WO2021158843A1 - Traitement et régime posologique pour modulateur du récepteur s1p - Google Patents

Traitement et régime posologique pour modulateur du récepteur s1p Download PDF

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Publication number
WO2021158843A1
WO2021158843A1 PCT/US2021/016703 US2021016703W WO2021158843A1 WO 2021158843 A1 WO2021158843 A1 WO 2021158843A1 US 2021016703 W US2021016703 W US 2021016703W WO 2021158843 A1 WO2021158843 A1 WO 2021158843A1
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patient
infection
vaccine
siponimod
zoster virus
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PCT/US2021/016703
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English (en)
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Jeffrey R. GARDNER
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Argentum Pharmaceuticals Llc
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Publication of WO2021158843A1 publication Critical patent/WO2021158843A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/397—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having four-membered rings, e.g. azetidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/12—Viral antigens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A61P31/20—Antivirals for DNA viruses
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/005—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from viruses
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2710/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA dsDNA viruses
    • C12N2710/00011—Details
    • C12N2710/16011—Herpesviridae
    • C12N2710/16711—Varicellovirus, e.g. human herpesvirus 3, Varicella Zoster, pseudorabies
    • C12N2710/16722—New viral proteins or individual genes, new structural or functional aspects of known viral proteins or genes
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2710/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA dsDNA viruses
    • C12N2710/00011—Details
    • C12N2710/16011—Herpesviridae
    • C12N2710/16711—Varicellovirus, e.g. human herpesvirus 3, Varicella Zoster, pseudorabies
    • C12N2710/16734—Use of virus or viral component as vaccine, e.g. live-attenuated or inactivated virus, VLP, viral protein
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

  • the present invention relates to a dosage regimen of an S1P receptor modulator or agonist in the course of the treatment of patients suffering from an inflammatory or autoimmune disease or disorder, for example multiple sclerosis (MS).
  • MS multiple sclerosis
  • Multiple sclerosis is an autoimmune disorder or disease which results in the demyelination of the insulating cover nerve cells in the brain and spinal cord.
  • the damage disrupts the ability of parts of the central nervous system to transmit and receive signals.
  • the disruption in signaling often causes physical, mental, and psychiatric problems. While the underlying mechanism of action remains unknown, multiple sclerosis is thought to be caused by destruction by the immune system of either myelin itself or myelin-producing cells.
  • Multiple sclerosis is the chief cause of neurological disability in young adults and the most common demyelinating disorder of the central nervous system.
  • Available therapies such as interferon-b and glatiramer acetate have modest efficacy and marginal effects on the progression of disability.
  • These biological agents are administered parenterally and are associated, e.g., with injection site reactions and pyretic symptoms, such as flu-like symptoms.
  • Sphingosine-1 -phosphate (S1P) receptor modulators are a class of drugs used as immunomodulators, for example for the treatment of autoimmune disorders or diseases such as multiple sclerosis (MS).
  • Suphingosine-1-phospate (S1P) is a signaling sphingolipid which binds with several S1P receptors, e.g. S1P Receptor 1 (S1PR1) to S1P Receptor 5 (S1PR5).
  • S1P interaction with S1PR1 (a G-protein-coupled S1P receptor) is needed for the egress of immune cells from the lymphoid organs (such as thymus and lymph nodes) into the lymphatic vessels.
  • S1P receptor modulators impact the ability of S1P to bind with S1PR1 through S1PR8.
  • S1PR1 based on interaction with S1PR1, it is believed such compounds modulate the release of certain lymphoid immune cells, which can ultimately reach the central nervous system.
  • Fingolimod is believed to cause the internalization of S1P receptors, including S1PR1, which sequesters lymphocytes in the lymph nodes, preventing them from moving to the central nervous system and causing a relapse of multiple sclerosis.
  • Fingolimod efficacy in the treatment of multiple sclerosis (MS) has been shown in humans (e.g. as described in “FTY720 therapy exerts differential effects on T call subsets in multiple sclerosis”.
