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Dosage Determination from Preclinical
to Proof-of-Concept Trials,
(Including Toxicology)
Charlie Taylor, PhD
CpTaylor Consulting
Chelsea, MI, USA
Choosing Doses for POC:
• Preclinical and early studies that enable dose selection
• Reasons for drug failure in clinical phase 2-3
• Need to choose both low (ineffective) and high (maximum
tolerated) doses within dose range
• Biomarkers (one endpoint: animal → human translation)
• PK/PD modeling – EC50 as a target for efficacy or AEs
• Toxicology/toxicokinetics – daily AUC(0-24) as a limit
• Putting it together – visualizing multiple datasets
• Human population PK modeling – determine which doses
best fit the constraints
2
Sequence of Studies Needed
Prior to Clinical Proof-of-Concept
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• Preclinical in vitro studies: action at drug target (pharmacology)
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• Animal toxicology & toxicokinetic studies to identify safety issues
• Preclinical in vivo pain models: indicate treatment of disease
• Safety pharmacology: animal studies for adverse effects
• Preclinical (& human liver microsome) metabolism studies
• Clinical Phase I studies of pharmacokinetics and tolerance in healthy
human volunteers
• (Optional) Biomarker studies with both animal models and humans to
establish proof of pharmacology in vivo (apart from efficacy)
*
Requires in vivo unbound plasma drug concentration or daily
drug exposure to help choose human efficacy DOSES
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Drug Development Failures – UK ’64-’85
Efficacy
29%
PharmKin
39%
Other
Com
mer
c.
Adv.
Events
Toxicol. 10%
11%
Prentis et al. (1988) Brit J Clin Pharmacol 25:387-396
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Determine Initial Phase 2 Dose Range ??
• Clinical doses MUST encompass both low end (lack
of efficacy) and high end (maximum tolerance)
• Data from animal efficacy, animal safety, biomarker
and human tolerance ALL must be considered
• The peak unbound plasma drug concentration
(animal studies), daily exposure (AUC0-24 - tox) and
human multiple-dose PK each need consideration
• How to consider all these factors??
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One Approach: Biomarkers – Surrogate
HUMAN Endpoints for Efficacy
• Defines drug action in vivo
• Examples: Imaging, Adverse Event or Mechanism
• e.g. PET to measure receptor occupancy in CNS
• e.g. Nystagmus, dizziness, balance platform
• e.g. Experimental pain model w/ volunteers
• e.g. Electrographic response (EEG, retinogram, TMS)
Biomarkers Allow no-go decision prior to proof of
efficacy, for example:
• Poor oral drug absorption or lack of CNS penetration
• Lack of receptor occupancy at highest safe dose
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Hypothetical Human Biomarker:
• Criterion: 75% drug receptor occupancy in human brain @ high dose
• This criterion met at animal effective dose (animal PET study)
• Drug displacement of PET ligand in human brain:
18F-x-drugamine
given IV in tracer amount
• If greatest human volunteer dose of experimental drug reaches < 30%
occupancy, NO-GO
• If greatest human volunteer dose > 75% occupancy, GO (further
development)
• Caveat: Criteria must be selected based on results with a prior known
compound – Otherwise, risk of poor validation
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Toxicology Findings (non-pharmacology) are
Based on Daily Drug Exposure (AUC0-24)
• Repeated-dose animal tox studies determine lowest
toxic dose and greatest no-effect (daily) dose
• Toxicokinetics determine drug exposure (AUC0-24)
in mg•hr/mL at greatest no-effect dose
• e.g. Drug X has 8 hr half-life; Cmax and AUC are
determined from plasma drug samples taken 0, 1, 4, 7,
12, and 24 hr after single oral dose at steady-state
• Similar human pharmacokinetic data and PK modeling
determine human drug exposure (AUC0-24) @ doses
• Analysis is adjusted for different drug binding of
plasma proteins between species
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Calculation of Animal Drug Exposure Toxicokinetic AUC(0-24)
• Samples of drug in plasma of animal tox species
— Begin sampling after reaching repeated dose steady state
— Orange symbols are mean from n = 8
Dose =
50 mg/kg/day
Free Plasma Drug Conc. (mg/mL)
• Mathematical fit to curves of oral absorption & elimination
• Measure area under curve for 0-24 hr = Drug Exposure
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Cmax = 10.8 mg/mL
12
10
AUC(0-24) =
136 mg•hr/mL
8
6
4
2
0
0
4
8
12
16
Hr After Dose
20
24
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Measured Drug Exposure in Rat Tox Studies
Toxicokinetic Parameters in Multidose Oral Toxicity Studies
Species
Durat.
