Combined Semi-mechanistic Target-Mediated Drug Disposition and Pharmacokinetic–Pharmacodynamic Models of Alirocumab, PCSK9, and Low-Density Lipoprotein Cholesterol in a Pooled Analysis of Randomized Phase I/II/III Studies

• DOI: 10.1007/s13318-022-00787-4
• Publication Date: 2022-08-16T16:03:08Z
• Authors: Patrick Nolain; Nassim Djebli; Aurélie Brunet; David Fabre; Sonia Khier
• Keywords: Alirocumab; PCSK9; Pharmacodynamics; Kexin

Alirocumab is a cholesterol-lowering monoclonal antibody targeting proprotein convertase subtilisin kexin type 9 (PCSK9) indicated in the prevention of cardiovascular risk and exhibiting target-mediated drug disposition (TMDD). The aim this work was to develop an integrated pharmacokinetic-pharmacodynamic model describe interaction alirocumab with PCSK9 its impact on evolution low-density lipoprotein cholesterol (LDL-C) levels explore labeling specification for subpopulations.Using data collected from nine phase I/II/III clinical studies (n = 527, subcutaneous or intravenous administration), TMDD considering quasi-steady-state approximation developed characterize dynamics PCSK9, combined indirect pharmacodynamic describing inhibition LDL-C by one-step approach using nonlinear-mixed effects modeling. A "full fixed modeling" strategy implemented quantify parameter-covariate relationships.The captures between target how mechanism drives depletion, estimation associated between-subject variability parameters quantification clinically relevant relationships. Co-administration statins found increase central volume distribution 1.75-fold (5.6 L versus 3.2 L) allow 14% greater maximum lipid-lowering effect (88% 74%), highlighting synergy action anti-PCSK9 therapeutic antibodies toward lowering plasma levels. Baseline were be related amplitude variations increasing concentration free necessary reach half capacity degradation.The achieved when close zero, as seen mostly after 150 mg every 2 weeks (Q2W) 300 4 (Q4W), indicating that there would no additional benefit dose higher than these recommended dosing regimens.