine and vegetable oils, for example.
• compositions may be presented in unit-dose or multi-dose containers, for example sealed ampoules and vials, and may be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid carried, for example water for injections, immediately prior to use.
• sterile liquid carried, for example water for injections, immediately prior to use.
• Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets.
• Pharmaceutical compositions can be substantially isotonic, implying an osmolality of about 250-400 mOsm/kg water.
• the pharmaceutical compositions may contain preserving agents, solubilizing agents, stabilizing agents, wetting agents, emulsifiers, sweeteners, colorants, odorants, salts (substances may themselves be provided in the form of a pharmaceutically acceptable salt), buffers, coating agents or antioxidants. They may also contain therapeutically active agents in addition to the substance.
• the pharmaceutical compositions may be employed in combination with one or more pharmaceutically acceptable excipients. Such excipients may include, but are not limited to, saline, buffered saline (such as phosphate buffered saline), dextrose, liposomes, water, glycerol, ethanol and combinations thereof.
• the antibodies and pharmaceutical compositions containing them may be administered in an effective regime for treating or prophylaxis of a patient’s disease including, for instance, administration by oral, intravitreal, intravenous, subcutaneous, intramuscular, intraosseous, intranasal, topical, intraperitoneal, and intralesional administration.
• Parenteral infusions include intramuscular, intravenous, intraarterial, intraperitoneal, or subcutaneous administration or routes among others.
• the active agent may be administered to an individual as an injectable composition, for example as a sterile aqueous dispersion
• the agent is isotonic or substantially isotonic.
• the dosage of the active agent is from 0.01 mg/kg body weight, typically around 1 mg/kg.
• the physician can determine the actual dosage most suitable for an individual which depends on factors including the age, weight, sex and response of the individual, the disease or disorder being treated and the age and condition of the individual being treated.
• the above dosages are exemplary of the average case. There can, of course, be instances where higher or lower dosages are merited.
• the dosage can be 0.5 to 20 mg/eye, e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, or 19 mg.
• This dosage may be repeated as often as appropriate (e.g., weekly, fortnightly, monthly, once every two months, quarterly, twice a year, yearly). If side effects develop the amount and/or frequency of the dosage can be reduced, in accordance with normal clinical practice.
• the pharmaceutical composition may be administered once every one to thirty days. In one embodiment, the pharmaceutical composition may be administered twice every thirty days. In one embodiment, the pharmaceutical composition may be administered once a week.
• the antibodies and pharmaceutical compositions can be employed alone or in conjunction with other compounds, such as therapeutic compounds or molecules, e.g. anti-inflammatory drugs, analgesics or antibiotics. Such administration with other compounds may be simultaneous, separate or sequential.
• the components may be prepared in the form of a kit which may comprise instructions as appropriate.
• the antibodies and pharmaceutical compositions disclosed herein can be used for treatment or prophylaxis of disease, particularly the ocular diseases or conditions described herein.
• the anti-VEGF antibody conjugates, or anti-VEGF protein conjugates, and pharmaceutical compositions containing them may be formulated for and administered by ocular, intraocular, and/or intravitreal injection, and/or juxtascleral injection, and/or subretinal injection and/or subtenon injection, and/or superchoroidal injection and/or subconjunctival and/or topical administration in the form of eye drops and/or ointment.
• Such antibodies and compositions can be delivered by a variety of methods, e.g. intravitreally as a device and/or a depot that allows for slow release of the compound into the vitreous, including those described in references such as Intraocular Drug Delivery, Jaffe, Ashton, and Pearson, editors, Taylor & Francis (March 2006).
• a device may be in the form of a minipump and/or a matrix and/or a passive diffusion system and/or encapsulated cells that release the compound for a prolonged period of time (Intraocular Drug Delivery, Jaffe, Ashton, and Pearson, editors, Taylor & Francis (March 2006)).
• Formulations for ocular, intraocular or intravitreal administration can be prepared by methods and using ingredients known in the art.
• a main requirement for efficient treatment is proper penetration through the eye. Unlike diseases of the front of the eye, where drugs can be delivered topically, retinal diseases require a more site-specific approach. Eye drops and ointments rarely penetrate the back of the eye, and the blood-ocular barrier hinders penetration of systemically administered drugs into ocular tissue. Accordingly, usually the method of choice for drug delivery to treat retinal disease, such as AMD and CNV, is direct intravitreal injection. Intravitreal injections are usually repeated at intervals which depend on the patient’s condition, and the properties and half-life of the drug delivered.
• Therapeutic antibodies and related conjugates generally are placed into a container having a sterile access port, for example, an intravenous solution bag or vial having a stopper pierceable by a hypodermic injection needle. Such compositions may also be supplied in the form of pre-filled syringes.
• a “stable” formulation is one in which the protein or protein conjugated to a polymer of other half-life extending moiety therein essentially retains its physical stability and/or chemical stability and/or biological activity upon storage. By “stable” is also meant a formulation which exhibits little or no signs of instability, including aggregation and/or deamidation.
• the formulations provided may remain stable for at least two year, when stored as indicated at a temperature of 5-8°C.
• Suitable formulations for an anti- VEGF antibody conjugate of the present disclosure is described in e.g., PCT publication number WO2017117464, which is incorporated by reference herein in its entirety.
• WO2017117464 which is incorporated by reference herein in its entirety.
• Various analytical techniques for measuring protein stability are available in the art and are reviewed in Peptide and Protein Drug Delivery, 247-301 (Vincent Lee ed., New York, N.Y., 1991) and Jones, 1993 Adv. Drug Delivery Rev. 10: 29-90, for examples. Stability can be measured at a selected temperature for a selected time period.
• the storage of the formulations is stable for at least 6 months, 12 months, 12- 18 months, or for 2 or more years.
• a protein such as an antibody or fragment thereof, "retains its physical stability" in a pharmaceutical formulation if it shows no signs of aggregation, precipitation, deamidation and/or denaturation upon visual examination of color and/or clarity, or as measured by UV light scattering or by size exclusion chromatography.
• a protein "retains its chemical stability” in a pharmaceutical formulation, if the chemical stability at a given time is such that the protein is considered to still retain its biological activity. Chemical stability can be assessed by detecting and quantifying chemically altered forms of the protein.
• Chemical alteration may involve size modification (e.g., clipping), which can be evaluated using size exclusion chromatography, SDS-PAGE and/or matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI/TOF MS), for examples.
• Other types of chemical alteration include charge alteration (e.g., occurring as a result of deamidation), which can be evaluated by ion- exchange chromatography, for example.
• An antibody "retains its biological activity" in a pharmaceutical formulation, if the biological activity of the antibody at a given time is within about 10% (within the errors of the assay) of the biological activity exhibited at the time the pharmaceutical formulation was prepared as determined in an antigen binding assay, for example.
• a protein-polymer conjugate “retains its chemical stability” the chemical bond between the protein and the polymer is maintained intact, e.g., it is not hydrolyzed or otherwise disrupted.
• the protein part of the conjugate retains its chemical stability as described above.
• isotonic is meant that the formulation of interest has essentially the same osmotic pressure as human blood or the vitreous for intravitreal injections. Isotonic formulations will generally have an osmotic pressure from about 250 to 400 mOsm. Isotonicity can be measured using a vapor pressure or ice-freezing type osmometer, for example.
• buffer refers to a buffered solution that resists changes in pH by the action of its acid-base conjugate components.
• the buffer has a pH from about 3.0 to about 8.0; for example from about 4.5 to 8; or about pH 6 to about 7.5; or about 6.0 to about 7.0, or about 6.5-7.0, or about pH 7.0 to about 7.5; or about 7.1 to about 7.4.
• a pH of any point in between the above ranges is also contemplated.
• PBS phosphate buffered saline, Tris based buffers and histidine based buffers are used.