  • Siponimod is another S1P receptor modulator which selectively binds to S1P receptors, including S1PR1. It is believed the mechanism of Siponimod is similar to the mechanism of Fingolimod; however, Siponimod may be more selective in the particular sphingosine-1 -phosphate receptors it modulates as compared to Fingolimod.
  • VZV Varicella zoster virus
  • Primary infection leads to acute varicella or “chickenpox,” usually from exposure either through direct contact with a skin lesion or through airborne spread from respiratory droplets.
  • VZV After initial infection, VZV establishes lifelong latency in cranial nerve and dorsal root ganglia, and can reactivate years to decades later as herpes zoster (HZ) or “shingles.”
  • HZ herpes zoster
  • shingles Herpes zoster
  • Vander DH Kleinschmidt-DeMasters BK, LaGuardia J J, Mahalingam R, Cohrs RJ, Neurologic complications of the reactivation of varicella-zoster virus, 342 N Engl J Med. 635-645 (2000).
  • VZV Varicella Zoster Virus
  • infections in individuals undergoing immunomodulating treatments can be particularly severe.
  • VZV infection has caused the death of clinical trial participants while the participants were undergoing treatment involving an immunomodulating agent (e.g. Arvin at al., “Varicella-Zoster Virus Infections in Patients Treated With Fingolimod,” JAMA Neurol. Author manuscript; available in PMC 2017 Apr 13.).
  • an immunomodulating agent e.g. Arvin at al., “Varicella-Zoster Virus Infections in Patients Treated With Fingolimod,” JAMA Neurol. Author manuscript; available in PMC 2017 Apr 13.
  • the possibility of infection, recurrence of prior infection, or reactivation of a latent infection can result in medical providers recommending against treatment, or in at- risk patients declining or delaying treatment, for certain diseases or disorders, including autoimmune disorders (e.g. multiple sclerosis).
  • a S1P receptor modulator or agonist such as Siponimod
  • a S1P receptor modulator or agonist such as Siponimod
  • the dosing regimen and methods of treatment of the invention is applicable for patients who are presently undergoing treatment for an inflammatory or autoimmune or disease or disorder, for example under treatment for multiple sclerosis, as well as patients who were never treated or were not diagnosed for an inflammatory or autoimmune or disease before taking a S1P receptor modulator or agonist.
  • the dosage regimen of the present invention is a regimen for a S1P receptor modulator or agonist therapy, which enables administration of a therapeutic dosage range of the S1P receptor to be achieved with controlled or minimal side effects, which could otherwise have been possibly associated with S1P receptor modulator therapy.
  • the present application encompasses S1P receptor modulators, agonists, and antagonists.
  • the S1P receptor modulators, agonists, and antagonists are compounds as described in U.S. Patent 7,939,519 and U.S. Patent 8,492,441.
  • the S1 P receptor modulator is Siponimod.
  • Siponimod may be referred to as by its lUPAC name, which is:
  • Siponimod may also be referred to by its trade name, MAYZENT.
  • Siponimod may also be referred to by the designation BAF-312.
  • Siponimod may also be referred to by chemical structure, shown below:
  • the present application encompasses the use of S1P receptor modulators, including Siponimod, to treat autoimmune diseases or disorders.
  • autoimmune diseases and disorders preferably include chronic long-term diseases, e.g. multiple sclerosis (MS), for example relapsing remitting multiple sclerosis (RRMS) or primary progressive multiple sclerosis (PPMS).
  • MS takes several forms, with new symptoms occurring either in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms).
  • the dosing regimens and methods of treatment according to the present invention are particularly adapted for multiple sclerosis, e.g. RRMS.
  • the dosing regimens and methods of treatment according to the present invention are particularly adapted for multiple sclerosis, e.g. RRMS.
  • Siponimod is administered at a daily maintenance dosage of 2 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.5 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.5 mg per day taken once daily.
  • Siponimod is administered at a daily maintenance dosage of 1.25 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1 75mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.75 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.25 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.1 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.2 mg per day taken once daily.
  • Siponimod is administered at a daily maintenance dosage of 0.3 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.4 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.6 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.7 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.8 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 0.9 mg per day taken once daily.
