Daclizumab

Daclizumab
Monoclonal antibody
Type Whole antibody
Source Humanized (from mouse)
Target CD25
Clinical data
Trade names Zinbryta (multiple sclerosis)
Zenapax (acute transplant rejection, discontinued in 2009)
AHFS/Drugs.com zinbryta
License data
Pregnancy
category
  • AU: B3
  • US: C (Risk not ruled out)
    Routes of
    administration    		 Subcutaneous injection (MS)
    Intravenous (transplant rejection, discontinued)
    ATC code
    Legal status
    Legal status
    • AU: S4 (Prescription only)
    • US: ℞-only
    • In general: ℞ (Prescription only)
    Pharmacokinetic data
    Bioavailability 90%
    Metabolism Proteases
    Elimination half-life 21 days (11–38 days)
    Identifiers
    CAS Number
    DrugBank
    ChemSpider
    • none
    UNII
    KEGG
    ChEMBL
    Chemical and physical data
    Formula C6332H9808N1678O1989S42
    Molar mass 142,612.1 g/mol
     ☒N☑Y (what is this?)  (verify)

    Daclizumab (trade name Zinbryta, by Biogen) is a therapeutic humanized monoclonal antibody which was used for the treatment of adults with relapsing forms of multiple sclerosis (MS). Daclizumab works by binding to CD25, the alpha subunit of the IL-2 receptor of T-cells.

    In March 2018, it was voluntarily withdrawn from the market by Biogen and Abbvie after reports of encephalitis in Europe.[1][2][3]

    Medical uses

    Daclizumab was used to treat adults with relapsing forms of multiple sclerosis.[4] It is administered subcutaneously.[5]

    In clinical trials it showed 45% decrease in annualized relapse rate, a 41% reduction in the proportion of patients who relapsed, and a 54% reduction in the number of new lesions.[5]

    Discontinued use

    Daclizumab was approved and used to prevent acute rejection of kidney transplant, along with cyclosporine and corticosteroids.[6] For that indication, side effects with a frequency of at least 10% included sleeplessness, tremor, headache, arterial hypertension, dyspnoea, gastrointestinal side effects and oedema. In rare cases, the drug could cause severe anaphylaxis.[7]

    Contraindications

    In the US, daclizumab is contraindicated in people with liver impairment, including significantly elevated liver enzymes (ALT, AST) and autoimmune hepatitis.[8] The European Medicines Agency (EMA) originally approved the drug without any contraindications apart from known hypersensitivity,[9] but required Biogen to implement a hepatic risk management guide for physicians.[10] In July 2017, the EMA has issued a provisional contraindication for patients with pre-existing liver disease or liver impairment.[11]

    Adverse effects

    In clinical trials for MS, there were no treatment-related deaths or increased risk of cancer; side effects that occurred more frequently with daclizumab versus interferon included infections (65% versus 57%), skin rashes (37% versus 19%) and liver complications (approximately 18% versus 12%).[5]

    Interactions

    As an antibody, daclizumab is expected to have a very low potential for pharmacokinetic interactions with other drugs.[9]

    Pharmacology

    Mechanism of action

    Daclizumab blocks IL-2 receptors containing the alpha subunit (CD25), which include the high-affinity receptors. Medium-affinity receptors, on the other hand, consist of two beta subunits (CD122) and are not affected by daclizumab. While the exact mechanism is unknown, the net effect is a reduction of T-cell responses and expansion of CD56bright natural killer cells.[9]

    Pharmacokinetics

    After subcutaneous injection of a single dose, daclizumab has a bioavailability of about 90% and reaches highest blood plasma levels after 5 to 7 days. Given every four weeks, steady state concentrations are found after the fourth dose. It is expected that daclizumab, like other antibodies, is degraded by proteases to peptides and finally amino acids, and that it does not interact with cytochrome P450 liver enzymes.[9]

    The biological half-life is 21 days. Patients who developed antibodies against daclizumab eliminated it 19% faster.[9]

    History

    Daclizumab was created by scientists at PDL BioPharma (called "Protein Design Labs" at that time) by humanizing the mouse mAb called anti-Tac, which targets CD25, the IL-2 receptor α chain; it blocks the interaction of IL-2 with the IL-2 receptor and prevents activation of T cells.[12] Anti-Tac had been discovered by Thomas A. Waldmann, M.D., chief of the Metabolism Branch at the National Cancer Institute and his team, and they had conducted animal studies and a small clinical trial of anti-Tac in people with T-cell leukemia, with promising results, but people quickly developed their own antibodies rejecting the mouse protein; Waldman, and his colleagues then approached Protein Design Labs to humanize the antibody.[13] PDL and the NIH scientists then approached Roche, a leader in transplant medicine development, to get the drug developed and approved, as PDL didn't have the resources to actually bring the product to market.[13] In March 2018 the drug was removed from the market world wide

    In December 1997 daclizumab was approved by the FDA for use in preventing acute rejection of kidney transplants, in combination with ciclosporin and corticosteroids; it was the first humanized antibody approved anywhere in the world.[14][15] At launch, the average wholesale price for the drug was estimated to be $6,800 for five doses and it was estimated that annual sales would be between $100 million and $250 million within five years of the launch and it was thought that the drug's use would be expanded for use in other organ transplants.[15] It was approved in Europe in 1999.[16]