• the PBS buffer is made up of at least Na 2 HPO 4 , KH 2 PO 4 and NaCl adjusted so as to provide the appropriate pH.
• the buffer may contain other pharmaceutical excipients such as KCl and other salts, detergents and/or preservatives so as to provide a stable storage solution.
• a “preservative” is a compound which can be included in the formulation to essentially reduce bacterial action therein, thus facilitating the production of a multi-use formulation, for example.
• preservatives examples include octadecyldimethylbenzyl ammonium chloride, hexamethonium chloride, benzalkonium chloride (a mixture of alkylbenzyldimethylammonium chlorides in which the alkyl groups are long-chain compounds), and benzethonium chloride.
• Other types of preservatives include aromatic alcohols such as phenol, butyl and benzyl alcohol, alkyl parabens such as methyl or propyl paraben, catechol, resorcinol, cyclohexanol, 3-pentanol, and m-cresol.
• Endotoxin is lipopolysaccharide (LPS) derived from the cell membrane of Gram-negative bacteria. Endotoxin is composed of a hydrophilic polysaccharide moiety covalently linked to a hydrophobic lipid moiety (lipid A). Raetz CR, Ulevitch RJ, Wright SD, Sibley CH, Ding A, Nathan CF. 1991. Gram-negative endotoxin: an extraordinary lipid with profound effects on eukaryotic signal transduction. FASEB J. 5(12):2652-2660.
• Lipid A is responsible for most of the biological activities of endotoxin, i.e., its toxicity. Endotoxins are shed in large amount upon bacterial cell death as well as during growth and division. They are highly heat-stable and are not destroyed under regular sterilizing conditions. Extreme treatments with heat or pH, e.g., 180-250°C and over 0.1 M of acid or base must be used (Petsch D, Anspach F. 2000. Endotoxin removal from protein solutions. J Biotechnol. 76: 97-119). Such conditions of course would be highly detrimental to biological drugs. [0437] In the biotech and pharmaceutical industries, it is possible to find endotoxin during both production processes and in final products.
• Endotoxin injection into an animal or human causes a wide variety of pathophysiological effects, including endotoxin shock, tissue injury and even death.
• EU is a measurement of the biological activity of an endotoxin.
• 100 pg of the standard endotoxin EC-5 and 120 pg of endotoxin from Escherichia coli O111:B4 have activity of 1 EU (Hirayama C, Sakata M. 2002. Chromatographic removal of endotoxin from protein solutions by polymer particles. J Chrom B 781:419-432). Meeting this threshold level has always been a challenge in biological research and pharmaceutical industry (Berthold W, Walter J. 1994. Protein Purification: Aspects of Processes for Pharmaceutical Products.
• Endophthalmitis falls into two classes: infectious and sterile. Infectious endophthalmitis is generally cause by bacteria, fungi or parasites. The symptoms of infectious endophthalmitis include severe pain, loss of vision, and redness of the conjunctiva and the underlying episclera. Infectious endophthalmitis requires urgent diagnosis and treatment. Possible treatments include intravitreal injection of antibiotics and pars plana vitrectomy in some cases. Enucleation may be called for to remove a blind and painful eye. See, e.g., Christy NE, Sommer A. 1979. Antibiotic prophylaxis of postoperative endophthalmitis.
• Sterile endophthalmitis in contrast does not involve an infectious agent and can be defined as the acute intraocular inflammation of the vitreous cavity that resolves without the need of intravitreal antibiotics and/or vitreoretinal surgery. If a vitreous microbiological study has been done, it needs to be negative culture proven to sustain a diagnosis of sterile endophthalmitis. Marticorena J, Romano V, Gomez-Ulla F.2012 “Sterile Endophthalmitis after Intravitreal Injections” Med Inflam.928123. [0442] It has been observed that intravitreal injection of biological drugs contaminated with endotoxin can result in sterile endophthalmitis.
• Bevacizumab (Avastin) is approved by the Food and Drug Administration for the treatment of glioblastoma and of metastatic colorectal cancer, advanced nonsquamous non-small-cell lung cancer and metastatic kidney cancer. Bevacizumab is also widely used off label as a treatment for wet AMD. Bevacizumab comes from the manufacturer as a 100 mg/4 ml. This solution cannot be directly used for intravitreal injection and should be compounded by a pharmacist. Clusters of sterile endophthalmitis have been observed and are theorized to be cause by inadvertent contamination of bevacizumab by endotoxin by the compounding pharmacist.
• a solution having an antibody or antibody-conjugate having an endotoxin level that does not exceed 5.0 EU/ml. In some embodiments, the endotoxin level does not exceed 1.0 EU/ml. In some embodiments, the endotoxin level does not exceed 0.5 EU/ml. In some embodiments, the endotoxin level does not exceed 0.2 EU/ml.
• the endotoxin level does not exceed 2, 1, 0.5, 0.2, 0.1, 0.09, 0.08, 0.07, 0.06, 0.05, 0.04, 0.03, 0.02 or 0.01 EU/ml.
• Two commonly used FDA-approved tests for the presence of endotoxin are the rabbit pyrogen test and Limulus Amoebodyte Lysate (LAL) assay (Hoffman S, et al. 2005. International validation of novel pyrogen tests based on human monocytoid cells J. Immunol. Methods 298:161-173; Ding JL, Ho BA. 2001. New era in pyrogen testing. Biotech. 19:277-281).
• the rabbit pyrogen test was developed in the 1920s and involves monitoring the temperature rise in a rabbit injected with a test solution. However, use of the rabbit pyrogen test has greatly diminished over the years due to expense and long turnaround time. Much more common is the LAL test. LAL is derived from the blood of a horseshoe crab and clots upon exposure to endotoxin. [0445] One of the simplest LAL assays is the LAL gel-clot assay. Essentially, the LAL clotting assay is combined with a serial dilution of the sample in question. Formation of the gel is proportional to the amount of endotoxin in the sample.
• Serial dilutions are prepared from the sample and each dilution assayed for its ability to form LAL gel. At some point a negative reaction is contained. The amount of endotoxin in the original sample can be estimated from the dilution assay.
• Other LAL tests have also been developed, including the turbidimetric LAL assay (Ong KG, Lelan JM, Zeng KF, Barrett G, Aourob M, Grimes CA. 2006. A rapid highly-sensitive endotoxin detection system.
• the method having the steps of contacting the composition with an affinity chromatography resin that binds to the antibody; eluting the antibody from the affinity chromatography resin to form an affinity chromatography eluent having the antagonist; contacting the affinity chromatography eluent with an ion-exchange resin that binds the antibody; and eluting the antibody from the ion- exchange resin, wherein the antibody eluted from the ion-exchange resin is substantially free from endotoxin.
• the above method for reducing the amount of endotoxin, or other method or process recited herein, can be performed in the order described in the steps above or it can optionally be performed by varying the order of the steps or even repeating one or more of the steps.
• the method of reducing the amount of endotoxin in a composition is performed in the order of the described steps.
• the affinity chromatography resin contacting, washing and eluting steps are repeated in the same order more than one time before contacting the affinity chromatography eluent with the ion exchange resin.
• the method can also include a filtering step using, for example, a 0.1 micron, 0.22 micron, or 0.44 micron filter, that can be performed on either one or more of the eluents removed after each resin binding step.
• the steps of contacting the composition with affinity chromatography resin, washing and eluting the antibody from the affinity chromatography resin can be repeated more than one time before contacting the first eluent with an ion- exchange resin.
• the affinity chromatography resin comprises a recombinant Protein A[0297] (“rProteinA”) resin.
• rProteinA recombinant Protein A[0297]
• a suitable recombinant Protein A resin is rProteinA Sepharose FF® resin (Amersham, Piscataway, N.J.).
• a suitable affinity chromatography resin would comprise a protein G chromatography resin.
