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WO2021158845A1 - Traitement et régime posologique pour modulateur du récepteur s1p - Google Patents

Traitement et régime posologique pour modulateur du récepteur s1p Download PDF

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WO2021158845A1
WO2021158845A1 PCT/US2021/016705 US2021016705W WO2021158845A1 WO 2021158845 A1 WO2021158845 A1 WO 2021158845A1 US 2021016705 W US2021016705 W US 2021016705W WO 2021158845 A1 WO2021158845 A1 WO 2021158845A1
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vaccine
infection
present application
patient
days
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Jeffrey R. GARDNER
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Argentum Pharmaceuticals LLC
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Argentum Pharmaceuticals LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/13—Amines
    • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
    • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/397—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having four-membered rings, e.g. azetidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4245—Oxadiazoles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/425—Thiazoles
    • A61K31/426—1,3-Thiazoles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals

Definitions

  • the present invention relates to kits for an S1P receptor modulator or agonist for the treatment of patients suffering from an inflammatory or autoimmune disease or disorder, for example multiple sclerosis (MS).
  • MS multiple sclerosis
  • Multiple sclerosis is an autoimmune disorder or disease which results in the demyelination of the insulating cover nerve cells in the brain and spinal cord.
  • the damage disrupts the ability of parts of the central nervous system to transmit and receive signals.
  • the disruption in signaling often causes physical, mental, and psychiatric problems. While the underlying mechanism of action remains unknown, multiple sclerosis is thought to be caused by destruction by the immune system of either myelin itself or myelin-producing cells.
  • Multiple sclerosis is the chief cause of neurological disability in young adults and the most common demyelinating disorder of the central nervous system.
  • Available therapies such as interferon-b and glatiramer acetate have modest efficacy and marginal effects on the progression of disability.
  • These biological agents are administered parenterally and are associated, e.g., with injection site reactions and pyretic symptoms, such as flu-like symptoms.
  • Sphingosine-1 -phosphate (S1P) receptor modulators are a class of drugs used as immunomodulators, for example for the treatment of autoimmune disorders or diseases such as multiple sclerosis (MS).
  • Suphingosine-1-phospate (S1P) is a signaling sphingolipid which binds with several S1P receptors, e.g. S1P Receptor 1 (S1PR1) to S1P Receptor 5 (S1PR5).
  • S1P interaction with S1PR1 (a G-protein-coupled S1P receptor) is needed for the egress of immune cells from the lymphoid organs (such as thymus and lymph nodes) into the lymphatic vessels.
  • S1 P receptor modulators impact the ability of S1 P to bind with S1 PR1 through S1 PR8.
  • S1 PR1 based on interaction with S1 PR1 , it is believed such compounds modulate the release of certain lymphoid immune cells, which can ultimately reach the central nervous system.
  • Fingolimod is believed to cause the internalization of S1 P receptors, including S1 PR1 , which sequesters lymphocytes in the lymph nodes, preventing them from moving to the central nervous system and causing a relapse of multiple sclerosis.
  • Fingolimod efficacy in the treatment of multiple sclerosis (MS) has been shown in humans (e.g. as described in “FTY720 therapy exerts differential effects on T call subsets in multiple sclerosis”.
  • VZV Varicella zoster virus
  • a zoster virus is a human virus belonging to the a- herpesvirus family. VZV is present worldwide and is highly infectious. Primary infection leads to acute varicella or “chickenpox,” usually from exposure either through direct contact with a skin lesion or through airborne spread from respiratory droplets. (Sawyer MH, Chamberlin CJ, Wu YN, Aintablian N, Wallace MR, Detection of varicella-zoster virus DNA in air samples from hospital rooms, 169 J Infect Dis.
  • VZV After initial infection, VZV establishes lifelong latency in cranial nerve and dorsal root ganglia, and can reactivate years to decades later as herpes zoster (HZ) or “shingles.”
  • HZ herpes zoster
  • shingles Herpes zoster
  • VZV Varicella Zoster Virus
  • infections in individuals undergoing immunomodulating treatments can be particularly severe.
  • VZV infection has caused the death of clinical trial participants while the participants were undergoing treatment involving an immunomodulating agent (e.g. Arvin at al., “Varicella-Zoster Virus Infections in Patients Treated With Fingolimod,” JAMA Neurol. Author manuscript; available in PMC 2017 Apr 13.).
