Population Pharmacokinetics of Risankizumab in Healthy Volunteers and Subjects with Moderate to Severe Plaque Psoriasis: Integrated Analyses of Phase I–III Clinical Trials

• Published in: Clinical pharmacokinetics Vol. 58; no. 10; pp. 1309 - 1321
• Main Authors: Suleiman, Ahmed A., Minocha, Mukul, Khatri, Amit, Pang, Yinuo, Othman, Ahmed A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2019; Springer Nature B.V
• Subjects: Administration, Intravenous; Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal - blood; Antibodies, Monoclonal - pharmacokinetics; Bioavailability; C-Reactive Protein - analysis; Clinical trials; Creatinine - blood; Cytokines; Datasets; Drug dosages; Female; Healthy Volunteers; Humans; Injections, Subcutaneous; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Models, Biological; Monoclonal antibodies; Original; Original Research Article; Pharmacokinetics; Pharmacology/Toxicology; Pharmacotherapy; Plasma; Population; Psoriasis; Psoriasis - blood; Psoriasis - metabolism; Serum Albumin, Human - analysis; Young Adult; United States > US
• ISSN: 0312-5963; 1179-1926; 1179-1926
• DOI: 10.1007/s40262-019-00759-z

Background and Objective Risankizumab is an anti-interleukin (IL)-23 monoclonal antibody being developed for treatment of moderate to severe plaque psoriasis. This study provided a comprehensive analysis of risankizumab pharmacokinetics in healthy subjects and patients with plaque psoriasis using data across phase I–III clinical trials. Methods Plasma pharmacokinetic data from 1899 subjects, including 13,123 observations, who received single or multiple intravenous or subcutaneous doses of risankizumab (0.01–5 mg/kg intravenous [IV], 200–1200 mg IV, 0.25–1 mg/kg subcutaneous [SC], and 18–300 mg SC) across the phase I–III clinical program were analyzed using a non-linear mixed-effects modeling approach. The developed model was qualified and the clinical relevance of covariates statistically correlated with risankizumab clearance (CL) was evaluated using simulation analyses. Results Risankizumab pharmacokinetics were best described using a two-compartment model with first-order absorption and elimination. Risankizumab CL, volume of distribution at steady state ( V ss ), and terminal-phase elimination half-life ( t ½ ) were estimated to be approximately 0.31 L/day, 11.2 L, and 28 days, respectively, for a typical 90 kg psoriatic subject, approaching steady-state plasma exposures by week 16 of dosing. Absolute SC bioavailability ( F ) was 89%. Bodyweight, anti-drug antibody (ADA) titers ≥ 128 (detected in only 1% of ADA-evaluable subjects in phase III studies), baseline serum albumin, high-sensitivity C-reactive protein (hs-CRP), and serum creatinine were statistically correlated with risankizumab CL; however, they had no clinically relevant impact on exposure. Conclusion Risankizumab is characterized by dose-proportional, bi-exponential disposition with no difference in exposure between healthy subjects and patients with psoriasis. None of the covariates identified as being statistically correlated with risankizumab CL has a clinically meaningful impact on its exposure with the proposed psoriasis clinical regimen of 150 mg administered SC at weeks 0 and 4, and every 12 weeks thereafter. ClinicalTrials.gov Identifiers NCT01577550, NCT02054481, NCT02596217, NCT02684370, NCT02672852, NCT02684357, NCT02694523.