• a suitable affinity chromatography resin comprises a mixed Protein A/Protein G resin.
• a suitable affinity chromatography resin comprises a hydrophobic charge induction resin that comprises a 4- mercaptoethylpyridine ligand such as a MEP HyperCel® resin (BioSepra, Cergy, Saint Christophe, France).
• the ion exchange resin comprises an anion- exchange resin.
• ion exchangers may be based on various materials with respect to the matrix as well as to the attached charged groups.
• the following matrices may be used, in which the materials mentioned may be more or less cross-linked: MacroCap Q (GE Healthcare Biosciences, Piscataway, NJ), agarose based (such as Sepharose CL-6B®, Sepharose Fast Flow® and Sepharose High Performance ®), cellulose based (such as DEAE Sephacel®), dextran based (such as Sephadex®), silica based and synthetic polymer based.
• the charged groups, which are covalently attached to the matrix may, for example, be diethylaminoethyl, quaternary aminoethyl, and/ or quaternary ammonium.
• the anion-exchange resin comprises a quaternary amine group.
• An exemplarily anion-exchange resin that has a quaternary amine group for binding the anti-M-CSF antibody is a Q Sepharose® resin (Amersham, Piscataway, N.J.).
• the composition may in the alternative be subjected to a cation exchange resin.
• any endotoxin in the composition should have a differential binding to the ion- exchange resin than the protein in question to allow purification of the protein from the endotoxin.
• endotoxin is negatively charged and will generally bind to an anion exchange resin. If both the protein and the endotoxin bind to the anion exchange resin, purification of one from the other may be effectuated by using a salt gradient to elute the two into different fractions. The relative binding of the protein to a particular resin may also be effected by changing the pH of the buffer relative to the pI of the protein. In some embodiments, cation-exchange chromatography is the sole ion-exchange chromatography employed.
• the composition may be further subjected to a second ion-exchange step, for example, by contacting the compositions with a cation exchange resin and followed by a wash step, then elution from the ion-exchange resin.
• the cation exchange resin comprises a sulfonic group for binding.
• Exemplary cation exchange resins are SP Sepharose® resin FF (Amersham, Piscataway, N.J.) Poros XS (CEX) (Life Technology, Grand Island, New York).
• the solution of antibody protein is produced having the specified level of endotoxin, there are a number of steps prior to final formulation of the protein.
• a half-life extending moiety is conjugated to the protein.
• the conjugate is then formulated into a final drug formulation which is injected into the patients.
• the conjugate is again purified on an ion-exchange resin which can be a cation-exchange resin.
• the protein is formulated. In all cases, normal laboratory procedures should be employed to prevent the introduction of endotoxin contaminants into the protein sample or into the protein-polymer conjugate.
• KSI-301 administered intravitreally showed extended half-life in the retina and choroid/retinal pigment epithelium (RPE) in a rabbit model ( Figure 1).
• RPE choroid/retinal pigment epithelium
• Ranibizumab data Gaudrealt et al (2007) IOVS 46(2) 726, Gaudrealt et al (2007) Retina 27(9) 1260, Bakri et al (2007) Ophthalmol 114(12) 2179;
• Aflibercept data EVER Congress Portoroz Slovenia (2008) Struble (Covance) Koehler-Stec (Regeneron).
• Aflibercept data was adjusted arithmetically to reflect 2,000 ⁇ g dose administered (based on rabbit in vivo dosing of 500 ⁇ g);
• KSI-301 data was adjusted arithmetically to reflect 5,000 ⁇ g dose administered (based on rabbit in vivo dosing of 725 ⁇ g). Error bars reflects standard error of the mean.
• KSI-301 administered intravitreally showed excellent retinal bioavailability (FIG. 2). Comparison of the KSI-301 data with published results for Aflibercept indicated better bioavailability of KSI-301.
• the data from FIG. 2 are from a covance rabbit ADME (absorption, distribution, metabolism, elimination) model. Aflibercept data (2008): EVER Congress Portoroz Slovenia Struble (Covance), Koehler-Stec (Regeneron). Error bars reflects standard error of the mean.
• Intravenously administered KSI-301 showed rapid systemic clearance (FIG. 3). Comparison of the KSI-301 data with published results for Bevacizumab indicated faster systemic clearance for KSI-301.
• the Bevacizumab data was from Yeung et al 2010 Cancer Research.
• Example 2 Ascending Dose Escalation Study of Intravitreal Administrations of KSI-301 in Subjects with Diabetic Macular Edema (DME) Study Design
• An ascending dose escalation study was carried out to assess ocular and systemic safety, tolerability, and establish a maximum tolerated dose (MTD) of KSI-301.
• KSI-301 When administered intravitreally provides an improvement in visual acuity and retinal thickness (measured on OCT) in a stable fashion through 12 weeks.
• KSI-301 results demonstrated that a single injection of KSI-301 resulted in rapid, high-magnitude responses durable to 12 weeks. No intraocular inflammation and no drug-related adverse events were observed. [0463] The results were obtained from application of 1.25 mg, 2.5 mg, or 5 mg (by weight of protein) of KSI-301 administered intravitreally to subjects with diabeti macular edema. The results show the effectiveness of KSI-301 as a single injection in patients, most of whom had previously been treated for their DME with other anti-VEGF agents (bevacizumab, aflibercept, and/or ranibizumab).
• anti-VEGF agents bevacizumab, aflibercept, and/or ranibizumab
• KSI-301 when administered in a single dose, as done here, had unexpected therapeutic effects because the visual acuity and retinal thickness (measured on OCT) improved in a stable fashion through 12 weeks.
• Example 3 Open Label, Multi-center Exploratory Study to Investigate Multiple Intravitreal Administrations of KSI-301 in Subjects with wet Age-Related Macular Degeneration (wAMD) [0464] The following study design and methods were followed in Examples 3, 4 and 5, unless indicated otherwise.
• patients who were anti-VEGF treatment na ⁇ ve and with either wAMD, DME, or RVO were randomly assigned to receive three monthly loading doses of either 2.5 mg or 5 mg (by weight of antibody) KSI-301 and then were followed every month or more often thereafter, and re-treated when either the physician determined that re-treatment due to disease activity was required or the patient met any re- treatment criteria.
• FIG. 1 Each subject received 3 initial intravitreal injections of KSI-301, the first at Day 1, the second at Week 4 and the third at Week 8 (Figure 5). All cohorts were randomized 1:3 to the 2.5 mg or 5 mg dose.
• Figure 5 Study design for a randomized, open label study to evaluate multidose safety, efficacy and durability of intravitreal administration of KSI-301.
• Subjects were evaluated every 4 weeks and may have received additional administration of the study drug starting at Week 16, if specific re-treatment criteria were met. There were no mandatory injections at assessment visits, except in the case of the wet AMD cohort, where a mandatory intravitreal injection was given at a visit if it had been 24 weeks since the last injection.
• KSI-301 was formulated in approximately 12.5 mM sodium phosphate and 0.025% polysorbate 20 as a aqueous solution at 50 mg/mL (based on antibody mass) and filled into single-use 2.0 mL vials.
• KSI-301 was well-tolerated and no intraocular inflammation was observed.113 subjects were dosed, with 308 total doses given (104 doses at day 1, 96 doses at week 4, 84 doses at week 8).
• Table 1 Study population characteristics Trial Assessments
• Re-treatment Criteria non-loading dose
• Re-treatment with intravitreal injection of KSI-301 was performed if at least one of the following re-treatment criteria were met.
• BCVA best corrected vision
• OCT optical coherence tomography
• CST central subfield thickness.
