Donanemab | ALZFORUM

in postmortem brain tissue from multitude with ad operating room down ‘s syndrome, donanemab bound to angstrom subset of roughly one-third of amyloid plaque, and strongly react with the plaque effect. information technology recognize vascular amyloid similarly to adenine pan-Aβ antibody. in brain tissue from ad mouse, the antibody detect intraneuronal Aβ ( Bouter et al., 2022 ). astatine the 2014 AAIC conference, Lilly report that ampere randomized preclinical analyze of combination therapy with N3pG and the BACE inhibitor LY2811376 clear more than eighty percentage of amyloid from the brain of PDAPP-transgenic mouse, compare to approximately fifty percentage headroom each for the respective monotherapies. Neuropathology study show that donanemab get rid of both core and soft plaque ( interpret Jul 2014 conference news program ). Donanemab, aka N3pG, be ampere humanize IgG1 monoclonal antibody antibody develop from mouse mE8-IgG2a. This biological drug greet Aβ ( p3-42 ), vitamin a pyroglutamate shape of Aβ that be aggregate indium starchlike brass. most Aβ antibody indiana remedy development bind versatile soluble operating room insoluble species merely have depleted affinity to lodge amyloid brass. The rationale buttocks donanemab be that target situate brass itself constitute necessary to clean existent amyloid burden from the genius, preferably than merely prevent deposition of new brass oregon emergence of exist brass. some former plaque-binding antibody get be abandon because they cause microhemorrhages in the brain. The mE8 antibody constitute report to net brass indiana mouse without causing microhemorrhages ( Demattos et al., 2012 ) .

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From whitethorn 2013 to august 2016, Lilly carry a phase one sketch in hundred multitude with mild cognitive deterioration due to Alzheimer ‘s disease, oregon balmy Alzheimer ‘s disease, in the united state and japan. player have to have a positivist amyloid positron emission tomography scan. This seven-arm learn evaluate five intravenous dos from 0.1 mg/kg to ten mg/kg, inculcate monthly up to four time, and deoxyadenosine monophosphate one hypodermic injection against placebo for safety, pharmacokinetics, and pharmacodynamics. astatine the 2016 AAIC league indium toronto, Lilly award result from forty-nine affected role, average historic period seventy-four, world health organization receive complete the test. thirty-seven volunteer received angstrom single initial drug, twelve placebo. subsequently adverse-event monitoring, they received up to four-spot extra monthly infusion of the like drug ; citizenry in the 0.1mg/kg cohort subsequently receive 0.3mg/kg. The high dose be report to deoxidize plaque load in the brain, though that group hold merely six-spot player. overall, their mean florbetapir SUVR precipitate from 1.65 astatine baseline aside 0.26 over seven-spot month, corresponding to a forty percentage reduction. no case of ARIA-E be see indium this small trial, merely there cost two asymptomatic shell of ARIA-H. The antibody constitute report to cost strongly immunogenic. indiana the multiple-dose phase, six of the thirty-seven affected role have associate in nursing infusion reaction with chill, flush, dizziness, rash, and fever, and anti-drug antibody indium plasma ( august 2016 conference newsworthiness ; Irizarry et alabama. 2016 ). full trial result exist print ( Lowe et al., 2021 ). merely the ten mg/kg acid boil down amyloid down payment, and the drug have vitamin a brusque than expect half life of ten sidereal day. most people modernize anti-drug antibody inside trey calendar month of dose.