  • Siponimod is administered at a daily maintenance dosage of 1.1 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.2 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.3 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.4 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.6 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.7 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.8 mg per day taken once daily. In one embodiment of the present application, Siponimod is administered at a daily maintenance dosage of 1.9 mg per day taken once daily.
  • Siponimod administration is initiated via a plurality of titration doses in a titration regimen.
  • the titration regimen includes a stepwise increase in the dose of Siponimod.
  • the dose of Siponimod on any given day is ⁇ 40% the combined dose of the previous two days (except for Day 1, as no dose would have been given prior to Day 1).
  • the dose of Siponimod on any given day is ⁇ 30% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1).
  • the dose of Siponimod on any given day is ⁇ 50% the combined dose of the previous two days (except for Day 1, as no dose would have been given prior to Day 1). In some embodiments, the dose of Siponimod on any given day is ⁇ 20% the combined dose of the previous two days (except for Day 1, as no dose would have been given prior to Day 1). In some embodiments, the dose of Siponimod on any given day is ⁇ 10% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ).
  • the titration regimen includes 1 day. In some embodiments, the titration regimen includes 2 days. In some embodiments, the titration regimen includes 3 days. In some embodiments, the titration regimen includes 4 days. In some embodiments, the titration regimen includes 5 days. In some embodiments, the titration regimen includes 6 days. In some embodiments, the titration regimen includes 7 days. In some embodiments, the titration regimen includes 8 days. In some embodiments, the titration regimen includes 9 days. In some embodiments, the titration regimen includes 10 days. In some embodiments, the titration regimen includes 11 days. In some embodiments, the titration regimen includes 12 days. In some embodiments, the titration regimen includes 13 days. In some embodiments, the titration regimen includes 14 days.
  • the titration regimen is as follows: on Day 1, the titration dose is 0.25mg taken once; on Day 2, the titration dose is 0.25mg taken once; on Day 3, the titration dose is 0.25mg taken twice for a total of 0.5mg; on Day 4, the titration dose is 0.25mg taken three times for a total of 0.75mg; on Day 5, the titration dose is 0.25mg taken five times for a total of 1.25mg.
  • the plurality of titration doses are restarted with Day 1 of the titration regimen.
  • the titration regimen is as follows: on Day 1 , the titration dose is 0.25mg taken once; on Day 2, the titration dose is 0.25mg taken once; on Day 3, the titration dose is 0.25mg taken twice for a total of 0.5mg; on Day 4, the titration dose is 0.25mg taken three times for a total of 0.75mg. In some embodiments of the present application, if one titration dose is missed for more than 24 hours, the plurality of titration doses are restarted with Day 1 of the titration regimen.
  • Siponimod administration is initiated via a plurality of loading doses in a loading regimen.
  • the loading regimen includes a stepwise increase in the dose of Siponimod.
  • the dose of Siponimod on any given day is ⁇ 40% the combined dose of the previous two days (except for Day 1, as no dose would have been given prior to Day 1).
  • the dose of Siponimod on any given day is ⁇ 30% the combined dose of the previous two days (except for Day 1, as no dose would have been given prior to Day 1).
  • the dose of Siponimod on any given day is ⁇ 50% the combined dose of the previous two days (except for Day 1, as no dose would have been given prior to Day 1). In some embodiments, the dose of Siponimod on any given day is ⁇ 20% the combined dose of the previous two days (except for Day 1, as no dose would have been given prior to Day 1). In some embodiments, the dose of Siponimod on any given day is ⁇ 10% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ). [0030] In some embodiments, the loading regimen includes 1 day. In some embodiments, the loading regimen includes 2 days. In some embodiments, the loading regimen includes 3 days.
  • the loading regimen includes 4 days. In some embodiments, the loading regimen includes 5 days. In some embodiments, the loading regimen includes 6 days. In some embodiments, the loading regimen includes 7 days. In some embodiments, the loading regimen includes 8 days. In some embodiments, the loading regimen includes 9 days. In some embodiments, the loading regimen includes 10 days. In some embodiments, the loading regimen includes 11 days. In some embodiments, the loading regimen includes 12 days. In some embodiments, the loading regimen includes 13 days. In some embodiments, the loading regimen includes 14 days.