• Figure 12 Durability of therapy in patients from the wAMD cohort. OCT scan of individual retinas at day 1 (row 1), week 1 (row 2), month
• FIG. 7 Treatment durability of KSI-301 in the wAMD cohort. Includes randomized patients that reached the first re-treatment opportunity (Week 12 visit) by the data cutoff date. Each bar represents an individual patient. Re-treatment is indicated by ( ⁇ ). All depicted patients were followed beyond the indicated last assessment time point (indicated by a right arrow).
• Example 4 Open Label, Multi-center Exploratory Study to Investigate Multiple Intravitreal Administrations of KSI-301 in Subjects Diabetic Macular Edema (DME) [0499] The overall study design and trial assessment were as described in Example 3.
• DME Cohort [0500] Patients included in the DME cohort had: treatment na ⁇ ve diabetic macular edema; a BCVA ETDRS letter score ⁇ 78 and ⁇ 23 ( ⁇ 20/25 to ⁇ 20/320 Snellen equivalent) in the study eye at Screening and confirmed at Day 1; Central subfield thickness (CST) of ⁇ 300 microns on SD-OCT (Heidelberg Spectralis or equivalent); and a decrease in vision in the study eye determined to be primarily the result of DME.
• CST Central subfield thickness
• Re-treatment Criteria non-loading dose
• Re-treatment with intravitreal injection of KSI-301 was performed if at least one of the following re-treatment criteria were met. These criteria are related to signs of disease recurrence and/or vision loss due to disease recurrence.
• BCVA of ⁇ 10 letters compared to the best prior BCVA, due to worsening DME/RVO disease activity (e.g.
• FIG. 15 depicts the Diabetic Retinopathy Severity results (DRSS).
• the figure shows the proportion of patients with differing levels of diabetic retinopathy severity, measured on a standardized photographic reading scale by an independent expert reading center.
• DR can be described as different levels of severity, from mild to moderate to severe non-proliferative diabetic retinopathy, for example, or mild to high-risk proliferative DR.
• the majority of patients had level 47 disease (moderate NPDR) at baseline.
• the images show a patient with proliferative (level 65) disease who had disease modification and improved to non-proliferative (level 53, 2 steps on the standard grading scale) at week 12.
• a patient with non-proliferative DR can be treated using an anti- VEGF antibody conjugate (e.g., KSI-301) with no or potentially only a few loading doses (e.g., 1 dose, 2 doses, or 3 initiating doses) and then retreated every 3 to 6 months for the treatment of non-proliferative DR.
• an anti- VEGF antibody conjugate e.g., KSI-301
• loading doses e.g., 1 dose, 2 doses, or 3 initiating doses
• Example 5 Open Label, Multi-center Exploratory Study to Investigate Multiple Intravitreal Administrations of KSI-301 in Subjects with Retinal Vein Occlusion (RVO) [0518] The overall study design and trial assessment were as described in Example 3.
• RVO Cohort [0519] Patients included in the RVO cohort had: treatment na ⁇ ve retinal vein occlusion with macular edema and secondary visual impairment; a BCVA ETDRS letter score ⁇ 78 and ⁇ 23 ( ⁇ 20/25 to ⁇ 20/320 Snellen equivalent) in the study eye at Screening and confirmed at Day 1; Central subfield thickness (CST) of ⁇ 300 microns on SD-OCT (Heidelberg Spectralis or equivalent); Branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO); and a decrease in vision in the study eye determined by the investigator to be primarily the result of macular edema secondary to RVO.
• CST Central subfield thickness
• BRVO Branch retinal vein occlusion
• CRVO central retinal vein occlusion
• Re-treatment Criteria [0521] Re-treatment with intravitreal injection of KSI-301 was performed if at least one of the following re-treatment criteria were met. These criteria are related to signs of disease recurrence and/or vision loss due to disease recurrence. - [0522] Increase in OCT central subfield retinal thickness (CST) ⁇ 75 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12 or the prior visit (4-week span between visits); or - [0523] Decrease in BCVA of ⁇ 10 letters compared to the best prior BCVA, due to worsening DME/RVO disease activity (e.g.
• the time between the first and second re-treatment was extended compared to the time between the last loading dose and the first re-treatment.
• the data shows that in the 5 mg dose group, the RVO patients were receiving first retreatment at 8 weeks or later ( Figure 11). This result is unexpected because conventional therapy requires monthly dosing to treat RVO.
• the time between first and second retreatment was extended, which was also unexpected because typically patients with RVO have disease recurrence on a particular pattern, or regular intervals.
• over half the patients (5/9) have gone for longer than 3 months since the last loading dose, which was also unexpected given the high intraocular VEGF load of RVO.
• Figure 11 Treatment durability of KSI-301 in the RVO cohort. Includes randomized patients that reached the first re-treatment opportunity (Week 12 visit) by the data cutoff date. Each bar represents an individual patient. Re-treatment is indicated by ( ⁇ ). Patients followed beyond the indicated last assessment time point are indicated by a right arrow. Discontinuation is indicated by a left arrow. Further results shown in FIG.
• an anti-VEGF antibody conjugate e.g., KSI-301
• KSI-301 an anti-VEGF antibody conjugate
• the subject will retain a therapeutic benefit of the anti-VEGF therapy for at least 12 weeks.
• DME diabetic macular edema
• RVO retinal vein occlusion
• AMD wet age-related macular degeneration
• DR alternative diabetic retinopathy
• an anti-VEGF antibody conjugate e.g., KSI-301
• KSI-301 an anti-VEGF antibody conjugate
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 16 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 20 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 24 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 30 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 36 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 42 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 48 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 54 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 60 weeks.
• This can be applied to diabetic macular edema (DME), retinal vein occlusion (RVO), wet age-related macular degeneration (AMD), and/or in the alternative diabetic retinopathy (DR).
• DME diabetic macular edema
• RVO retinal vein occlusion
• ALD wet age-related macular degeneration
• DR diabetic retinopathy
• Example 7 provides a method of treating retinal vein occlusion (RVO).
• the method comprises administering an anti-VEGF antibody conjugate (e.g., KSI- 301) to a subject with RVO at a first loading dose.
• One can then repeat the loading dose, once or in the alternative two times.
• Example 7.5 The present example provides a method of treating retinal vein occlusion (RVO).
• the method comprises administering an anti-VEGF antibody conjugate (e.g., KSI- 301) to a subject with RVO at a first loading dose.
• an anti-VEGF antibody conjugate e.g., KSI- 301
• Example 8 [0539] The present example provides a method of improving perfusion of an eye, the method comprises identifying a subject with DME, DR or RVO.
• an anti-VEGF antibody conjugate e.g., KSI-301
• Example 9 [0540] The present example provides a method of improving perfusion of an eye.
• the method involves identifying a subject with non-proliferative DR and administering an initial dose of an anti-VEGF antibody conjugate (e.g., KSI-301) to the subject (between 1 and 5 mg of antibody), to provide improved perfusion in at least one eye. The dose is repeated until perfusion is achieved within the subject’s treated eye.
• an anti-VEGF antibody conjugate e.g., KSI-301
• the present example provides a method of treating a subject with DME, DR or RVO.
• the method comprises administering 1-3 loading doses of an anti-VEGF antibody conjugate (e.g., KSI-301) (at 1-5 mg of antibody on a once monthly basis) to a subject with DME, DR or RVO.
• Example 10.5 The present example provides a method of treating a subject with DME, DR or RVO.
• the method comprises administering 1-3 loading doses of an anti-VEGF antibody conjugate (e.g., KSI-301) (at 1-5 mg of antibody on a once monthly basis) to a subject with DME, DR or RVO.
• an anti-VEGF antibody conjugate e.g., KSI-301
• one provides a follow-on application of the anti- VEGF antibody conjugate (retreatment) at a point in time no sooner than 16 weeks after a last loading dose.
• one provides a follow-on application of the anti-VEGF antibody conjugate (retreatment) at a point in time no sooner than 20 weeks after a last loading dose.
