A Randomized, Double-Blind Study Comparing Pharmacokinetics and Pharmacodynamics of Proposed Biosimilar ABP 798 With Rituximab Reference Product in Subjects With Moderate to Severe Rheumatoid Arthritis.

ABP 798 is a proposed biosimilar to rituximab reference product (RP), an anti-CD20 monoclonal antibody. Pharmacokinetics (PK), pharmacodynamics (PD), and safety results from the comparative clinical study that evaluated the PK, PD, safety, efficacy, and immunogenicity of ABP 798 versus rituximab RP are presented here. Subjects with moderate to severe rheumatoid arthritis (RA) received 2 doses of ABP 798, United States-sourced RP (rituximab US) or European Union-sourced RP (rituximab EU), each consisting of two 1000-mg infusions 2 weeks apart. For the second dose (week 24), ABP 798- and rituximab EU-treated subjects received the same treatment; rituximab US-treated subjects transitioned to ABP 798. End points included area under the serum concentration-time curve from time 0 extrapolated to infinity and maximum observed serum concentration following the second infusion of the first dose (PK) and percentage of subjects with complete CD19+ cell depletion days 1-33 (PD). Primary analysis established PK similarity between ABP 798 and rituximab RP based on 90% confidence intervals of the adjusted geometric mean ratios being within a prespecified equivalence margin of 0.8 and 1.25. Complete CD19+ B-cell depletion on day 3 among groups confirmed PD similarity. These findings demonstrated PK/PD similarity between ABP 798 and rituximab RP in subjects with moderate to severe RA.

Statistical Considerations on Clinical Efficacy Studies of Biosimilar for PMDA Submission.

In general, similar to FDA and other health authorities, the PMDA requires clinical efficacy study(ies) to evaluate equivalence between a reference biological product and a Biosimilar product for new drug applications. Even if an identical clinical efficacy study is included in both of PMDA and FDA submissions, the coefficients of confidence interval (CI) used for comparison with the equivalence margins could be different between the two submissions (e.g., 95% CI vs. 90% CI). In this article, we will focus on clinical efficacy studies of Biosimilar products and provide an overview of the two one-sided tests (TOST) and the type I error rate for equivalence design. Then, we summarize published PMDA review reports of Biosimilar products in terms of the coefficients of CI and other elements of the primary endpoints, and explain some Japanese guidelines of Biosimilar and Statistics behind the difference between PMDA and FDA submissions. In addition, we discuss how to use statistical methods correctly and efficiently for PMDA submissions.

A randomized, double-blind, single-dose, three-arm, parallel group study to determine pharmacokinetic similarity of ABP 959 and eculizumab (Soliris® ) in healthy male subjects.

OBJECTIVES: ABP 959 is a proposed biosimilar to eculizumab, a monoclonal antibody targeting the human C5 complement protein. The objective of this randomized, double-blind, three-arm, study was to demonstrate pharmacokinetic (PK) and pharmacodynamic (PD) similarity of ABP 959 relative to the eculizumab reference product (RP) in healthy adult male subjects. METHODS: Eligible subjects aged 18-45 years were randomized to receive a 300-mg IV infusion of ABP 959, or FDA-licensed eculizumab (eculizumab US), or EU-authorized eculizumab (eculizumab EU). Primary PK endpoint was area under the total serum concentration-time curve from 0 to infinity (AUC0-∞ ); primary PD endpoint was area between the effect curve (ABEC) of CH50-time data. RESULTS: The geometric mean of PK and PD parameters were similar between ABP 959 versus eculizumab US and eculizumab EU; PK and PD similarity was established based on 90% confidence intervals of the geometric mean ratio being within prespecified equivalence margin of 0.8 and 1.25. The incidence of treatment-emergent adverse events was similar across groups. The incidence of binding anti-drug antibodies was similar across treatments; no subjects developed neutralizing antibodies. CONCLUSIONS: This study demonstrated PK and PD similarity of ABP 959 to eculizumab RP; safety and immunogenicity profiles were also similar.