    PDL began clinical trials of daclizumab on its own, and in September 2004 after the drug had shown promise in a Phase II trial, PDL and Roche agreed to expand their relationship to include codevelopment of daclizumab for asthma and other respiratory conditions.[17] In August 2005, PDL and Biogen Idec agreed to collaborate to develop daclizumab in indications outside the fields of organ rejection and respiratory disease.[18] In November 2005 Roche and PDL agreed to try to develop a formulation of daclizumab that would be useful as a subcutaneous injection for longterm maintenance in organ transplant.[19] The next year Roche and PDL announced that the collaboration for all indications was ending,[20] and in 2009 it announced that it was discontinuing Zenapax worldwide "in view of available alternative treatments and the diminishing market demand" and "not due to any safety issue."[21][22]

    in 2008 PDL spun out its active development programs into a company called Facet Biotech and development of daclizumab for multiple sclerosis and the partnership with Biogen was included in that spinout.[23][24] In 2009 Biogen attempted a hostile buy out of Facet for $350M;[25] Facet rejected that offer and was purchased by Abbvie for $450 million in cash the next year.[26] In May 2016 the FDA approved daclizumab for the treatment of relapsing multiple sclerosis in adults in 2016 under the trade name Zinbryta, with requirements for postmarketing studies and to submit a formal Risk Evaluation and Mitigation Strategy.[4][27]

    Research

    Daclizumab has been studied in a small clinical trial of people with birdshot chorioretinopathy.[28]

    References

    1. ↑ "Biogen, AbbVie withdraw multiple sclerosis drug Zinbryta". Reuters. 2018.
    2. ↑ Loftus, Peter (2 March 2018). "Biogen and Abbvie Take Multiple Sclerosis Drug Off Market". Wall Street Journal.
    3. ↑ "Drug Safety and Availability - FDA working with manufacturers to withdraw Zinbryta from the market in the United States". www.fda.gov. Retrieved 15 March 2018.
    4. 1 2 FDA BLA Approval letter May 27, 2016
    5. 1 2 3 Lycke J. Monoclonal antibody therapies for the treatment of relapsing-remitting multiple sclerosis: differentiating mechanisms and clinical outcomes. Ther Adv Neurol Disord. 2015 Nov;8(6):274-93. Review. PMID 26600872 PMC 4643868
    6. ↑ Rejection label Supplement label update September 2005
    7. ↑ "EPAR for Zenapax" (PDF). European Medicines Agency. 2007.
    8. ↑ FDA Professional Drug Information for Zinbryta.
    9. 1 2 3 4 5 Haberfeld, H, ed. (2016). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag.
    10. ↑ "Zinbryta Summary of Product Characteristics" (PDF). European Medicines Agency. 2016.
    11. ↑ "Zinbryta Article-20 referral - Summary of provisional measures" (PDF). European Medicines Agency. 20 July 2017.
    12. ↑ Tsurushita, N.; Hinton, P. R.; Kumar, S. (2005). "Design of humanized antibodies: From anti-Tac to Zenapax". Methods. 36 (1): 69–83. doi:10.1016/j.ymeth.2005.01.007. PMID 15848076.
    13. 1 2 Marwick C. Scientists recall progress and promise of translational research. J Natl Cancer Inst. 2001 Jan 3;93(1):13-5. PMID 1113683.
    14. ↑ Lawrence M. Fisher for The New York Times. December 12, 1997 Genetically Engineered Drug Approved for Kidney Transplants
    15. 1 2 Staff, The Pharma Letter. December 17, 1997. Roche's Zenapax Gets First Approval For Transplants
    16. ↑ Roche. March 04, 1999 Roche Press Release: Zenapax (daclizumab), The First Humanized Monoclonal Antibody To Prevent Organ Rejection, Approved In The European Union
    17. ↑ Candace Hoffmann for First Word Pharma. September 16, 2004 Roche in new deal to co-development asthma drug
    18. ↑ Thiel KA. A very firm handshake: biotech's growing negotiating power. Nat Biotechnol. 2005 Oct;23(10):1221-6. PMID 16211058
    19. ↑ Staff, PharmaTimes. November 1, 2005 Roche inks new deal for transplant drug
    20. ↑ PharmaTimes November 23, 2006 Roche ducks out of transplant drug alliance
    21. ↑ EMEA: Withdrawal of the marketing authorisation in the European Union
    22. ↑ Roche via the FDA Letter to Healthcare Professionals September 2009
    23. ↑ John Carroll for FierceBiotech. 2009 Emerging Drug Developer: Facet Biotech
    24. ↑ PDL BioPharma, Inc. Form 8-K December 17, 2008
    25. ↑ Luke Timmerman for Xconomy. September 4, 2009 Biogen Idec Makes Hostile $350M Takeover Bid for Facet Biotech
    26. ↑ Staff, New York Times Dealbook. March 9, 2010. Abbott to Buy Facet Biotech for 67% Premium
    27. ↑ FDA News Release: FDA approves Zinbryta to treat multiple sclerosis May 27, 2016
    28. ↑ Sobrin L; Huang JJ; Christen W; Kafkala C; Choopong P; Foster CS (2008). "Daclizumab for treatment of birdshot chorioretinopathy". Arch. Ophthalmol. 126 (2): 186–191. doi:10.1001/archophthalmol.2007.49. PMID 18268208.
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