The goal of developing a biotherapeutic that is safe and efficacious and receives regulatory approval with few hurdles is beset with challenges. Management of interfering drug in the ADA assay is clearly a common difficulty, together with the timing and protocol for neutralizing antibody assays, and the clinical significance of all immunogenicity assays, particularly in the presence of pre-existing drug. CHI's Eighth Annual Immunogenicity Assessment & Clinical Relevance conference presents approaches from leading Pharma and Biotech and from the clinic for a wide range of products: enzyme replacement therapies, multi-domain antibody products, ADCs, Pegylated biotherapeutics, Botulinum neurotoxins and anti-TNF monoclonal antibodies. The FDA and NDA Advisory Board will present the regulatory perspectives for innovators and biosimilars.
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Wednesday, October 26
7:30 am Registration and Morning Coffee
8:30 Chairperson’s Opening Remarks
Boris Gorovits, Ph.D., Senior Director, PDM, Pfizer, Inc.
Regulatory and Industry Perspectives on Immunogenicity Assessment for Innovators and Biosimilars
8:35 KEYNOTE PRESENTATION: FDA Regulatory Perspectives on Immunogenicity - an Update
João Pedras-Vasconcelos, Ph.D., Biotech Quality and Immunogenicity Reviewer, Biotechnology Products, CDER-FDA
The cost to the biotechnology industry of developing a biologic from early stage all the way to licensing is very high, and many factors can impinge upon approval, particularly the occurrence of immune responses against the biologic. Immunogenicity can impact product efficacy and safety depending on patient-related and product-related factors. This presentation will provide an updated overview of the FDA regulatory perspective to immunogenicity risk management for innovator and biosimilar biologics including risk assessment and mitigation, and anti-drug antibody detection.
9:05 Challenges in Assessing Relative Immunogenicity for Biosimilars and for Manufacturing Change
Paul Chamberlain, NDA Advisory Board
This presentation will reflect on how the extent of the evaluation of relative immunogenicity of closely related therapeutic proteins is strongly dependent on the nature of the product and the regulatory purpose. Directly comparative clinical evaluation is normally required for biosimilars, whereas a requirement for clinical data is exceptional in the case of manufacturing process changes for authorized products. The importance of minimization of bioanalytical bias, sensitivity of the clinical population, and duration of interventional monitoring for building an effective strategy will be highlighted.
9:35 Creating Reference Sera and Standardized Antibody Panels to Assist Standardization of ADA Assays for Therapeutic Proteins
Kimberly Florence, MS, Investigator, Immunogenicity and Clinical Immunology, GlaxoSmithKline
As biopharmaceuticals revolutionize patient care, safety issues may arise through drug/anti-drug antibody interactions. How do we ensure that immunogenicity testing post licensing in routine clinical practice is standardized and fit for purpose? Although there is no “perfect” ADA assay, can universal standards be implemented in the ADA sphere? This presentation will focus on newly developed approaches to use reference standards in the assessment of immunogenicity.
10:05 Presentation to be Announced
10:35 Coffee Break in the Exhibit Hall with Poster Viewing
Application and Significance of Neutralizing Antibody Assays
11:15 Challenges in Developing Neutralizing Antibody Assays for Antibody Drug Conjugates
Shan Chung, Ph.D., Senior Scientist, BioAnalytical Sciences, Genentech, Inc.
Antibody Drug Conjugates (ADCs) are a new class of anti-cancer medicines consisting of a tumor-specific antibody, a cytotoxic toxin, and a linker. Each of these components either by itself or in combination with the others can induce immune responses in patients including generation of antibodies (NAbs) capable of neutralizing the therapeutic effects of the ADC. This presentation will describe technical challenges and potential solutions in development of NAb assays for ADCs.
11:45 Neutralizing Antibody Titers Measured with a Cell-Based Flow Cytometry Assay Show No Association with Reduced Efficacy or Pharmacodynamic Effect in Elosulfase Alfa Treated Subjects
Andrew C. Melton, Ph.D., Scientist II, Bioanalytical R&D, BioMarin Pharmaceutical, Inc.
Many enzyme replacement therapies (ERTs) utilize the cation-independent mannose-6-phosphate receptor (CI-M6PR) to target lysosomal delivery of ERTs. However, patients receiving ERTs may produce neutralizing antibodies that interfere with CI-M6PR binding. We validated a cell-based flow cytometry assay that detects antibodies capable of interfering with uptake of elosulfase alfa. Consistent with earlier findings, no correlations were observed between NAb titers and the clinical outcomes of elosulfase alfa-treated patients with Morquio A.