Bayesian design of biosimilars clinical programs involving multiple therapeutic indications.

In this paper, we propose a Bayesian design framework for a biosimilars clinical program that entails conducting concurrent trials in multiple therapeutic indications to establish equivalent efficacy for a proposed biologic compared to a reference biologic in each indication to support approval of the proposed biologic as a biosimilar. Our method facilitates information borrowing across indications through the use of a multivariate normal correlated parameter prior (CPP), which is constructed from easily interpretable hyperparameters that represent direct statements about the equivalence hypotheses to be tested. The CPP accommodates different endpoints and data types across indications (eg, binary and continuous) and can, therefore, be used in a wide context of models without having to modify the data (eg, rescaling) to provide reasonable information-borrowing properties. We illustrate how one can evaluate the design using Bayesian versions of the type I error rate and power with the objective of determining the sample size required for each indication such that the design has high power to demonstrate equivalent efficacy in each indication, reasonably high power to demonstrate equivalent efficacy simultaneously in all indications (ie, globally), and reasonable type I error control from a Bayesian perspective. We illustrate the method with several examples, including designing biosimilars trials for follicular lymphoma and rheumatoid arthritis using binary and continuous endpoints, respectively.

Improving the power to establish clinical similarity in a Phase 3 efficacy trial by incorporating prior evidence of analytical and pharmacokinetic similarity.

To improve patients' access to safe and effective biological medicines, abbreviated licensure pathways for biosimilar and interchangeable biological products have been established in the US, Europe, and other countries around the world. The US Food and Drug Administration and European Medicines Agency have published various guidance documents on the development and approval of biosimilars, which recommend a "totality-of-the-evidence" approach with a stepwise process to demonstrate biosimilarity. The approach relies on comprehensive comparability studies ranging from analytical and nonclinical studies to clinical pharmacokinetic/pharmacodynamic (PK/PD) and efficacy studies. A clinical efficacy study may be necessary to address residual uncertainty about the biosimilarity of the proposed product to the reference product and support a demonstration that there are no clinically meaningful differences. In this article, we propose a statistical strategy that takes into account the similarity evidence from analytical assessments and PK studies in the design and analysis of the clinical efficacy study in order to address residual uncertainty and enhance statistical power and precision. We assume that if the proposed biosimilar product and the reference product are shown to be highly similar with respect to the analytical and PK parameters, then they should also be similar with respect to the efficacy parameters. We show that the proposed methods provide correct control of the type I error and improve the power and precision of the efficacy study upon the standard analysis that disregards the prior evidence. We confirm and illustrate the theoretical results through simulation studies based on the biosimilars development experience of many different products.

Assessing temporal agreement between central and local progression-free survival times.

In oncology clinical trials, progression-free survival (PFS), generally defined as the time from randomization until disease progression or death, has been a key endpoint to support licensing approval. In the U.S. Food and Drug Administration guidance for industry, May 2007, concerning the PFS as the primary or co-primary clinical trial endpoint, it is recommended to have tumor assessments verified by an independent review committee blinded to study treatments, especially in open-label studies. It is considered reassuring about the lack of reader-evaluation bias if treatment effect estimates from the investigators' and independent review committees' evaluations agree. The agreement between these evaluations may vary for subjects with short or long PFS, while there exist no such statistical quantities that can completely account for this temporal pattern of agreements. Therefore, in this paper, we propose a new method to assess temporal agreement between two time-to-event endpoints, while the two event times are assumed to have a positive probability of being identical. This method measures agreement in terms of the two event times being identical at a given time or both being greater than a given time. Overall scores of agreement over a period of time are also proposed. We propose a maximum likelihood estimation to infer the proposed agreement measures using empirical data, accounting for different censoring mechanisms, including reader's censoring (event from one reader dependently censored by event from the other reader). The proposed method is demonstrated to perform well in small samples via extensive simulation studies and is illustrated through a head and neck cancer trial.

Expression of protocadherin-19 in the nervous system of the embryonic zebrafish.

