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Atlas/Oligonucleotides/Izervay/Efficacy evidence

Izervay: animal efficacy model or human cells?

avacincaptad pegol · C5 (aptamer)
Efficacy evidence
In vitro and ex vivo complement functional assays plus in vivo complement inhibition in monkey
“Avacincaptad pegol has demonstrated complement inhibitory activity in several in vitro and ex vivo functional assays and in vivo in the monkey.”
✓ VerifiedFDA pharmacology/toxicology review, p. 7Source ↗
Why that model
Human C5-specific aptamer: monkey has 1/10th and rat 1/1000th of activity against human C5
“The monkey is the only species identified that could be considered relevant showing 1/10th of the ARC1905 in an in vitro activity assay against human C5. The rat has 1/1000th of the in vitro activity against human C5.”
✓ VerifiedFDA pharmacology/toxicology review, p. 35Source ↗
Reviewer's view of the efficacy data
FDA: monkey data imply ~10 µg/mL needed for complete C5 inhibition; clinical Cmax 68.3 ng/mL is over 140x lower
“Based on this fact, it seems we can assume plasma concentrations of approximately 10 μg/mL will be required in humans for complete C5 inhibition. The clinical Cmax was 68.3 ng/mL, over 140X lower than the estimated concentration for complete C5 inhibition.”
✓ VerifiedFDA pharmacology/toxicology review, p. 37Source ↗

Same question, other oligonucleotides

Amondys 45

casimersen · DMD exon 45 (PMO)
In vitro only: human rhabdomyosarcoma cells and normal primary myoblasts

Amvuttra

vutrisiran · TTR (siRNA)
hTTR V30M transgenic mice and cynomolgus monkeys: up to >=98% serum TTR reduction

Cyfendus

anthrax vaccine adsorbed, adjuvanted · TLR9 (CpG 7909 adjuvant)
Guinea pig and cynomolgus macaque lethal aerosolized B. anthracis spore challenge after two IM vaccinations

Dawnzera

donidalorsen · Prekallikrein / KLKB1 (ASO)
Mouse-specific surrogate ASO ISIS 482584 in five in vivo mouse vascular permeability studies

Defitelio

defibrotide · Fragmented DNA oligonucleotides
In vitro studies, primarily in a human microvascular endothelial cell line

Exondys 51

eteplirsen · DMD exon 51 (PMO)
Exon 51 skipping in human muscle cell cultures, DMD patient muscle explants, transgenic hDMD mice (IM) and cynomolgus monkey (IV)

Givlaari

givosiran · ALAS1 (siRNA)
Mouse and rat AIP disease models: givosiran prevented and reduced phenobarbital-induced ALA and PBG

Heplisav-B

hepatitis B vaccine (recombinant), adjuvanted · TLR9 (CpG 1018 adjuvant)
Anti-HBsAg immunogenicity of the adjuvanted vaccine in mice, rats and baboons

Kynamro

mipomersen · APOB (ASO)
Species-specific surrogate apoB ASOs in mouse, hamster, rabbit and monkey lipid models (mouse atherosclerosis models)

Leqvio

inclisiran · PCSK9 (siRNA)
PCSK9/LDL-C lowering in human PCSK9 transgenic mice and healthy NHPs

Macugen

pegaptanib · VEGF-165 (aptamer)
Mouse retinopathy of prematurity (hypoxia-induced retinal neovascularization), rat corneal pocket angiogenesis, guinea pig dermal permeability

Onpattro

patisiran · TTR (siRNA)
V30M/Hsf-1 KO mouse disease model (ALN-TTR01, same siRNA): 97-100% tissue TTR protein suppression

Oxlumo

lumasiran · HAO1 (siRNA)
Genetic PH1 mouse model (AGXT-/-): dose-dependent urinary oxalate reduction (~50% at 3 mg/kg)

Qalsody

tofersen · SOD1 (ASO)
Clinical molecule in transgenic human SOD1G93A mice and rats: SOD1 mRNA reduction; improved lifespan and rotarod in mouse

Qfitlia

fitusiran · Antithrombin / SERPINC1 (siRNA)
Hemophilia A and B knockout mice, genetic hemophilia A dog and antibody-induced hemophilia A monkey

Redemplo

plozasiran · APOC3 (siRNA)
Human ApoC-III transgenic (dyslipidemic) mouse, healthy cynomolgus monkey and dyslipidemic rhesus macaque

Rivfloza

nedosiran · LDHA (siRNA)
PH1 (Agxt knockout) and hydroxyproline-induced mouse models with mouse-active analog DCR-m355; LDHA knockdown in monkeys

Rytelo

imetelstat · Telomerase (oligo)
Xenograft mice with ovarian cancer and AML cell lines and paediatric AML patient-derived cells

Spinraza

nusinersen · SMN2 (ASO)
Transgenic SMA mouse models expressing human SMN2 (ICV and IT dosing)

Tegsedi

inotersen · TTR (ASO)
Transgenic mouse expressing human TTR Ile84Ser mutation and cynomolgus monkey (TTR mRNA/protein lowering)

Tryngolza

olezarsen · APOC3 (ASO)
Human apoC-III transgenic mice, wild-type CD-1 mice (mouse surrogate) and cynomolgus monkeys; primary hepatocytes in vitro

Viltepso

viltolarsen · DMD exon 53 (PMO)
DMD patient fibroblasts differentiated into myotubes: exon 53 skipping (EC50 0.63-2.3 µM) and dystrophin production

Vitravene

fomivirsen · CMV IE2 mRNA (ASO)
In vitro HCMV inhibition in primary human retinal pigment epithelial (RPE) cells

Vyondys 53

golodirsen · DMD exon 53 (PMO)
Rhabdomyosarcoma cells and immortalized and primary myoblasts from DMD patients; no in vivo exon 53 skipping study with golodirsen

Wainua

eplontersen · TTR (ASO)
Human mutant TTR (I84S) transgenic mice: hepatic hTTR mRNA and plasma TTR reduction

Waylivra

volanesorsen · APOC3 (ASO)
Fructose-fed hypertriglyceridemic rhesus monkeys dosed with volanesorsen (binding site 100% homologous)

Zanvastro

zilganersen · GFAP (ASO)
Transgenic mice overexpressing human GFAP (AxD-like features reduced); species surrogate ASO in rat AxD model

Summary across all 28 oligonucleotides →