  • an immunomodulating agent e.g. Arvin at al., “Varicella-Zoster Virus Infections in Patients Treated With Fingolimod,” JAMA Neurol. Author manuscript; available in PMC 2017 Apr 13.
  • the possibility of infection, recurrence of prior infection, or reactivation of a latent infection can result in medical providers recommending against treatment, or in at-risk patients declining or delaying treatment, for certain diseases or disorders, including autoimmune disorders (e.g. multiple sclerosis).
  • Barriers to effective healthcare that limit or delay the ability to receive adequate treatment include the absence of healthcare facilities in rural areas, tribal reservations, or other locations distant from treatment centers, laboratories, clinicians, or specialists.
  • kits which lower or eliminate the barriers to effective healthcare and/or accelerate the ability of patients to receive medical interventions, including interventions that involve S1P receptor modulators or agonists.
  • kits addressing these needs. Surprisingly, it has been found that by administering a S1 P receptor modulator or agonist, such as Siponimod, Fingolimod, Ozanimod, Ponesimod, and Ceralifimod, using kits according to the present application, it is possible to accelerate treatment for patients having barriers to receiving effective or adequate medical treatment. These kits permit fast and efficient treatment while controlling, reducing, or eliminating possible adverse events, e.g. infection, recurrence of infection, or reactivation of latent infection, which may be associated with administration of such a compound.
  • a S1 P receptor modulator or agonist such as Siponimod, Fingolimod, Ozanimod, Ponesimod, and Ceralifimod
  • kits provided according to the present application are applicable for patients who are presently undergoing treatment for an inflammatory or autoimmune or disease or disorder, for example under treatment for multiple sclerosis, as well as patients who were never treated or were not diagnosed for an inflammatory or autoimmune or disease before taking a S1 P receptor modulator or agonist.
  • kits according to the present application include a dosage regimen for a S1 P receptor modulator or agonist therapy, which enables administration of a therapeutic dosage range of the S1 P receptor to be achieved with controlled or minimal side effects, which could otherwise have been possibly associated with S1 P receptor modulator therapy.
  • the present application encompasses S1 P receptor modulators, agonists, and antagonists.
  • the S1 P receptor modulators, agonists, and antagonists are compounds as described in U.S. Patent 5,604,229, U.S. Patent 8,324,283, U.S. Patent 7,939,519, U.S. Patent 8,492,441 .
  • the S1 P receptor modulator, agonist, or antagonist is FTY720 (Fingolimod), MT1303 (Amiselimod), ACT-128800 (Ponesimod), BAF312 (Siponimod), RPC1063 (Ozanimod), GSK20 18682, CYM-5442, ONO-4641 (Ceralifimod), AUY954, SEW-2871 , CS-0777 ((R)-1-(5-(3-amino-4-hydroxy-3-methylbutyl)-1 -methyl-1 H-pyrrol-2-yl)-4-(p- tolyl)butan-1-one), Syl930, AAL-R ((R)-2-amino-4-(4-heptyloxyphenyl)-2- methylbutanol), RP-001 (N-[4-[5-[3-Cyano-4-(1-methylethoxy)phenyl]-1 ,
  • the S1 P receptor modulator is Siponimod.
  • Siponimod may be referred to as by its lUPAC name, which is:
  • Siponimod may also be referred to by its trade name, MAYZENT.
  • Siponimod may also be referred to by the designation BAF-312.
  • Siponimod may also be referred to by chemical structure, shown below:
  • the S1 P receptor modulator is Fingolimod.
  • Fingolimod may be referred to as by its lUPAC name, which is:
  • Fingolimod may also be referred to by its trade name, GILENYA. In the present application, Fingolimod may also be referred to by the designation FTY720. [0023] In the present application, Fingolimod may also be referred to by chemical structure, shown below:
  • the S1P receptor modulator is Ozanimod.
  • Ozanimod may be referred to by its lUPAC name, which is:
  • Ozanimod may also be referred to by the designation RPC1063.
  • Ozanimod may also be referred to by chemical structure, shown below:
  • the S1P receptor modulator is Ponesimod.
  • Ponesimod may be referred to by its lUPAC name, which is:
  • Ponesimod may also be referred to by the designation ACT-128800.
