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Hemlibra: what safety margin did regulators accept?

emicizumab · FIXa x FX
Safety margin at NOAEL
Monkey NOAEL (30 mg/kg, 26-week) ~11x human AUC at 3 mg/kg QW
“The NOAEL dose of 30 mg/kg in the 26-week study (1060134) resulted in a steady state AUC0−168h (AUC0−168h ss) exposure of 8680 µg.d/mL. This is approximately 11-fold above the clinical exposure in a 3 mg/kg QW dosing regimen which is the regimen that is anticipated to yield the highest exposure in patients.”
✓ VerifiedEMA assessment report, p. 35Source ↗
NOAEL / key findings
NOAEL 30 mg/kg/wk SC (26-week), ~11x clinical AUC; findings limited to injection-site reactions and aPTT shortening
“This is approximately 11-fold above the clinical exposure in a 3 mg/kg QW dosing regimen which is the regimen that is anticipated to yield the highest exposure in patients.”
✓ VerifiedEMA assessment report, p. 35Source ↗

Same question, other bispecifics

Blincyto

blinatumomab · CD19 x CD3
Chimpanzee exposure (Cmax 0.9-1.36 ng/mL) higher than human Css at 9 and 28 µg/day; no NOAEL or multiple stated

Columvi

glofitamab · CD20 x CD3
Monkey exposure below clinical: AUC multiples 0.03-0.28 in studies without obinutuzumab pretreatment

Elrexfio

elranatamab · BCMA x CD3
Monkey NOAEL/LOEL 0.3 mg/kg exposure well below human exposure (0.1x or 0.2x)

Epkinly

epcoritamab · CD20 x CD3
Monkey SC NOAEL 10 mg/kg: 5x clinical steady-state AUC; IV 1 mg/kg exposure equal to clinical AUC

Korjuny

catumaxomab · EpCAM x CD3
No margin: surrogate BiLu mouse NOAEL (0.2-3.0 µg/kg) equivalent to the clinical catumaxomab dose (1.43 µg/kg)

Lunsumio

mosunetuzumab · CD20 x CD3
No NOAEL; CRS and infections in monkeys at exposures 0.008-1.84x human AUC

Rybrevant

amivantamab · EGFR x MET
Monkey AUC at 120 mg/kg 5x human AUC at the 1050 mg clinical dose

Tecvayli

teclistamab · BCMA x CD3
Monkey NOEL 30 mg/kg IV weekly: 22x AUCtau, 48x Cmax vs human 1.5 mg/kg SC weekly

Vabysmo

faricimab · VEGF-A x Ang-2
Ocular NOAEL 0.5 mg/eye (6-month monkey): exposure margin only around 1x human

Ziihera

zanidatamab · HER2 x HER2 (biparatopic)
Monkey NOAEL 150 mg/kg: exposure ~10-fold above clinically relevant exposure

Bizengri

zenocutuzumab · HER2 x HER3
Not stated in public reviews

Imdelltra

tarlatamab · DLL3 x CD3
Not stated in public reviews

Kimmtrak

tebentafusp · CD3 x gp100 (TCR fusion)
Not stated in public reviews

Lynozyfic

linvoseltamab · BCMA x CD3
Not stated in public reviews

Ordspono

odronextamab · CD20 x CD3
Not stated in public reviews

Removab

catumaxomab · EpCAM x CD3
Not stated in public reviews

Talvey

talquetamab · GPRC5D x CD3
Not stated in public reviews

Summary across all 18 bispecifics →