• one provides a follow-on application of the anti-VEGF antibody conjugate (retreatment) at a point in time no sooner than 24 weeks after a last loading dose.
• one provides a follow-on application of the anti-VEGF antibody conjugate (retreatment) at a point in time no sooner than 30 weeks after a last loading dose.
• one provides a follow-on application of the anti-VEGF antibody conjugate (retreatment) at a point in time no sooner than 36 weeks after a last loading dose.
• one provides a follow-on application of the anti-VEGF antibody conjugate (retreatment) at a point in time no sooner than 42 weeks after a last loading dose.
• one provides a follow-on application of the anti-VEGF antibody conjugate (retreatment) at a point in time no sooner than 48 weeks after a last loading dose.
• one provides a follow-on application of the anti-VEGF antibody conjugate (retreatment) at a point in time no sooner than 54 weeks after a last loading dose.
• Example 11 provides a method of treating a subject with non- proliferative DR.
• One identifies a patient in need of therapy and administers 1 or 2 loading doses of an anti-VEGF antibody conjugate(e.g., KSI-301) (1-5 mg, once a month) to a subject with non-proliferative DR.
• an anti-VEGF antibody conjugate e.g., KSI-301
• Example 11.5 [0544] The present example provides a method of treating a subject with non- proliferative DR. One identifies a patient in need of therapy and administers 1 or 2 loading doses of an anti-VEGF antibody conjugate (e.g., KSI-301) (1-5 mg, once a month) to a subject with non-proliferative DR. One does not administer more than 2 loading doses to the subject.
• an anti-VEGF antibody conjugate e.g., KSI-301
• Example 12 provides a method of treating a subject with RVO.
• the method comprises administering 1 or 2 loading doses of an anti-VEGF antibody conjugate(e.g., KSI-301) (1-5 mg, once monthly) to a subject with RVO. No additional loading doses are administered to the3 subject.
• the present example provides a method of treating a subject with RVO.
• the method comprises administering 1 or 2 loading doses of an anti-VEGF antibody conjugate (e.g., KSI-301) (1-5 mg, once monthly) to a subject with RVO. No additional loading doses are administered to the3 subject.
• an anti-VEGF antibody conjugate e.g., KSI-301
• the retreatment occurs no sooner than 36 weeks.
• the retreatment occurs no sooner than 42 weeks. In the alternative, the retreatment occurs no sooner than 48 weeks. In the alternative, the retreatment occurs no sooner than 54 weeks. In the alternative, the retreatment occurs no sooner than 60 weeks.
• Example 13 [0547] The present example provides a method of treating RVO. One administers an anti-VEGF antibody conjugate(e.g., KSI-301) (1-5 mg, once a month) to a subject in need of treating RVO at 1-3 loading doses. The subject thereby retains a therapeutic result of the anti-VEGF antibody conjugate therapy for RVO for at least 8 weeks after a final loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301
• Example 13.5 The present example provides a method of treating RVO.
• One administers an anti-VEGF antibody conjugate e.g., KSI-301 (1-5 mg, once a month) to a subject in need of treating RVO at 1-3 loading doses.
• the subject thereby retains a therapeutic result of the anti-VEGF antibody conjugate therapy for RVO for at least 12 weeks after a final loading dose.
• the subject will retain at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least 18 weeks following the last application of the anti-VEGF antibody bioconjugate.
• the subject retains at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least 24 weeks following the last application of the anti-VEGF antibody bioconjugate.
• the subject retains at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least 30 weeks following the last application of the anti-VEGF antibody bioconjugate.
• the subject retains at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least 36 weeks following the last application of the anti-VEGF antibody bioconjugate.
• the subject retains at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least42 weeks following the last application of the anti-VEGF antibody bioconjugate.
• the subject retains at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least 48 weeks following the last application of the anti-VEGF antibody bioconjugate.
• the subject retains at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least 54 weeks following the last application of the anti-VEGF antibody bioconjugate.
• the subject retains at least one, if not most or all of the therapeutic benefits over this period of time, such that the subject will not substantially benefit from another retreatment for at least 60 weeks following the last application of the anti-VEGF antibody bioconjugate.
• EXAMPLE 14 [0549] One first identifies a subject in need of having an eye disorder treated (either prophylactically or otherwise).
• an anti-VEGF antibody conjugate e.g., KSI-301
• KSI-301 an anti-VEGF antibody conjugate
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 12 weeks.
• DME diabetic macular edema
• RVO retinal vein occlusion
• AMD wet age-related macular degeneration
• DR alternative diabetic retinopathy
• EXAMPLE 14.5 One first identifies a subject in need of having an eye disorder treated (either prophylactically or otherwise). Then one administers between 1 and 5 mg of antibody of an anti-VEGF antibody conjugate (e.g., KSI-301) to the subject in a first loading dose, and optionally a second loading dose and optionally a third loading dose (within about one month of each other). Following the last loading dose, the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 18 weeks. Alternatively following the last loading dose, the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 24 weeks.
• an anti-VEGF antibody conjugate e.g., KSI-301
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 30 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 36 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 42 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 48 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 54 weeks.
• the subject will retain a therapeutic benefit of the anti-VEGF antibody conjugate therapy for at least 60 weeks.
• Example 15 The present example summarizes the safety and characteristics observed for the use of KSI-301 through repeated administration. 113 subjects were dosed over phase 1a and 1b. 308 total doses were administered.
• ABSI- 301 has achieved important development results, including: [0554] Excellent Safety: zero cases of intraocular inflammation after 300+ doses [0555] Strong Efficacy: across 3 major phenotypically variable retinal diseases wet AMD, DME/DR & RVO [0556] Remarkable Biological Durability: majority of treated eyes extended to 4 months or beyond without retreatment after 3 loading doses.
• FIGs. 17A and 17B depict OCT and OCT angiography of a wet AMD patient that has been treated with 3 loading doses of 5mg KSI-301 at baseline, week 4 and week 8.
• FIGs. 18A-18D show an example of a DME with disease modification post 3 loading doses, with significant DRSS improvement and reperfusion representing disease modification.
• FIG. 18A shows a time course revealing that it is possible to get both fast and long lasting effect in DME with only 3 loading doses (no retreatment required for at least 5 months).
• FIG. 18B demonstrates that the effectiveness of only three loading doses of KSI-301 is present in proliferative diabetic retinopathy.
• FIG. 19 displays the results in an RVO patient, that after 3 loading doses, no additional doses were required for at least 5 months, representing what is believed to be disease modification. Thus, use of KSI-301 in the manner provided herein can be used to achieve disease modification.
• FIG. 19 [0564] FIG.
• FIG. 21A-21C Show the results of a single injection of KSI-301. Phase 1 Single Dose Study – Summary: • Rapid high-magnitude and durable treatment responses were seen at all dose levels tested.
• FIG. 21A show a graph of the median changes from baseline to week 12. It demonstrates a rapid, high response that is durable for KSI-301 administration. Case study 1 results are shown in FIG. 21B, which demonstrates the effectiveness of KSI-301 administration on chronic macular edema in a subject with prior suboptimal response.
• FIG. 21B shows the effectiveness of KSI-301 administration on chronic macular edema in a subject with prior suboptimal response.
• FIG. 22 Treatment durability of KSI-301 in the wAMD cohort. Includes randomized patients that reached the first re-treatment opportunity (Week 12 visit) by the data cutoff date. Each bar represents an individual patient. Re-treatment is indicated by ( ⁇ ). Patients followed beyond the indicated last assessment time point (indicated by a right arrow). One discontinued patient is indicated by left arrow.
• High PED defined as presence of a PED with baseline CST ⁇ 500 microns. Includes randomized patients that reached Week 20 visit by the data cutoff date; 2.5 and 5 mg doses were pooled.
• Figure 26 Improvements in BCVA and OCT in wet AMD patients with high PED, treated with KSI-301.