  • Ponesimod may also be referred to by chemical structure, shown below:
  • the S1P receptor modulator is Ceralifimod.
  • Ceralifimod may be referred to by its lUPAC name, which is:
  • Ceralifimod may also be referred to by the designation ONO-4641.
  • Ceralifimod may also be referred to by chemical structure, shown below:
  • the present application encompasses the use of S1 P receptor modulators, including Siponimod, Fingolimod, Ozanimod, Ponesimod, and Ceralifimod, to treat autoimmune diseases or disorders.
  • autoimmune diseases and disorders preferably include chronic long term diseases, e.g. multiple sclerosis (MS), for example relapsing remitting multiple sclerosis (RRMS) or primary progressive multiple sclerosis (PPMS).
  • MS takes several forms, with new symptoms occurring either in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms).
  • the dosing regimens and methods of treatment according to the present invention are particularly adapted for multiple sclerosis, e.g. RRMS.
  • the infection is caused by a bacteria, fungus, or virus.
  • the infection is caused by a bacteria or virus selected from the group consisting of varicella zoster virus, adenovirus, bacillus anthracis (anthrax), vibrio cholerae (cholera), corynebacterium diphtheriae (diphtheria), hepatitis A, hepatitis B, haemophilus influenzae type b, human papillomavirus, seasonal influenza, japanese encephalitis, measles, Neisseria meningitidis (meningococcal), mumps rubulavirus (mumps), bordetella pertussis (whooping cough), pneumococcal, poliovirus (polio), rabies, rotavirus, rubella, variola major and minor (smallpox), Clostridium tetani (t)
  • a kit includes a first agent which includes a test for determining a patient’s risk.
  • the test includes testing a blood sample of the patient for the presence of antibodies to a pathogen causing the infection.
  • the test includes a serologic IgA, IgG, IgM, IgE, and/or IgD test.
  • the test includes a Radioimmunoassay (RIA).
  • the test includes an enzyme immunoassay (EIA).
  • the test includes a fluorescent immunoassay (FIA)
  • the test includes a chemiluminescent immunoassay (CLIA).
  • the CLIA assay includes an alkaline phosphate, galactosidase, glucose oxidase, glucose-6-phosphate dehydrogenase, b-N-acetylglucosaminidase, peroxidase, invertase, and/or xanthine oxidase label.
  • identifying a patient at risk for contracting an infection includes screening for pathogen-specific CD4 and/or CD8 cells.
  • the pathogen is varicella zoster virus.
  • identifying a patient at risk for contracting an infection includes a polymerase chain reaction (PCR) assay.
  • the PCR assay screens for DNA or RNA associated with a pathogen.
  • identifying a patient at risk for contracting an infection includes testing saliva of a patient using one of the aforementioned techniques.
  • saliva may be obtained using a buccal swab or by spitting.
  • saliva may be analyzed using one of the aforementioned techniques, including Radioimmunoassay (RIA), enzyme immunoassay (EIA), fluorescent immunoassay (FIA), and/or chemiluminescent immunoassay (CLIA).
  • RIA Radioimmunoassay
  • EIA enzyme immunoassay
  • FIA fluorescent immunoassay
  • CLIA chemiluminescent immunoassay
  • the kit includes a CLIA directed to antibodies associated with a specific infection.
  • the infection is varicella zoster virus.
  • the presence of antibodies to varicella zoster virus in a patient’s blood indicates the patient is at a lower risk of varicella zoster virus infection.
  • the kit includes a buccal swap or a vessel for collecting saliva from spitting.
  • saliva obtained from the buccal swab or the vessel is analyzed by an assay included in the kit, e.g. a Radioimmunoassay (RIA), enzyme immunoassay (EIA), fluorescent immunoassay (FIA), and/or chemiluminescent immunoassay (CLIA).
  • RIA Radioimmunoassay
  • EIA enzyme immunoassay
  • FIA fluorescent immunoassay
  • CLIA chemiluminescent immunoassay
  • CLIA is capable of modulating an amount of light produced by the assay in the presence or absence of a specific antibody or antigen.
  • the CLIA assay emits photons when in the presence of the specific target.