  • a titration regimen as described herein is followed by a loading regimen as described herein, which is then followed by a maintenance regimen as described herein.
  • the method of treatment before initiating the titration regimen, includes identifying a patient at risk for contracting an infection.
  • the infection is caused by a bacteria, fungus, or virus.
  • the infection is caused by a bacteria or virus selected from the group consisting of varicella zoster virus, adenovirus, bacillus anthracis (anthrax), vibrio cholerae (cholera), corynebacterium diphtheriae (diphtheria), hepatitis A, hepatitis B, haemophilus influenzae type b, human papillomavirus, seasonal influenza, japanese encephalitis, measles, Neisseria meningitidis (meningococcal), mumps rubulavirus (mumps), bordetella pertussis (whooping cough), pneumococcal, poliovirus (polio), rabies, rotavirus, rubella, variola major and minor (smallpox), Clostridium tetani (tetanus), mycobacterium tuberculosis (tuberculosis), salmonella enterica (ta bacteria or virus selected from the
  • identifying a patient at risk for contracting an infection includes testing a blood sample of the patient for the presence of antibodies to a pathogen causing the infection. In some embodiments, identifying a patient at risk for contracting an infection includes administering a serologic IgA, IgG, IgM, IgE, and/or IgD test. In some embodiments of the present application, identifying a patient at risk for contracting an infection includes a Radioimmunoassay (RIA). In some embodiments of the present application, identifying a patient at risk for contracting an infection includes an enzyme immunoassay (EIA).
  • EIA enzyme immunoassay
  • identifying a patient at risk for contracting an infection includes a fluorescent immunoassay (FIA).
  • identifying a patient at risk for contracting an infection includes a chemiluminescent immunoassay (CLIA).
  • the CLIA assay includes an alkaline phosphate, galactosidase, glucose oxidase, glucose-6-phosphate dehydrogenase, b-N-acetylglucosaminidase, peroxidase, invertase, and/or xanthine oxidase label.
  • the pathogen is varicella zoster virus.
  • identifying a patient at risk for contracting an infection includes a polymerase chain reaction (PCR) assay.
  • the PCR assay screens for DNA or RNA associated with a pathogen.
  • identifying a patient at risk for contracting an infection includes testing saliva of a patient using one of the aforementioned techniques.
  • saliva may be obtained using a buccal swab or by spitting.
  • saliva may be analyzed using one of the aforementioned techniques, including Radioimmunoassay (RIA), enzyme immunoassay (EIA), fluorescent immunoassay (FIA), and/or chemiluminescent immunoassay (CLIA).
  • RIA Radioimmunoassay
  • EIA enzyme immunoassay
  • FIA fluorescent immunoassay
  • CLIA chemiluminescent immunoassay
  • the method of treatment includes vaccinating the at-risk patient to prevent the infection from occurring.
  • the vaccine is a recombinant vaccine.
  • the vaccine is a live attenuated vaccine.
  • the vaccine is an inactivated vaccine.
  • the vaccine is a subunit vaccine,
  • the vaccine is a polysaccharide vaccine.
  • the vaccine is a conjugate vaccine.
  • the vaccine is a toxoid vaccine.
  • the vaccine is a nucleic acid vaccine.
  • the vaccine is a vaccine against an infection is caused by a bacteria, fungus, or virus.
  • the vaccine is against a bacteria or virus selected from the group consisting of varicella zoster virus, adenovirus, bacillus anthracis (anthrax), vibrio cholerae (cholera), corynebacterium diphtheriae (diphtheria), hepatitis A, hepatitis B, haemophilus influenzae type b, human papillomavirus, seasonal influenza, japanese encephalitis, measles, Neisseria meningitidis (meningococcal), mumps rubulavirus (mumps), bordetella pertussis (whooping cough), pneumococcal, poliovirus (polio), rabies, rotavirus, rubella, variola major and minor (smallpox), Clostridium tetani
  • the vaccine comprises a varicella zoster virus gE antigen.
  • the vaccine comprises a truncated varicella zoster virus gE antigen.