12:15 pm Sponsored Presentation (Opportunity Available)
12:45 Luncheon Presentation (Sponsorship Opportunity Available)
1:15 Session Break
Managing Drug and Target Interference
2:15 Chairperson’s Remarks
2:20 New Method for Overcoming Drug and Target Interference in ADA Assays
Jad Zoghbi, MSc, Senior Scientist, Biomarkers and Clinical Bioanalyses, Sanofi
I will describe a novel method that is effective at solving interference problems in immunogenicity assays. I will outline the principles behind the Precipitation and Acid (PandA) approach developed by Sanofi for detecting free and drug-bound ADA in the presence of high levels of circulating drug and drug target in patient samples. Case studies demonstrating superiority over other methods will be presented.
2:50 Practical Approaches to Improving Drug Tolerance in ADA Assays: Impact of Assay Format and Platform
Mitra Azadeh, Ph.D, Principal Scientist, Bioanalytical & Biomarker Development, Nonclinical Development, R&D, Shire
Drug intolerance in ADA assays remains a significant bioanalytical challenge as it interferes with the proper assessment of immunogenicity. This presentation is aimed at providing practical approaches to reducing drug interference in ADA assays. Case studies where changes to either assay format or platform as well as specific examples in which simple modifications to assay parameters and reagents resulted in ten-fold or higher increase in drug tolerance will be presented.
3:20 Refreshment Break in the Exhibit Hall with Poster Viewing
4:00 Method to Improve the Recovery of pH Labile Anti-Drug Antibodies during Acid Dissociation and Extraction
Weifeng Xu, Ph.D., Senior Research Investigator, Bioanalytical Science-Biologics, BMS
When large amounts of biotherapeutic drug are present in clinical samples, these drugs have to be dissociated and removed from anti-drug antibodies (ADA) so that ADAs can be detected by either ligand-binding assays or cell-based bioassays. By screening a panel of more than 20 ADA positive control (PC) Abs, we found that the current widely used acid dissociation method followed by biotinylated-drug extraction led to low recovery of more than 40% of these ADA PCs, due to sensitivity to low pH and denaturation. Here we discuss the alternative methods for ADA extraction so that pH labile species can be maximally recovered. This will increase the sensitivity of immunogenicity testing.
4:30 Problem Solving Roundtable Discussions
Table 1: Meeting Regulatory Expectations Regarding Immunogenicity AssessmentKathleen A. Clouse, Ph.D., Director, Division of Biotechnology Review and Research 1, OBP/OPQ/CDER/FDA
Table 2: Challenges in Developing Neutralizing Antibody (NAb) AssaysShan Chung, Ph.D., Senior Scientist, BioAnalytical Sciences, Genentech, Inc.
Table 3: Overcoming Drug Interference in ADA AssaysMelissa R. Snyder, Ph.D., Laboratory Director, Antibody Immunology Laboratory, Pathology and Laboratory Medicine, Mayo Clinic
Table 4: Critical Issues in ADA Assay ValidationJim McNally, Ph.D., Associate Director and Immunogenicity Expert, Global Early Development, Quantitative Pharmacology & Drug Disposition, EMD Serono
Table 5: Practical Application of Immunogenicity Preclinical Risk AssessmentBoris Gorovits, Ph.D., Senior Director, PDM, Pfizer, Inc.
Table 6: Focus on Immunogenicity of BiosimilarsPaul Chamberlain, NDA Advisory Board
Table 7: Dealing with Pre-Existing Positive ADA Activity in Study PatientsLi Xue, Ph.D., Principal Scientist, Pharmacokinetics Dynamics & Metabolism, NBE, Pfizer, Inc.