  • the CLIA assay is highly sensitive, develops quickly, and is easy to read by a physician. Accordingly, care providers in remote areas can utilize CLIA, or other tests according to the present application, to rapidly assess the risk of infection or identify a patient at risk of infection prior to beginning treatment with Siponimod, Fingolimod, Ozanimod, Ponesimod, or Ceralifimod.
  • the kit includes a second agent.
  • the second agent is a vaccine against an infection for which the patient is identified as having some risk to contract.
  • the vaccines of the present application can rapidly induce an immune response in a subject, it would not necessarily be required to first assess a patient’s individual risk before administering a vaccine.
  • the vaccine is a recombinant vaccine.
  • the vaccine is a live attenuated vaccine.
  • the vaccine is an inactivated vaccine.
  • the vaccine is a subunit vaccine,
  • the vaccine is a polysaccharide vaccine.
  • the vaccine is a conjugate vaccine.
  • the vaccine is a toxoid vaccine.
  • the vaccine is a nucleic acid vaccine.
  • the vaccine is a vaccine against an infection is caused by a bacteria, fungus, or virus.
  • the vaccine is against a bacteria or virus selected from the group consisting of varicella zoster virus, adenovirus, bacillus anthracis (anthrax), vibrio cholerae (cholera), corynebacterium diphtheriae (diphtheria), hepatitis A, hepatitis B, haemophilus influenzae type b, human papillomavirus, seasonal influenza, japanese encephalitis, measles, Neisseria meningitidis (meningococcal), mumps rubulavirus (mumps), bordetella pertussis (whooping cough), pneumococcal, poliovirus (polio), rabies, rotavirus, rubella, variola major and minor (smallpox), Clostridium tetani (tetanus), mycobacterium tuberculosis (tuberculosis), salmonella enterica (ty
  • the vaccine comprises a varicella zoster virus gE antigen.
  • the vaccine comprises a truncated varicella zoster virus gE antigen.
  • the vaccine comprises a truncated varicella zoster virus gE antigen, in which the antigen is a C-terminal truncate.
  • the vaccine comprises a live-attenuated varicella zoster antigen.
  • the vaccine comprises an adjuvant system.
  • the adjuvant system includes aluminum, aluminum salts, virosomes, squalene, MF59, vitamin E, ISA51 , Lipid A, MPL, 3D-MPL, LPS, RC-529, GLA, E6020, ONO-4007, aminoalkyl glucosamine-4-phosphates, CRX- 527, CRX-547, CRX-601 , GSK1795091 , SLA, PHAD, 3D-PHAD, 3D-(6-acyl)-PHAD, OM-294, OM-174, OK-432, IL-1 , IL-2, IL-12, CpG 7909, Freund’s adjuvant, Quil-A, QS-21 , QS-7, compounds obtained or isolated from the bark of Quillaja, or combinations thereof.
  • the adjuvant system of the present application includes MPL and
  • the adjuvant system includes a liposome.
  • the liposome includes amphiphilic lipids.
  • the liposome includes phospholipids.
  • the adjuvant system contains an oil in water emulsion.
  • the adjuvant system includes a salt of the adjuvant.
  • the vaccine is administered as a single dose.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 30 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 30 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 28 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 28 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 28 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 28 days.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 14 days.
  • the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 7 days.
  • the kit comprises one or more doses of Siponimod, Fingolimod, Ozanimod, Ponesimod, or Ceralifimod.
  • the kit comprises a plurality of doses of Siponimod, Fingolimod, Ozanimod, Ponesimod, or Ceralifimod.
  • the plurality of doses includes a loading or titration or loading regimen as described herein below.
  • the plurality of doses includes one or more doses of Siponimod, Fingolimod, Ozanimod, Ponesimod, or Ceralifimod.
  • kits of the present application permit rapid assessment of risk (if needed), vaccination against said risk, thus accelerating a course of treatment of an S1 P receptor modulator or agonist, such as Siponimod, Fingolimod, Ozanimod, Ponesimod, or Ceralifimod.
  • an S1 P receptor modulator or agonist such as Siponimod, Fingolimod, Ozanimod, Ponesimod, or Ceralifimod.
  • a provider having a kit of the present application could assess whether a patient having multiple sclerosis (e.g. RRMS) is at risk of contracting an infection in less than a day, and, if necessary, administer the appropriate vaccination the same day.
