Abstract Details

Title Nipocalimab Dose Selection for A Phase 3 Study in Adult Patients with Generalized Myasthenia Gravis

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-018

Background Nipocalimab (JNJ-80202135) is a fully human IgG1λ monoclonal antibody that blocks neonatal Fc receptors (FcRn) inhibiting IgG recycling and lowering systemic IgG, including pathogenic IgG autoantibodies. Potential for nipocalimab efficacy in autoimmune diseases was demonstrated in a Phase 2 (Ph2) study in patients with generalized myasthenia gravis (gMG).

Objective To determine the optimal nipocalimab dose and dosing regimen using modeling and simulation for a pivotal Ph3 study in gMG patients.

Design/Methods Mathematical models linking nipocalimab IV dosing with its pharmacokinetics (PK), FcRn occupancy, total IgG reduction and efficacy (ie. MG - Activities of Daily Living [MG-ADL]), were developed based on the data collected from nipocalimab Ph1 studies in healthy participants and a Ph2 study in gMG patients. Model-based simulations were conducted to identify the optimal nipocalimab dose, schedule and loading dose for a Ph3 gMG study.

Results Nipocalimab exhibited nonlinear FcRn-mediated disposition and rapid, dose-dependent IgG lowering in Ph1 and Ph2 studies. Ph2 gMG study dosing ranged from 5 mg/kg Q4W to 60 mg/kg Q2W. Dose-dependent improvements in MG-ADL associated with a 70% IgG reduction accounted for ~90% of the maximum MG-ADL reduction. Model-based simulation indicated a 15 mg/kg Q2W maintenance dose that achieved >70% target IgG lowering with minimal gains at higher doses. A 30 mg/kg loading dose was incorporated to lower IgG and MG-ADL scores by 2 weeks. The proposed dosing regimen is predicted to have an average steady-state albumin lowering of 12%, and total cholesterol and LDL increase of 6% and 8%, respectively, which are expected to have limited clinical impact.

Conclusions A 30 mg/kg loading dose followed by 15 mg/kg Q2W maintenance dose was identified as optimal for the Ph3 gMG study. The predicted exposure in patients with gMG is well below the exposure from 60 mg/kg q2w dosing regimen in Ph2, which was generally safe and well-tolerated.

Authors/Disclosures
Yaowei Zhu, PhD (Janssen Research & Development, LLC) PRESENTER	Dr. Zhu has received personal compensation for serving as an employee of Janssen Research & Development, LLC.
	No disclosure on file
	No disclosure on file
Marie-Helene Jouvin (Fulcrum Therapeutics)	Marie-Helene Jouvin has received personal compensation for serving as an employee of Fulcrum Therapeutics. Marie-Helene Jouvin has received personal compensation for serving as an employee of Pharvaris. Marie-Helene Jouvin has stock in Fulcrum Therapeutics. Marie-Helene Jouvin has stock in Pharvaris.
Sindhu Ramchandren, MD (Janssen Pharmaceutical Companies of Johnson & Johnson)	Dr. Ramchandren has received personal compensation for serving as an employee of Janssen Pharmaceutical Companies of Johnson & Johnson. Dr. Ramchandren has a non-compensated relationship as a Scientific Advisory Board Member with CMT Research Foundation (CMTRF) that is relevant to AAN interests or activities.
Yan Xu, MD, PhD (Biogen)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Leona Ling, PhD (Janssen Pharmaceuticals (J&J))	Dr. Ling has received personal compensation for serving as an employee of Janssen Pharmaceuticals (Johnson&Johnson). Dr. Ling has stock in Janssen Pharmaceuticals (Johnson&Johnson). Dr. Ling has received intellectual property interests from a discovery or technology relating to health care. Dr. Ling has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Hong Sun, MD, PhD (Janssen)	Dr. Sun has received personal compensation for serving as an employee of Janssen.