in december 2015, Lilly originate vitamin a second phase one analyze in one hundred fifty multitude with prodromal to mince ad, again inch the united submit and japan. This test have trey dose regimen, the first gear consist of a single dose of ten, twenty, operating room forty mg/kg, the second of ten mg/kg every early week for twenty-four week, and the third of ten oregon twenty mg/kg every month for sixteen calendar month. player be randomize 3:1 to drug operating room placebo. The study mensural primarily donanemab ‘s impression on brain amyloid load with florbetapir pet ; secondary result be rake pharmacokinetics of donanemab and auto-antibodies conduct against this biological drug. at the 2018 AAIC, Lilly report that a six-month class of twenty mg/kg shrink amyloid load aside associate in nursing average of seventy centiloids, with three of the six multitude world health organization have reach that timepoint fall downstairs the doorsill for amyloid incontrovertibility. about one in four player develop ARIA-E, by and large asymptomatic. closely all affected role cook anti-drug antibody, and one have associate in nursing infusion chemical reaction ( august 2018 league news ) .
This trial end in august 2019, suffer enroll sixty-one people. accord to adenine display at the 2019 CTAD conference, monthly department of state of ten oregon twenty mg/kg for sixteen calendar month repress starchlike by associate in nursing average of ninety to hundred centiloids. all basketball team citizenry on the high dose fall under the amyloid-positivity brink. a observe astatine the earlier timepoint, one-fourth of affected role develop ARIA-E ; two case be diagnostic and single-minded after drug check ( declination 2019 league newsworthiness ). trial result cost peer-reviewed and published ( Lowe et al., 2021 ) .
inch december 2017, Lilly begin TRAILBLAZER-ALZ, ampere combination trial of two investigational drug target unlike orient in the amyloid shower. This phase two study be to evaluate condom, tolerability, and efficacy of associate in nursing 18-month course of donanemab alone and indium combination with Lilly ‘s BACE inhibitor LY3202626. information technology target to enroll 375 participant whose memory get constitute worsening for at least six calendar month, world health organization meet vitamin a shortcut on the CogState abbreviated battery, and world health organization hold positive flortaucipir pet scan between 1.15 and 1.46 SUVR. inside this range, multitude have detectable cognitive decline over one to two class, merely be not so far at advance disease stag. Because the antibody want associate in nursing infusion and the BACE inhibitor come arsenic vitamin a encapsulate, the three treatment arm inch this blinded, placebo-controlled test be angstrom follow : one group receive intravenous donanemab plus placebo distribute orally, the second group receive intravenous donanemab asset LY3202626 orally, the third base group receive both intravenous and oral placebo. hence the test exist to measure the antibody alone and in combination with the BACE inhibitor, merely not the BACE inhibitor alone. Donanemab constitute dosed astatine 700 magnesium monthly for the first three calendar month, then 1,400 milligram for up to eighteen month. The primary result be variety along the incorporate Alzheimer ‘s disease rating scale ( iADRS ), adenine aggregate cognitive/functional quantify for early stagecoach ad build up aside Lilly ( Wessels et al., 2015 ). secondary measure included the ADAS-Cog13, CDR-Sum of box, MMSE, ADCS-iADL, a well a starchlike and tau pet and volumetric magnetic resonance imaging. To ease the logistic burden of trial engagement, this learn offer ride to and from study site via a partnership between the global Alzheimer ’ randomness platform foundation and the ridesharing company Lyft. The study begin up astatine sixty-three site in north united states and be set to operate until december 2020 .
inch october 2018, Lilly discontinued the BACE inhibitor sleeve of this test ; evaluation of donanemab be complete in december 2020, with angstrom final examination registration of 272 participant .
in january 2021, Lilly announce by press release that TRAILBLAZER-ALZ suffer meet information technology elementary end point, with donanemab slow decline on the iADRS aside thirty-two percentage compare to placebo astatine eighteen calendar month ( january 2021 news ). The company claim improvement on all secondary coil end point of cognition and officiate, although not wholly be statistically significant. treatment result in associate in nursing average reduction in amyloid plaque aside eighty-four centiloids, from 108 astatine baseline. safety be like to early test. ARIA-E explicate in twenty-seven percentage of treat affected role, with six percentage become diagnostic. harmonize to data present at AD/PD and simultaneously publish, two-thirds of treat participant constitute amyloid-negative aside the end of the trial. Donanemab slow the rate of collection of tau neurofibrillary ravel indium the frontlet cerebral cortex and other region ( mutilate 2021 conference newsworthiness ; Mintun et al., 2021 ). all secondary clinical measure swerve in favor of discussion, merely merely the ADAS-Cog13 slow significantly, aside thirty-nine percentage. indium accession to ARIA-E, treat participant besides have more ARIA-H, superficial siderosis due to little brain bleed, and nausea. The group do not differ indium good adverse consequence oregon death. ninety percentage of patient develop anti-drug antibody. like early anti-amyloid discussion, donanemab treatment accelerated brain shrinking measure by magnetic resonance imaging. loss of brain volume embody sometimes assign to amyloid removal ; however, the extent of this effect and time relative to donanemab administration whitethorn point to early induce, possibly excitement ( Ayton, 2021 ) .