  • RRMS multiple sclerosis
  • the vaccines of the present application provide superior efficacy, it is possible to start the patient on Siponimod, Fingolimod, Ozanimod, Ponesimod, or Ceralifimod in approximately 7, 14, 21 , 28, or 30 days, rather than the much longer time period it currently would take to do so.
  • the dosing regimens and methods of treatment according to the present invention are particularly adapted for multiple sclerosis, e.g. RRMS.
  • an S1 P modulator, agonist, or antagonist is administered daily. In one embodiment of the present application the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 2 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.5 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1.5 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1.25 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 75mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.75 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.25 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.1 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.2 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.3 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.4 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.6 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.7 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.8 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.9 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .1 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .2 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .3 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .4 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .6 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .7 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .8 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 1 .9 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 5 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 10 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 15 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 20 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 25 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 30 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 35 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 40 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 45 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 50 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.01 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.025 mg per day taken once daily. In one embodiment of the present application, the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.05 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist is administered at a daily maintenance dosage of 0.1 mg per day taken once daily.
  • the S1 P modulator, agonist, or antagonist administration is initiated via a plurality of titration doses in a titration regimen.
  • the titration regimen includes a stepwise increase in the dose of The S1 P modulator, agonist, or antagonist.
  • the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 40% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ).
  • the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 30% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ). In some embodiments, the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 50% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1). In some embodiments, the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 20% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ). In some embodiments, the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 10% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ).
  • the titration regimen includes 1 day. In some embodiments, the titration regimen includes 2 days. In some embodiments, the titration regimen includes 3 days. In some embodiments, the titration regimen includes 4 days. In some embodiments, the titration regimen includes 5 days. In some embodiments, the titration regimen includes 6 days. In some embodiments, the titration regimen includes 7 days. In some embodiments, the titration regimen includes 8 days. In some embodiments, the titration regimen includes 9 days. In some embodiments, the titration regimen includes 10 days. In some embodiments, the titration regimen includes 11 days. In some embodiments, the titration regimen includes 12 days. In some embodiments, the titration regimen includes 13 days. In some embodiments, the titration regimen includes 14 days.
  • the S1 P modulator, agonist, or antagonist administration is initiated via a plurality of loading doses in a loading regimen.
  • the loading regimen includes a stepwise increase in the dose of The S1 P modulator, agonist, or antagonist.
  • the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 40% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ).
  • the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 30% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ). In some embodiments, the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 50% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1). In some embodiments, the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 20% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ). In some embodiments, the dose of The S1 P modulator, agonist, or antagonist on any given day is ⁇ 10% the combined dose of the previous two days (except for Day 1 , as no dose would have been given prior to Day 1 ).
  • the loading regimen includes 1 day. In some embodiments, the loading regimen includes 2 days. In some embodiments, the loading regimen includes 3 days. In some embodiments, the loading regimen includes 4 days. In some embodiments, the loading regimen includes 5 days. In some embodiments, the loading regimen includes 6 days. In some embodiments, the loading regimen includes 7 days. In some embodiments, the loading regimen includes 8 days. In some embodiments, the loading regimen includes 9 days. In some embodiments, the loading regimen includes 10 days. In some embodiments, the loading regimen includes 11 days. In some embodiments, the loading regimen includes 12 days. In some embodiments, the loading regimen includes 13 days. In some embodiments, the loading regimen includes 14 days.
  • a titration regimen as described herein is followed by a loading regimen as described herein, which is then followed by a maintenance regimen as described herein.
  • the method of treatment before initiating the titration regimen, includes identifying a patient at risk for contracting an infection.
  • the infection is caused by a bacteria, fungus, or virus.
  • the infection is caused by a bacteria or virus selected from the group consisting of varicella zoster virus, adenovirus, bacillus anthracis (anthrax), vibrio cholerae (cholera), corynebacterium diphtheriae (diphtheria), hepatitis A, hepatitis B, haemophilus influenzae type b, human papillomavirus, seasonal influenza, japanese encephalitis, measles, Neisseria meningitidis (meningococcal), mumps rubulavirus (mumps), bordetella pertussis (whooping cough), pneumococcal, poliovirus (polio), rabies, rotavirus, rubella, variola major and minor (smallpox), Clostridium tetani (tetanus), mycobacterium tuberculosis (tuberculosis), salmonella enterica (ta bacteria or virus selected from the
  • identifying a patient at risk for contracting an infection includes testing a blood sample of the patient for the presence of antibodies to a pathogen causing the infection. In some embodiments, identifying a patient at risk for contracting an infection includes administering a serologic IgA, IgG, IgM, IgE, and/or IgD test. In some embodiments of the present application, identifying a patient at risk for contracting an infection includes a Radioimmunoassay (RIA). In some embodiments of the present application, identifying a patient at risk for contracting an infection includes an enzyme immunoassay (EIA).