Dose
(mg/kg)
Plasma Concentration
(mg/mL)
Male
Rat
Gavage
500
1250
2500
2 Week
Diet
500
1250
2500
Female
AUC(0-24)
(mg·hr/mL)
Male
Female
13.5
27.6
47.4
9.92
25.2
40.7
120.0
332.0
626.0
102.0
334.0
602.0
11.5
25.9
50.7
10.7
19.0
32.4
199.0
491.0
921.0
181.0
336.0
606.0
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Tumor
Decr fetal wt
Rhinitis
Skin Sores
Leukopenia
Hypoactivity
Death
Animal Toxicology: Human Exposure Limits
Are Set by Daily Drug Exposure (AUC0-24)
100000
DOG
MOUSE
AUC(0-24)
RAT
10000
1000
100
No-Effect Dose Limit:
200 mg•hr/mL – determines maximum permissible human exposure
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Free Plasma Drug Conc. (nM)
(mg/mL)
PK Modeling of Drug in Human Plasma
(daily dosing of 50 mg oral)
Human Cmax Limit
based on Animal
Toxicology
(Max no-effect
dose AUC0-24)
100
10
AUC0-24
1
0 10 20 30 40 50 60 70 80 90 100 110 120
Time (hours)
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CYP2D6 Heterogeneity – Ca2+ Channel Blocker
Smith & Jones (1999) Curr Opin Drug Discov Devl 2:33-41
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Q: How to Predict Human Efficacious
and Adverse Drug Doses Based on
Animal Efficacy, Animal AEs and Human
Pharmacokinetic Data??
A: Compare plasma drug Cmax
obtained in animal pharmacology
tests using a Napiergram to human
Pharmacokinetic Cmax data
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“Napiergram”
• Named for John Napier of Merchistoun (aka
Marvelous Merchiston, Scotland)
• Inventor of Napier’s bones (slide rule),
popularization of logarithms and the decimal point
• Also: used a pet black rooster to tell fortunes and
devine truths
• Napiergram: graphic comparison
of log10 unbound plasma drug
concentrations associated with
pharmacology and with safety
concerns
John Napier (1550-1617)
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From Dose:Response experiments:
Obtain ED5, ED50, ED95
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Transform Pharmacology from ED50 to EC50
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liver tox
essure
decr blood p
r
ataxia (rotor
od)
on C
in vivo functi
on B
in vivo functi
on
on A
in vivo functi
Cmax = 2,500 nM
or 0.5 mg/mL
(unbound)
in vitro functi
receptor bin
d
ing
Napiergram: Many Pharmacology Datasets –
Animal Cmax for doses with 5% 50% & 95% effect
Cmin = 125 nM
or 0.026 mg/mL
(unbound)
Free Fraction (nM)
1000000
100000
10000
1000
100
10
1
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Free Plasma Drug Conc. (nM)
(mg/mL)
PK Modeling of Drug in Human Plasma
(daily dosing of 50 mg oral)
100
Cmax (hi dose)
10
Cmax (mid dose)
Animal Adverse
Limit
(EC50 for ataxia)
Actual Human
PK – mid dose
Cmax (low dose)
1
EC20 for
Efficacy in
Animal Model
0 10 20 30 40 50 60 70 80 90 100 110 120
Time (hours)
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Phase 2 Dose Selection (final chapter)
• Requires Deliberation from team of experts:
• Animal tox, Pharmacokinetics, PK/PD modeling, Clinical
research, Preclinical pharmacology, (Biomarkers)
• Who pays the clinical trial bills? Clinical Research
— Despite planning, dosage and regimen often are readjusted
during Phase 2 (toleration, efficacy or new safety findings)
— Dosages MUST continue to include both low (ineffective) and
maximal tolerated dosages to provide basis for FDA approval
— Dose toleration may vary between healthy volunteers and
patients with serious disease
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SUMMARY: Preclinical Studies to Determine
Phase 2 Dose Selection
• In vitro and in vivo animal pharmacology
– target Cmax for therapy and adverse effects
• Animal toxicology & toxicokinetic studies
– determines maximal human drug exposure (AUC0-24)
• Phase 1 Clinical trials
- determines human pharmacokinetics & drug exposure
• Napiergram – allows consideration of Cmax from
multiple animal datasets & compare to human PK
• Phase 2 dose adjustment is common!
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Example “Drug Killer” Problems
• Poor Oral Absorption (F < 25%)
• Poor Aqueous Solubility
• Poor Elimination Kinetics (t1/2 < 4 hr or t1/2 > 36 hr)
• Nonlinear Elimination Kinetics
(e.g. blocked clearance at high doses)
• Extensive metabolism to active or toxic compound
• Excessive plasma protein binding (> 99%)
PK
• Metabolism by variable CyP450 (CYP2D6, CYP2C19)
• Cardiac Q-T interval prolongation (hERG channel block)
• Genotoxic compound (Ames positive)
Tox
• Hepatic toxicity
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