• N 29.
• High PED defined as presence of a PED with baseline CST ⁇ 500 microns. Includes randomized patients that reached Week 12 visit by the data cutoff date; 2.5 and 5 mg doses were pooled.
• Figure 27 Treatment durability of KSI-301 in the DME cohort. Includes randomized patients that reached the first re-treatment opportunity (Week 12 visit) by the data cutoff date. Each bar represents an individual patient. Re-treatment is indicated by ( ⁇ ). All depicted patients were followed beyond the indicated last assessment time point (indicated by a right arrow). [0578] Improvement in BCVA and OCT CST were observed in DME patients at Week 20, 12 weeks after the last loading dose (Figure 28). Therapeutic effect of KSI-301 was sustained during the loading phase, and continued for at least 12 weeks after the final loading dose administered at Week 8. Improvement in BCVA and OCT CST was observed in a larger cohort of DME patients that reached Week 12 ( Figure 29).
• BCVA best corrected visual acuity
• OCT optical coherence tomography
• CST central subfield thickness. Error bars represent standard error of the mean.
• EXAMPLE 24 [0586] During the study described in Examples 22-23, multiple-dose exposure of KSI-301 was well-tolerated and no intraocular inflammation was observed. 116 subjects were dosed, with 338 total doses given (107 doses at day 1, 103 doses at week 4, 96 doses at week 8).
• EXAMPLE 24 [0595] The study described in Examples 3-5, 15-23 was further extended to up to 72 weeks, as shown in Figure 33.
• Figure 33 Updated study design for a randomized, open label study to evaluate multidose safety, efficacy and durability of intravitreal administration of KSI-301.
• the updated average characteristics of the study population is show in Table 2.
• FIG. 34 Treatment durability of KSI-301 in the wAMD cohort. Includes randomized patients that reached the first re-treatment opportunity (Week 12 visit) by the data cutoff date. Each bar represents an individual patient. Re-treatment is indicated by ( ⁇ ). Patients followed beyond the indicated last assessment time point are indicated by a right arrow. One discontinued patient is indicated by the left arrow. [0600] Improved BCVA and OCT CST was maintained in patients at week 24, 16 weeks after the last loading dose ( Figure 35). The baseline (pre-treatment) BCVA for this cohort was 64.1 ETDRS letters.
• the average improvement in BCVA at Week 24 was +5.9 letters (corresponding to 20/40 Snellen VA).
• the improved BCVA and OCT CST values were comparable to reported improvements in a standard of care anti-VEGF therapy (baseline of 60.8 letters, gain of ⁇ 6 letters; or baseline of 61.5, gain of ⁇ 5.2 letters at Week 20).
• the average improvement in OCT CST was -58 microns at Week 24.
• the therapeutic effect of KSI-301 was sustained during the loading phase, and continued for at least 16 weeks after the final loading dose administered at Week 8 ( Figure 35). [0601] Over the 16 weeks after the final loading dose, a patient received on average 0.16 injections of KSI-301 for retreatment. ( Figure 35).
• FIG. 35 Improvements in best corrected vision (BCVA) and retinal thickness (OCT) in patients with wet AMD.
• N 31. Includes randomized patients that reached Week 24 visit by the data cutoff date; 2.5 and 5 mg doses were pooled.
• EXAMPLE 25 [0603] Further follow-up assessments of patients enrolled in the study described in Example 22 were performed.
• EXAMPLE 27 [0613] During the study described in Examples 3-5, and 15-26, multiple-dose exposure of KSI-301 was well-tolerated and no intraocular inflammation was observed. 130 subjects were dosed, with 420 total doses given (121 doses at day 1, 112 doses at week 4, 105 doses at week 8).
• EXAMPLE 28 Phase 2 Randomized Study of KSI-301 and a Standard of Care Treatment in wAMD
• the standard of care treatment includes 3 loading doses of the therapeutic (at 2 mg per administration) administered at 4-week intervals, followed by alternating administration of a maintenance dose or sham injection every 4 weeks, starting at 16 weeks after initial treatment ( Figure 40).
• the standard of care therapeutic is administered to the patient every 8 weeks.
• KSI-301 is administered (at 5 mg per administration) to another patient cohort with 3 loading doses at 4-week intervals.
• KSI-301-treated patients After the final loading dose (Week 8), patients receive at least a sham injection every 4 weeks, starting at 16 weeks after initial treatment ( Figure 40).
• One cohort of KSI-301-treated patients are assessed for disease activity every 12 weeks (Q12W) after the last loading dose (Week 8).
• Another cohort of KSI-301-treated patients are assessed for disease activity every 16 weeks (Q16W) after the last loading dose (Week 8).
• a patient is retreated with KSI-301 if the assessed disease activity meets pre- specified retreatment criteria.
• a third cohort of KSI-301-treated patients are administered KSI-301 every 20 weeks (Q20W) after the last loading dose (Week 8). All patients are administered KSI-301 at 20 weeks after the last loading dose (Week 8).
• Figure. 40 Study design for randomized study to evaluate KSI-301 against Aflibercept in treating treatment na ⁇ ve wAMD patients.
• KSI-301 is dosed as infrequently as every 20 weeks.
• Re-treatment Criteria non-loading dose
• Re-treatment with intravitreal injection of KSI-301 is performed if at least one of the following re-treatment criteria is met. These criteria are related to signs of disease recurrence and/or vision loss due to disease recurrence.
• Figures 41A and 41B Treatment durability of KSI-301 in the wAMD cohort under hypothetical retreatment criteria in a Phase 2 clinical trial (Figure 41), and hypothetical probability of a patient remaining on Q20W dosing (Figure 41B). Includes randomized patients that would have met retreatment criteria before or at Week 28 by the data cutoff date. Each bar represents an individual patient.
• EXAMPLE 29 [0633] The study described in Examples 3-5, 15-24 was further extended to Weeks 76 to 148 (Months 19 to 36) ( Figure 43). Figure 43 shows an updated study design for a randomized, open label study to evaluate multidose safety, efficacy and durability of intravitreal administration of KSI-301.
• EXAMPLE 30 This example shows further follow-up assessments of the clinical study of KSI-301 for wAMD described in Examples 21 and 24. The results showed improved average BCVA and OCT CST was maintained in patients at week 44, 36 weeks after the last loading dose (Figure 44). The therapeutic effect of the anti-VEGF antibody conjugate was sustained during the loading phase, and continued for at least 36 weeks after the final loading dose administered at Week 8. 58% of patients received their first retreatment dose at Week 32 (Q6M dosing), which was a mandated retreatment dose for any patient who had not been retreated since the last loading dose.
• Figure 45A shows the individual break down of the follow-up assessment. Durability of the anti-VEGF antibody conjugate treatment in patients from the wAMD cohort extended to 3 to 6 or more months.
• Figure 45B summarizes the results shown in Figure 45A. In 72% of patients, the patient achieved at least one treatment interval of 6 months (Q6M – the mandated cap for the interval between treatment doses) sometime after the last loading dose (Figure 45B).
• FIG. 46 shows a case example of a wAMD patient in the Phase 1b study described above, treated with KSI-301 with 6-month dosing through 1 year. OCT images were taken at the indicated time points. BCVA was also assessed (indicated by the change in ETDRS Letters value under the Week label). OCT and BCVA improvement was observed as early as 1 month (Week 12) after the last loading dose, and was sustained for at least 6 months (Week 32) after the last loading dose.
• a wAMD patient is administered intravitreally an effective amount of an anti-VEGF antibody conjugate, e.g., KSI-301, at a dosing interval of about 3 months, about 4 months, about 5 months, or about 6 months, or any time interval between any two of the above values, at any time period after the patient is administered the last loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301
• a wAMD patient is not administered a maintenance dose of the anti-VEGF antibody conjugate until at least about 3 months, at least about 4 months, at least about 5 months, or at least about 6 months or more, or until any time point between any two of the above values, after the last loading dose.