  • the vaccine comprises a truncated varicella zoster virus gE antigen, in which the antigen is a C-terminal truncate.
  • the vaccine comprises a live-attenuated varicella zoster antigen.
  • the vaccine comprises an adjuvant system.
  • the adjuvant system includes aluminum, aluminum salts, virosomes, squalene, MF59, vitamin E, ISA51, Lipid A, MPL, 3D-MPL, LPS, RC-529, GLA, E6020, ONO-4007, aminoalkyl glucosamine-4-phosphates, CRX-527, CRX-547, CRX-601 , GSK1795091, SLA, PHAD, 3D-PHAD, 3D-(6-acyl)-PHAD, OM- 294, OM-174, OK-432, IL-1, IL-2, IL-12, CpG 7909, Freund’s adjuvant, Quil-A, QS- 21, QS-7, compounds obtained or isolated from the bark of Quillaja, or combinations thereof.
  • the adjuvant system of the present application includes MPL and QS-21.
  • the adjuvant system of the present application includes MPL and QS-21.
  • the adjuvant system includes a liposome.
  • the liposome includes amphiphilic lipids.
  • the liposome includes phospholipids.
  • the adjuvant system contains an oil in water emulsion.
  • the adjuvant system includes a salt of the adjuvant.
  • the vaccine is administered as a single dose.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 99% within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 28 days.
  • the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 28 days.
  • the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 28 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 28 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 21 days.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 7 days.
  • a patient receiving a treatment regimen as described herein may therefore accelerate the start of the initial dosing regimen of Siponimod as compared to the current state of the art.
  • the patient may receive a vaccine against the infection and still commence treatment with Siponimod within 30, 28, 21, 14, or 7 days, unlike the current state of the art.
  • screening a patient for risk of contracting an infection can take from several days to a week. Because the patient may commence Siponimod after receiving a vaccination very quickly according to embodiments of the present application, in some instances it is is not necessary to screen the patient for risk of contracting an infection before administering the vaccine. In this way, the patient may accelerate the start of the initial dosing regimen of Siponimod and decrease their infection risk as compared to the current state of the art.
  • the patient may receive a vaccine against varicella zoster virus without being screened to identify risk of contracting a VZV infection. Because the VZV vaccine of the present application is highly-effective at a single dose within a short period of time, the patient is able to commence a Siponimod regimen relatively quickly as compared to other treatment regimes.
  • the patient is administered a test to screen for the risk of contracting an infection.
  • the patient Before the results of the test are obtained, the patient is vaccinated against the infection.
  • the patient may begin treatment with the S1P receptor modulator or agonist, e.g. Siponimod, immediately. If the patient is not immune to the infection, however, the patient begins treatment with the S1 P receptor modulator or agonist, e.g. Siponimod, once the vaccine has taken effect, i.e. , the patient has become immune to the infection or has substantially reduced the risk of infection as a result of the vaccine.
  • the S1P receptor modulator or agonist e.g. Siponimod
  • kits include a first agent which is a vaccine against an infection, and a second agent which is Siponimod.
  • the vaccine against the infection is a vaccine against varicella zoster virus as described herein.
  • the Siponimod comprises a plurality of doses of Siponimod.
  • the plurality of doses includes the titration regimen as described herein.
  • the plurality of doses includes one or more 2 mg doses of Siponimod.

Abstract

La présente invention concerne un régime posologique d'un modulateur ou d'un agoniste du récepteur S1P dans le cadre du traitement de patients souffrant d'une maladie ou d'un trouble inflammatoire ou auto-immun, par exemple la sclérose en plaques (MS). Par l'administration d'un modulateur ou d'un agoniste du récepteur S1P selon le régime posologique spécifique, il est possible de traiter efficacement le patient tout en contrôlant, réduisant ou éliminant d'éventuels événements indésirables, par exemple une infection, la récurrence d'une infection, ou la réactivation d'une infection latente, qui peut être associée à l'administration d'un tel composé.
PCT/US2021/016703 2020-02-07 2021-02-05 Traitement et régime posologique pour modulateur du récepteur s1p WO2021158843A1 (fr)

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