  • EIA enzyme immunoassay
  • identifying a patient at risk for contracting an infection includes a fluorescent immunoassay (FIA).
  • identifying a patient at risk for contracting an infection includes a chemiluminescent immunoassay (CLIA).
  • the CLIA assay includes an alkaline phosphate, galactosidase, glucose oxidase, glucose-6-phosphate dehydrogenase, b-N-acetylglucosaminidase, peroxidase, invertase, and/or xanthine oxidase label.
  • the pathogen is varicella zoster virus.
  • identifying a patient at risk for contracting an infection includes a polymerase chain reaction (PCR) assay.
  • the PCR assay screens for DNA or RNA associated with a pathogen.
  • identifying a patient at risk for contracting an infection includes testing saliva of a patient using one of the aforementioned techniques.
  • saliva may be obtained using a buccal swab or by spitting.
  • saliva may be analyzed using one of the aforementioned techniques, including Radioimmunoassay (RIA), enzyme immunoassay (EIA), fluorescent immunoassay (FIA), and/or chemiluminescent immunoassay (CLIA).
  • RIA Radioimmunoassay
  • EIA enzyme immunoassay
  • FIA fluorescent immunoassay
  • CLIA chemiluminescent immunoassay
  • the method of treatment includes vaccinating the at-risk patient to prevent the infection from occurring.
  • the vaccine is a recombinant vaccine.
  • the vaccine is a live attenuated vaccine.
  • the vaccine is an inactivated vaccine.
  • the vaccine is a subunit vaccine,
  • the vaccine is a polysaccharide vaccine.
  • the vaccine is a conjugate vaccine.
  • the vaccine is a toxoid vaccine.
  • the vaccine is a nucleic acid vaccine.
  • the vaccine is a vaccine against an infection is caused by a bacteria, fungus, or virus.
  • the vaccine is against a bacteria or virus selected from the group consisting of varicella zoster virus, adenovirus, bacillus anthracis (anthrax), vibrio cholerae (cholera), corynebacterium diphtheriae (diphtheria), hepatitis A, hepatitis B, haemophilus influenzae type b, human papillomavirus, seasonal influenza, japanese encephalitis, measles, Neisseria meningitidis (meningococcal), mumps rubulavirus (mumps), bordetella pertussis (whooping cough), pneumococcal, poliovirus (polio), rabies, rotavirus, rubella, variola major and minor (smallpox), Clostridium tetani
  • the vaccine comprises a varicella zoster virus gE antigen.
  • the vaccine comprises a truncated varicella zoster virus gE antigen.
  • the vaccine comprises a truncated varicella zoster virus gE antigen, in which the antigen is a C-terminal truncate.
  • the vaccine comprises a live-attenuated varicella zoster antigen.
  • the vaccine comprises an adjuvant system.
  • the adjuvant system includes aluminum, aluminum salts, virosomes, squalene, MF59, vitamin E, ISA51 , Lipid A, MPL, 3D-MPL, LPS, RC-529, GLA, E6020, ONO-4007, aminoalkyl glucosamine-4-phosphates, CRX- 527, CRX-547, CRX-601 , GSK1795091 , SLA, PHAD, 3D-PHAD, 3D-(6-acyl)-PHAD, OM-294, OM-174, OK-432, IL-1 , IL-2, IL-12, CpG 7909, Freund’s adjuvant, Quil-A, QS-21 , QS-7, compounds obtained or isolated from the bark of Quillaja, or combinations thereof.
  • the adjuvant system of the present application includes MPL and
  • the adjuvant system includes a liposome.
  • the liposome includes amphiphilic lipids.
  • the liposome includes phospholipids.
  • the adjuvant system contains an oil in water emulsion.
  • the adjuvant system includes a salt of the adjuvant.
  • the vaccine is administered as a single dose.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 99% within 30 days.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 28 days.