5:30 Welcome Reception in the Exhibit Hall with Poster Viewing
6:30 End of Day One
Thursday, October 27
8:00 Chairperson’s Remarks
João Pedras-Vasconcelos, Ph.D., Biotech Quality and Immunogenicity Reviewer, Office of Biotechnology Products, CDER-FDA
Clinical Relevance of Drug Target Interference
8:05 Impact and Challenges of Drug Target Interference on Immunogenicity Assessment: Perspectives from a Clinical Laboratory
Melissa R. Snyder, Ph.D., Laboratory Director, Antibody Immunology Laboratory, Pathology and Laboratory Medicine, Mayo Clinic
Assessment of immunogenicity is increasingly becoming the standard of care for patients being treated with monoclonal antibody therapeutics, particularly for evaluation of loss of response. However, a significant challenge is the potential for drug target interference. In this session, methods for assessment of anti-drug antibodies to adalimumab and infliximab will be discussed, with a focus on the analytical impact and clinical relevance of drug target interference.
8:35 Determination of the Clinical Significance of Pre-Existing Antibodies
Li Xue, Ph.D., Senior Principal Scientist, Pharmacokinetics Dynamics & Metabolism, NBE, Pfizer, Inc.
Therapeutic reactive pre-existing antibodies have been widely detected during clinical immunogenicity evaluation and have received growing attention in the past decade. The related clinical significance ranges from severe adverse safety findings to no impact at all. This talk will provide an overview of the known clinical impact of pre-existing antibodies and discuss the clinical risk assessment and management strategies.
9:05 FEATURED PRESENTATION: Relationship between Immunogenicity, Drug Concentration, Efficacy, Safety and How this Correlates with Tests/Methods for TNF Inhibitors
This presentation will focus on reported immunogenicity data for anti-TNF mAb and similar compounds with the goal to link with PK, efficacy and other clinical observations. Also, to understand whether the methods applied to evaluate immunogenicity responses had any influence on the outcome of the correlation to determine relevance of immunogenicity assays.
9:35 Immunogenicity Strategy for a Multidomain Protein Containing Endogenous Counterparts
Jim McNally, Ph.D., Associate Director and Immunogenicity Expert, Global Early Development, Quantitative Pharmacology & Drug Disposition, EMD Serono
This talk will describe the ongoing immunogenicity risk assessment, strategic planning and bioanalytical assay development to support a novel biotherapeutic containing multiple effector domains each with an endogenous counterpart. In addition to the need to closely monitor anti-drug antibody responses due to the potential cross reactivity against the endogenous counterparts, the biotherapeutic also has soluble targets that have the possibility of generating false positives in screening ADA assays using the bridging format. The goal will be to present the case for early assessment of immunogenicity risk to drive the generation of the numerous reagents and associated procedures to support the clinical development of this molecule.
10:05 Sponsored Presentation (Opportunity Available)
11:10 Application of a Cell-Based Neutralizing Antibody Assay for Botulinum Neurotoxin ADA
Samuel Pine, Ph.D., Principal Scientist, Immunology, Allergan
Immunogenicity measurements for anti-botulinum neurotoxin serotype A (BoNT/A) antibodies have historically relied on mouse protection bioassays. We devised a cell-based method that captures the complexity of all three biologically relevant steps of BoNT/A activity – receptor binding, translocation and target cleavage – to assess human serum samples for anti-BoNT/A neutralizing antibodies. Method validation results indicate the assay detects clinically relevant neutralizing antibodies similarly to the currently accepted mouse protection assay.
11:40 Implementation of Therapeutic Drug Monitoring in Clinical Practice as a Reactive or Proactive Tool to Optimize Treatment Outcomes of Biologics
Niels Vande Casteele, Pharm.D., Ph.D., Postdoctoral Fellow, Gastroenterology, University of California, San Diego
Anti-drug antibodies (ADA) can impair the treatment effect of biologics and have been associated with adverse events. However, it is important to distinguish transient from persistent ADA and how this covariate (continuous or categorical) is included in pharmacological models. ADA are typically used in a reactive setting to support treatment decisions, whereas drug concentrations can be used in a proactive setting to guide dosing based on exposure.
12:10 pm rFVIIa Analog Clinical Trial Including 3-Year Follow Up Study in Patients with Anti-Drug Antibodies
Karin Nana Weldingh, Ph.D., Principal Scientist, Immunogenicity Assessment, Novo Nordisk
A FVIIa analogue with 3 amino acid mutations compared to the native molecule was developed to improve the treatment of bleeds in hemophilia patients. In the Phase III trial, 8/72 (11%) of the treated patients developed anti-drug antibodies (ADAs). The presentation will describe the characterisation and consequences of these ADAs. Furthermore, data from a 3 year follow-up study of the ADA positive patients will be presented.
12:40 End of Conference
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