| الوصف: |
Typically, therapeutic proteins (TPs) have a low risk for eliciting meaningful drug interactions (DIs). However, there are select instances where TP drug interactions (TP-DIs) of clinical concern can occur. This white paper discusses the various types of TP-DIs involving mechanisms such as changes in disease state, target-mediated drug disposition (TMDD), neonatal Fc receptor (FcRn), or anti-drug antibodies (ADAs) formation. The nature of TP drug interaction being investigated should determine whether the examination is conducted as a standalone TP-DI study in healthy subjects, in patients, or assessed via population pharmacokinetic (PopPK) analysis. DIs involving antibody-drug conjugates are discussed briefly but the primary focus here will be DIs involving cytokine modulation. Cytokine modulation can occur directly by certain TPs, or indirectly due to moderate-to-severe inflammation, infection, or injury. Disease states that have been shown to result in indirect disease-DIs that are clinically meaningful have been listed (i.e., typically a 2-fold change in the systemic exposure of a co-administered sensitive CYP substrate drug). Type of disease and severity of inflammation should be the primary drivers for risk assessment for disease-DIs. While more clinical inflammatory marker data needs to be collected, the use of two or more clinical inflammatory markers (such as c-reactive protein, albumin, or interleukin-6) may help broadly categorize whether the predicted magnitude of inflammatory disease-drug interaction risk is negligible, weak, or moderate-to-strong. Based on current knowledge, clinical DI studies are not necessary for all TPs, and should no longer be conducted in certain disease patient populations such as psoriasis, which do not have sufficient systemic inflammation to cause a meaningful indirect disease-DI. |