  • the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 28 days.
  • the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 28 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 28 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 21 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 21 days.
  • the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 14 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 90% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 95% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 98% in human adults within 7 days. In some embodiments, the single dose of the vaccine exhibits an efficacy of at least 99% within 7 days.
  • a patient receiving a treatment regimen as described herein may therefore accelerate the start of the initial dosing regimen of The S1 P modulator, agonist, or antagonist as compared to the current state of the art.
  • the patient may receive a vaccine against the infection and still commence treatment with The S1 P modulator, agonist, or antagonist within 30, 28, 21 , 14, or 7 days, unlike the current state of the art.
  • screening a patient for risk of contracting an infection can take from several days to a week.
  • the patient may commence The S1 P modulator, agonist, or antagonist after receiving a vaccination very quickly according to embodiments of the present application, in some instances it is not necessary to screen the patient for risk of contracting an infection before administering the vaccine. In this way, the patient may accelerate the start of the initial dosing regimen of The S1 P modulator, agonist, or antagonist and decrease their infection risk as compared to the current state of the art.
  • the patient may receive a vaccine against varicella zoster virus without being screened to identify risk of contracting a VZV infection.
  • the VZV vaccine of the present application is highly-effective at a single dose within a short period of time, the patient is able to commence a S1 P modulator, agonist, or antagonist regimen relatively quickly as compared to other treatment regimes.
  • the patient is administered a test to screen for the risk of contracting an infection.
  • the patient Before the results of the test are obtained, the patient is vaccinated against the infection.
  • the patient may begin treatment with the S1 P receptor modulator or agonist immediately. If the patient is not immune to the infection, however, the patient begins treatment with the S1 P receptor modulator or agonist once the vaccine has taken effect, i.e. , the patient has become immune to the infection or has substantially reduced the risk of infection as a result of the vaccine.

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Abstract

La présente invention concerne un kit comprenant un test, et/ou une ou plusieurs doses d'un modulateur ou d'un agoniste du récepteur S1P dans le cadre du traitement de patients souffrant d'une maladie ou d'un trouble inflammatoire ou auto-immun, par exemple la sclérose en plaques (MS). Par l'administration d'un modulateur ou d'un agoniste du récepteur S1P à l'aide de kits selon la présente invention, il est possible d'accélérer le traitement pour des patients ayant des difficultés à recevoir un traitement médical efficace ou adéquat.
PCT/US2021/016705 2020-02-07 2021-02-05 Traitement et régime posologique pour modulateur du récepteur s1p Ceased WO2021158845A1 (fr)

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Citations (6)

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US20050064516A1 (en) * 2003-09-18 2005-03-24 Kantor Aaron B. Biological markers for diagnosing multiple sclerosis
US20060121052A1 (en) * 2004-11-03 2006-06-08 Sotelo-Morales Julio E Recombinant vaccine from gE, gI, and gB proteins of the varicella-zoster virus for the treatment and prevention of multiple sclerosis
US20060172338A1 (en) * 2005-01-31 2006-08-03 Nir Dotan Method for diagnosing multiple sclerosis
US20170304289A1 (en) * 2014-10-16 2017-10-26 Novartis Ag Combinations comprising siponimod and laquinimod for the treatment of multiple sclerosis
US20170333418A1 (en) * 2011-10-12 2017-11-23 Teva Pharmaceutical Industries, Ltd. Treatment of multiple sclerosis with combination of laquinimod and fingolimod
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US20060121052A1 (en) * 2004-11-03 2006-06-08 Sotelo-Morales Julio E Recombinant vaccine from gE, gI, and gB proteins of the varicella-zoster virus for the treatment and prevention of multiple sclerosis
US20060172338A1 (en) * 2005-01-31 2006-08-03 Nir Dotan Method for diagnosing multiple sclerosis
US10543179B2 (en) * 2009-09-29 2020-01-28 Novartis Ag Dosage regimen of an S1P receptor modulator
US20170333418A1 (en) * 2011-10-12 2017-11-23 Teva Pharmaceutical Industries, Ltd. Treatment of multiple sclerosis with combination of laquinimod and fingolimod
US20170304289A1 (en) * 2014-10-16 2017-10-26 Novartis Ag Combinations comprising siponimod and laquinimod for the treatment of multiple sclerosis

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