• a wAMD patient has about 40%, about 50%, about 55%, about 60%, or about 65% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 6 months or more after the last loading dose or the last maintenance dose.
• a wAMD patient has about 50%, about 55%, about 60%, about 65%, or about 70% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 5 months or more after the last loading dose or the last maintenance dose. In some embodiments, a wAMD patient has about 50%, about 60%, about 70%, or about 80% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 4 months or more after the last loading dose or the last maintenance dose.
• a wAMD patient has about 60%, about 70%, about 80%, or about 90% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 3 months or more after the last loading dose or the last maintenance dose.
• a subject receives 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer intravitreal injections of the anti-VEGF antibody conjugate in the first year of treatment for wAMD, including the loading doses.
• a subject receives 4 or fewer, 3 or fewer, 2 or fewer, or 1 maintenance doses of the anti-VEGF antibody conjugate per year for treatment of wAMD.
• EXAMPLE 31 shows benchmarking of KSI-301 durability compared to aflibercept (Eylea®) long-interval RCT data for treatment-na ⁇ ve wAMD (Figure 47) and Eylea real-world data for wAMD (Figure 48).
• Figure 47 shows the distribution of treatment intervals among treatment-na ⁇ ve wAMD patients in the KSI-301 Phase 1b study described above was compared to that in a treat-and-extend randomized clinical trial for Ranibizumab and Aflibercept, a combination of two conventional anti-VEGF treatments.
• Figure 48 shows a comparison of the mean treatment interval for patients treated with KSI-301 in the Phase 1b study described above and the mean treatment interval from real-world data for aflibercept (Eylea®) treat-and-extend.
• the mean maximum interval for treating wAMD with the anti-VEGF antibody conjugate, e.g., KSI-301 is at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90%, at least about 100%, at least about 110%, at least about 120%, at least about 130%, at least about 140%, at least about 150%, at least about 170% or at least about 200% longer than the mean maximum interval for a conventional anti-VEGF treatment.
• the anti-VEGF antibody conjugate is administered to a wAMD patient at a frequency that is at most about 80%, at most about 70%, at most about 60%, at most about 50%, at most about 40%, at most about 30%, at most about 20%, at most about 10% or less than the frequency of administration of a conventional anti-VEGF treatment to treat wAMD.
• EXAMPLE 32 This example shows further follow-up assessments of the clinical study of KSI-301 for DME described in Examples 22 and 25. Figure 49 shows that the therapeutic effect of KSI-301 was sustained during the loading phase, and continued for at least 36 weeks after the final loading dose administered at Week 8.
• Figure 50A shows the individual break down of the follow-up assessment. Durability of the KSI-301 treatment in patients from the DME cohort extended to 3 to 6 or more months.
• Figure 50B summarizes the results shown in Figure 50A. 45% (15/33) of the patients to date (more than 6 months since the last loading dose) have not required a retreatment dose after the loading doses. In 79% of patients, the patient achieved at least one treatment interval of 6 months or longer sometime after the last loading dose.
• FIG. 51 shows a case example of a DME patient in the Phase 1b study described above, treated with KSI-301 with no treatment after the loading phase. OCT images were taken at the indicated time points. BCVA was also assessed (indicated by the change in ETDRS Letters value under the Week label).
• OCT and BCVA improvement was observed as early as 1 month (Week 12) after the last loading dose, and was sustained for at least 12 months (Week 56) after the last loading dose. No retreatment doses were required for over 12 months after the last loading dose. In total, the patient received 3 intravitreal injections in the first year of treatment.
• a DME patient is administered intravitreally an effective amount of an anti-VEGF antibody conjugate, e.g., KSI-301, at a dosing interval of about 3 months, about 4 months, about 5 months, about 6 months, about 7 months, about 8 months, about 9 months, or about 10 months, about 11 months, about 12 months, about 13 months, or about 14 months or more, or any time interval between any two of the above values, at any time period after the patient is administered the last loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301
• a DME patient is not administered a maintenance dose of the anti-VEGF antibody conjugate until at least about 3 months, at least about 4 months, at least about 5 months, at least about 6 months, at least about 7 months, at least about 8 months, at least about 9 months, at least about 10 months, at least about 11 months, at least about 12 months, at least about 13 months, or at least about 14 months or more, or until any time point between any two of the above values, after the last loading dose.
• a DME patient has about 30%, about 35%, about 40%, about 45%, or about 50% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 7 months or more after the last loading dose or the last maintenance dose.
• a DME patient has at least about 40%, at least about 50%, at least about 55%, at least about 60%, or at least about 65% chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 6 months or more after the last loading dose or the last maintenance dose. In some embodiments, a DME patient has at least about 50%, at least about 55%, at least about 60%, at least about 65%, or at least about 70% chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 5 months or more after the last loading dose or the last maintenance dose.
• a DME patient has at least about 50%, at least about 60%, at least about 70%, or at least about 75% chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 4 months or more after the last loading dose or the last maintenance dose. In some embodiments, a DME patient has at least about 60%, at least about 70%, at least about 80%, at least about 90%, or at least about 95% chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 3 months or more after the last loading dose or the last maintenance dose.
• a subject receives 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, or 3 or fewer, intravitreal injections of the anti-VEGF antibody conjugate in the first year of treatment for DME, including the loading doses. In some embodiments, a subject receives 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer, or no maintenance doses of the anti-VEGF antibody conjugate per year for treatment of DME.
• EXAMPLE 33 This example shows benchmarking of KSI-301 durability compared to Eylea in DME.
• Figure 52 shows the mean number of injections required in one-year interval for patients with DME treated with KSI-301 (right) in the Phase 1b study described above, or with Eylea (aflibercept) (left), a conventional anti-VEGF treatment.
• Patients on conventional anti-VEGF treatment required on average 6 monthly loading doses, and 3.2 maintenance doses, for a total of 9.2 injections in the first year of treatment.
• patients treated with KSI-301 required only on average 3 monthly loading doses, and 1 maintenance dose, for a total of 4 injections in the first year of treatment.
• KSI-301 allowed for treatment of DME at half the number of loading and maintenance doses compared to a conventional anti- VEGF treatment.
• the number of loading doses (e.g., monthly loading doses) required for treatment of DME with the anti-VEGF antibody conjugate, e.g., KSI-301, is at most about 75%, at most about 70%, at most about 65%, at most about 60%, at most about 55%, at most about 50%, at most about 45%, or at most about 40% of the number of loading doses required for treatment with a conventional anti-VEGF treatment.
• the number of maintenance doses required for treatment of DME with the anti- VEGF antibody conjugate is at most about 75%, at most about 70%, at most about 65%, at most about 60%, at most about 55%, at most about 50%, at most about 45%, or at most about 40% of the number of maintenance doses required for treatment with a conventional anti- VEGF treatment.
• the total number of doses per year required for treatment of DME with the anti-VEGF antibody conjugate is at most about 75%, at most about 70%, at most about 65%, at most about 60%, at most about 55%, at most about 50%, at most about 45%, or at most about 40% of the total number of doses required per year for treatment with a conventional anti-VEGF treatment.
• EXAMPLE 34 shows further follow-up assessments of the clinical study of KSI-301 for RVO described in Examples 23 and 26.
• Figure 53 shows that the therapeutic effect of the anti-VEGF antibody conjugate was sustained during the loading phase, and continued for at least 36 weeks after the final loading dose administered at Week 8.
• a patient received on average 1.33 injections of the anti-VEGF antibody conjugate between Week 12 and 40, and only 36% of patients required more than one retreatment dose.
• the mean number of injections according to the label for a conventional treatment (aflibercept) over the same time period would be 8.
• Figure 54A shows the individual break down of the follow-up assessment.