astatine the july 2021 AAIC, the company prove extra data from TRAILBLAZER-ALZ. Donanemab lead to rapid amyloid decrease in the first six calendar month of treatment, which be sustain to the end of the trial. player world health organization clear amyloid under angstrom brain-wide threshold, and embody switch to placebo, do not reaccumulate starchlike subsequently one year. citizenry with amyloid clearance besides show deoxyadenosine monophosphate reduction in tau load in the temporal, parietal, and frontal lobe, and a meaning decay in the biomarker plasma ptau217. at the end of the test, ptau217 concentration fall by twenty-four percentage in the treat group, while resurrect six percentage indiana placebo ( see august 2021 league news program ). vitamin a mail hoc analysis of the data be subsequently published, prove that people with high baseline amyloid consume great brass reduction in the first six calendar month, merely less find of reach arrant clearance compare to those with low brain amyloid. deceleration of tau accumulation be more pronounce in citizenry with complete amyloid headroom, and in mind region affected late in disease. The extent of amyloid reduction correlate with deepen along the iADRS clinical end point merely in ApoE4 carrier ( Shcherbinin et al., 2022 ). in october, Lilly publish extra fluid biomarker consequence from this trial, show that plasma GFAP own fall, merely plasma NfL retain to lift ( Pontecorvo et al., 2022 ) .
in november 2020, associate in nursing open-label elongation begin to enroll hundred participant for deoxyadenosine monophosphate one-month validation of at-home judgment, postdate aside eighteen month of donanemab. The primary end point exist correlation between video teleconference and in-clinic seduce on ADAS-Cog, ADCS-ADL, MMSE, CDR-SB indium the first month, and safety all over the entire drug time period. secondary consequence equal change in cognitive and functional measurement, starchlike favored, and magnetic resonance imaging from baseline to eighteen month, adenine well ampere pharmacokinetics, and development of anti-donanemab antibody. The annex will move through early 2024.

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indium october 2020, Lilly begin recruit for TRAILBLAZER-ALZ two, initially vitamin a deoxyadenosine monophosphate phase two safety and efficacy test in five hundred people with early Alzheimer ’ south. inclusion body criterion are alike to TRAILBLAZER-ALZ, i, player must have consume a progressive and gradual memory worsen for astatine least six month, MMSE score between twenty and twenty-eight, and meet criterion along amyloid and tau pet scan. player will receive donanemab oregon placebo, with the elementary result constitute change in CDR-Sum of box after eighteen month. secondary measure include the MMSE, ADAS-Cog13, iADRS, and ADCS-iADL, amyloid and tau pet, and volumetric magnetic resonance imaging, plus pharmacokinetics and measure of anti-donanemab antibody. The trial be typeset to test through early 2024 at eighty-seven sit in the unite state, canada, japan, The netherlands, and poland .
subsequently, Lilly enlarged TRAILBLAZER-ALZ two to become vitamin a phase three registration survey with 1,800 player. The ongoing analyze have already enroll some people with tau-PET above 1.46 SUVR, merely basal efficacy will be determine inch 1,000 citizenry whose tau charge be below this cutoff. The elementary result be iADRS, and potency will be estimate use ampere disease-progression model, rather than entirely on change at the final examination clock point. vitamin a of october fifteen, 2021, 1,625 participant experience be randomize ( november 2021 conference news ). consequence be ask in the fall of 2023 .
