Amondys 45
casimersen · DMD exon 45 (PMO)In vitro only: human rhabdomyosarcoma cells and normal primary myoblasts
Leqvio: animal efficacy model or human cells?
inclisiran · PCSK9 (siRNA)
Efficacy evidence
PCSK9/LDL-C lowering in human PCSK9 transgenic mice and healthy NHPs
“Pharmacodynamic activity, measured as reduced PCSK9 levels and/or LDL-C lowering, was demonstrated in transgenic mice expressing human PCSK9 (hPCSK9) and in healthy non-human primates (NHPs).”
Why that model
Disease models judged of minimal value: PCSK9 target validated clinically by antibodies; species differences in cholesterol fractions
“In response to a request, the applicant clarified that in vivo studies in animal disease models of hypercholesterolemia would be of minimal impact to the understanding of inclisiran’s biology and pharmacology in human. The argumentation included among others the facts that use of PCSK9 antibodies in clinical practice has validated PCSK9 as a pharmacologic target for reducing LDL-C and that there are species differences in cholesterol fractions.”
Reviewer's view of the efficacy data
EMA: pharmacodynamics demonstrated in transgenic mice and monkeys; the four species used considered relevant
“Pharmacodynamics of inclisiran was demonstrated in transgenic mice and monkeys. The four animal species used for non-clinical studies, especially the general and reproductive toxicology studies, are considered relevant.”
Same question, other oligonucleotides
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 oligonucleotidesIn 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
Izervay
avacincaptad pegol · C5 (aptamer)In vitro and ex vivo complement functional assays plus in vivo complement inhibition in monkey
Kynamro
mipomersen · APOB (ASO)Species-specific surrogate apoB ASOs in mouse, hamster, rabbit and monkey lipid models (mouse atherosclerosis models)
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