• FIG 54B summarizes the results shown in Figure 54A. 81% of the patients achieved at least one treatment interval of 4 months or longer sometime after the last loading dose. In 56% (18/32) of patients time to retreatment was 4 months or longer after the last loading dose. 66% (21/32) of patients did not receive retreatment for 3 months or longer after the last loading dose. 94% (31/33) of patients did not receive retreatment for 2 months or longer after the last loading dose. Only 6% (2/34) of patients were retreated at 1 month after the last loading dose.
• FIG. 56 shows a case example of a CRVO patient in the Phase 1b study described above, treated with KSI-301. OCT images were taken at the indicated time points and thickness measurement is indicated below the Week labels on the left. BCVA was also assessed (indicated by the change in ETDRS Letters value on the right). The OCT measurement before treatment indicated the patient had the most severe CRVO. OCT and BCVA improvement was observed as early as 1 week after the first loading dose, and continued to improve over the following 3 weeks until the next monthly loading dose.
• OCT images were taken at the indicated time points and thickness measurement is indicated below the Week labels on the left. BCVA was also assessed (indicated by the change in ETDRS Letters value on the right). The OCT measurement before treatment indicated the patient had the most severe CRVO. OCT and BCVA improvement was observed as early as 1 week after the first loading dose, and continued to improve over the following 3 weeks until the next monthly loading dose.
• a RVO (e.g., BRVO, CRVO) patient is administered intravitreally an effective amount of an anti-VEGF antibody conjugate, e.g., KSI-301, at a dosing interval of about 2 months, about 3 months, about 4 months, about 5 months, about 6 months, about 7 months, about 8 months, about 9 months, about 10 months, about 11 months, about 12 months, about 13 months, about 14 months, or about 15 months or more, or any time interval between any two of the above values, at any time period after the last loading dose.
• an anti-VEGF antibody conjugate e.g., KSI-301
• a RVO patient is not administered a maintenance dose of the anti-VEGF antibody conjugate until at least about 2 months, at least about 3 months, at least about 4 months, at least about 5 months, at least about 6 months, at least about 7 months, at least about 8 months, at least about 9 months, at least about 10 months, at least about 11 months, at least about 12 months, at least about 13 months, at least about 14 months, or at least about 15 months or more, or any time point between any two of the above values, after the last loading dose.
• a RVO patient has about 45%, about 50%, about 55%, about 60%, about 65%, or about 70% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 4 months or more after the last loading dose or the last maintenance dose. In some embodiments, a RVO patient has about 50% or higher, about 55% or higher, about 60% or higher, about 65% or higher, or about 70% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 3 months or more after the last loading dose or the last maintenance dose.
• a RVO patient has about 60%, about 70%, about 80%, about 85%, about 90%, or about 95% or higher chance of not requiring a maintenance dose of the anti-VEGF antibody conjugate until about 2 months or more after the last loading dose or the last maintenance dose.
• a subject receives 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer intravitreal injections of the anti-VEGF antibody conjugate in the first year of treatment for RVO, including the loading doses.
• a subject receives 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 maintenance doses of the anti-VEGF antibody conjugate per year for treatment of RVO.
• an RVO patient receives 2 or 3 loading doses of the anti-VEGF antibody conjugate.
• EXAMPLE 35 shows benchmarking of KSI-301 durability compared to Eylea in RVO.
• Figure 55 shows the mean number of injections required in one-year interval for patients with RVO treated with KSI-301 (right) in the Phase 1b study described above, or with Eylea (aflibercept) (left), a conventional anti-VEGF treatment.
• Patients on conventional anti-VEGF treatment required on average 6 monthly loading doses, and 2.6 maintenance doses, for a total of 8.6 injections in the first year of treatment.
• KSI-301 In contrast, patients treated with KSI-301 required only on average 3 monthly loading doses, and 1.7 maintenance doses, for a total of 4.7 injections in the first year of treatment. Thus, KSI-301 allowed for treatment of RVO at half the number of loading doses, and about 2/3 the number of maintenance doses compared to a conventional anti-VEGF treatment. These results demonstrate the superior duration of the therapeutic effect of the anti-VEGF antibody conjugate compared to conventional anti-VEGF treatments for treating RVO.
• the number of loading doses (e.g., monthly loading doses) required for treatment of RVO with the anti-VEGF antibody conjugate, e.g., KSI-301 is at most about 75%, at most about 70%, at most about 65%, at most about 60%, at most about 55%, at most about 50%, at most about 45%, or at most about 40% of the number of loading doses required for treatment with a conventional anti-VEGF treatment.
• the number of maintenance doses required for treatment of RVO with the anti- VEGF antibody conjugate is at most about 80%, at most about 75%, at most about 70%, at most about 65%, or at most about 60% of the number of maintenance doses required for treatment with a conventional anti-VEGF treatment.
• the total number of doses per year required for treatment of RVO with the anti-VEGF antibody conjugate is at most about 80%, at most about 75%, at most about 70%, at most about 65%, at most about 60%, at most about 55%, or at most about 50% of the total number of doses required per year for treatment with a conventional anti-VEGF treatment.
• EXAMPLE 36 This example provides a Phase 2b/3 wAMD study with KSI-301 dosed as infrequently as once every 20 weeks (after the loading doses).
• Figure 57 shows a schematic view of the study design. Patients in the KSI-301 treatment arm of the study are on Q12W, Q16W or Q20W dosing schedule, unless a disease activity assessment criteria (below) are met at any follow up assessment, at which time the patient is administered a maintenance dose.
• Disease Activity Assessment Criteria non-loading dose
• These criteria are related to signs of disease recurrence and/or vision loss due to disease recurrence.
• OCT central subfield retinal thickness (CST) ⁇ 50 ⁇ m with a decrease in BCVA of ⁇ 5 letters compared to Week 12; - Decrease in BCVA of ⁇ 10 letters compared to the best prior BCVA, due to worsening wAMD activity (e.g. increased intraretinal fluid, increased subretinal fluid, new intraretinal hemorrhage, new subretinal hemorrhage); - Increase in OCT central subfield retinal thickness (CST) ⁇ 75 ⁇ m compared to Week 12; - New macular hemorrhage.
• CST OCT central subfield retinal thickness
• EXAMPLE 37 This example provides a Phase 3 DME studies with KSI-301 that is dosed as infrequently as once every 24 weeks (after the loading doses).
• Figure 58 shows a schematic view of the study design. Patients in the KSI-301 treatment arm of the study are on Q8W, Q12W, Q16W, Q20W, Q24W dosing schedule, unless a disease activity assessment criteria (below) are met at any follow up assessment, at which time the patient is administered a maintenance dose.
• Disease Activity Assessment Criteria non-loading dose
• Patients in the KSI-301 treatment arm of the study receive two monthly loading doses followed by two every 8-week dosing, then every 8 week dosing with disease activity assessment to individualize dosing. If disease activity assessment criteria (below) are met at any follow up assessment, the patient is administered a maintenance dose.
• Disease Activity Assessment Criteria (non-loading dose) [0662] These criteria are related to signs of disease recurrence and/or vision loss due to disease recurrence. - Increase in OCT central subfield retinal thickness (CST) ⁇ 75 ⁇ m compared to lowest previous measurement due to worsening of RVO disease activity; - Increase in OCT CST ⁇ 75 ⁇ m compared to lowest previous measurement due to worsening of RVO disease activity.
• ETDRS DRSS Diabetic retinopathy severity score
• EXAMPLE 40 [0664] During the study described in Examples 3-5, 15-26, and 29-35, multiple- dose exposure of KSI-301 was well-tolerated and no intraocular inflammation was observed. 130 subjects were dosed, with 546 total doses given. 121 subjects completed the loading phase in Phase 1b, and 81 received at least one additional retreatment at Week 12 or later.

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