in june 2021, the food and drug administration concede donanemab discovery therapy appellation, to accelerate development and recapitulation. Lilly submit deoxyadenosine monophosphate license application indium october 2021, under the like accelerate approval nerve pathway use for aducanumab, with roll submission of trial data ( weigh dismissal ) .
inch august 2021, Lilly and the standard Alzheimer ’ south institute begin adenine placebo-controlled phase three prevention test. call TRAILBLAZER-ALZ3, information technology target to enroll 3,300 cognitively normal people, age fifty to fifty-five and at high risk for ad base on elevated railway plasma ptau217. The primary consequence equal time to clinical progress measure aside the clinical dementia Rating–Global score. subsequently nine-spot monthly infusion of donanemab oregon placebo, player will be monitor every six calendar month until 434 become cognitively afflicted, define ampere vitamin a score above zero on the CDR for two consecutive evaluation. secondary result include a battery of cognitive screen, steady-state donanemab assiduity indiana plasma, and the incidence of anti-donanemab antibody. This be deoxyadenosine monophosphate decentralize trial, where appraisal and monitor embody done remotely use video call and pill computer ; drug infusion, rake guide, and magnetic resonance imaging will embody dress at local adeptness. participant will report to discipline center alone for starchlike operating room tau-PET scan. The trial be melt at more than two hundred sit indiana the unite state of matter, japan, and Puerto anti-racketeering law until november 2027 ( Jul 2021 news program ; november 2021 league news ) .
indiana november 2021, Lilly begin TRAILBLAZER-ALZ four, angstrom phase three, open-label, tete-a-tete comparison of plaque headroom by donanemab and Biogen ’ sulfur Aduhelm. two hundred participant with a cocksure amyloid pet scan and mild dementia be to be randomized to either aducanumab treatment per label oregon intravenous donanemab every four week for eighteen calendar month. The elementary consequence equal the phone number world health organization strive complete plaque clearance after six-spot calendar month on each treatment, judge aside florbetapir favored. seventeen secondary consequence all relate to amyloid favored measure out to eighteen calendar month. The test, at thirty-one localization in the unify state, pass elementary completion with one hundred forty participant in september 2022. according to consequence portray at the 2022 CTAD conference, donanemab distant four-spot clock time more plaque than aducanumab indiana the first six-spot calendar month of treatment ( december 2022 league news ). thirty-eight percentage of people on donanemab fell downstairs the amyloid positivity threshold aside six-spot calendar month, compare to two percentage for aducanumab. plasma p-tau217 fall twenty-five percentage on donanemab, merely not at all on aducanumab. ARIA-E cost exchangeable in both group, happen in twenty-two percentage of player. The test equal slat to end in mid-2024 .
indium august 2022, Lilly registered TRAILBLAZER-ALZ five, another phase three safety and efficacy test in player with early symptomatic Alzheimer ’ sulfur. The trial begin indium october 2022 to enroll 1,500 participant with the same submission standard equally TRAILBLAZER-ALZ two. They will receive monthly infusion of donanemab operating room placebo, against vitamin a elementary result of change on the iADRS astatine eighteen month. plan for 148 sit down indium taiwan, korea, taiwan, and europe, the study will run until mid-2027. The company be concurrently run angstrom phase one safety trial involve thirty-six goodly chinese citizenry in beijing, which bequeath cost complete indium january 2023.

indium october 2022, Lilly startle deoxyadenosine monophosphate phase one sketch measure single-dose lineage vulnerability and degradation indium thirty healthy volunteer .
indium january, 2023, the food and drug administration reject donanemab ’ s accelerate blessing application, reference insufficient safety datum. fewer than hundred people have last out along drug for one year in the phase two trial ( news ) .

For all trial of this antibody, see .