We have analyzed the expression pattern of protocadherin-19, a member of the delta2-protocadherins, in the nervous system of developing zebrafish using in situ hybridization methods. mRNA encoding protocadherin-19 (Pcdh19) began to be expressed at about 12 hours post fertilization (hpf) showing a segmental expression pattern in the anterior 1/3 of the neural keel, with strong expression in the presumptive forebrain, cerebellum/rhombomere 1 and rhombomere 4. Pcdh19 expression in the posterior neural keel was continuous and confined to the midline region. By 24 hpf, Pcdh19 was expressed widely in the brain and spinal cord, with higher expression levels in the ventral telencephalon, dorsal and central thalamus, optic tectum, central tegmentum, cerebellum and dorsolateral regions of the hindbrain. As development proceeded, Pcdh19 expression domains became restricted to the dorsal and/or lateral regions of the central nervous system, and Pcdh19 expression was not detected in the spinal cord of two- and three-day old embryos. Pcdh19 was also expressed by the eye primordium, developing retina, lens and otic vesicle. Similar to its expression in the brain, Pcdh19 expression in the eye and ear was also spatially and temporally regulated.

Endophytic Fusarium verticillioides reduces disease severity caused by Ustilago maydis on maize.

Endophytic fungi represent diverse taxa that inhabit plant hosts without causing disease symptoms. We used endophytic isolates of Fusarium verticillioides (Sacc.) Nirenberg to understand how endophytic fungi interact with pathogens, in this case, the corn smut pathogen, Ustilago maydis DC (Corda). Endophytic F. verticillioides strains were inoculated onto maize seedlings before, simultaneously, or after inoculation with U. maydis, and the effects on smut disease severity and on plant growth were assessed. When F. verticillioides is simultaneously coinoculated with U. maydis, smut disease severity is significantly decreased and plant growth is increased, compared with other treatments. Controls show that F. verticillioides by itself does not have measurable effects on plant growth. Together, our results suggest that a commonly occurring fungal endophyte on maize, F. verticillioides, ameliorates the effects of a host-specific pathogen, U. maydis, by interfering with the early infection process and limiting disease development, resulting in increased plant growth.

Expression of protocadherin-9 and protocadherin-17 in the nervous system of the embryonic zebrafish.

In this study we analyzed expression patterns of two delta-protocadherins, protocadherin-9 and protocadherin-17, in the developing zebrafish using in situ hybridization and RT-PCR methods. Both protocadherins were mainly detected in the embryonic central nervous system, but each showed a distinct expression pattern. Protocadherin-9 message (Pcdh9) was expressed after 10h post fertilization (hpf). It was found mainly in small clusters of cells in the anteroventral forebrain and ventrolateral hindbrain, and scattered cells throughout the spinal cord of young embryos (24 hpf). Pcdh9 expression in the hindbrain was segmental, reflecting a neuromeric organization, which became more evident at 34 hpf. As development proceeded, Pcdh9 expression increased throughout the brain, while its expression in the spinal cord was greatly reduced. Pcdh9 was also found in the developing retina and statoacoustic ganglion. Protocadherin-17 message (Pcdh17) expression began much earlier (1.5-2 hpf) than Pcdh9. Similar to Pcdh9 expression, Pcdh17 expression was found mainly in the anteroventral forebrain at 24 hpf, but its expression in the hindbrain and spinal cord, confined mainly to lateroventral regions of the hindbrain and anterior spinal cord, was more restricted than Pcdh9. As development proceeded, Pcdh17 expression was increased both in the brain and spinal cord: detected throughout the brain of two- and three-day old embryos, strongly expressed in the retina and in lateral regions of spinal cord in two-day old embryos. Its expression in the retina and spinal cord was reduced in three-day old embryos. Our results showed that expression of these two protocadherins was both spatially and temporally regulated.

Fungal-fungal associations affect the assembly of endophyte communities in maize (Zea mays).

Many factors can affect the assembly of communities, ranging from species pools to habitat effects to interspecific interactions. In microbial communities, the predominant focus has been on the well-touted ability of microbes to disperse and the environment acting as a selective filter to determine which species are present. In this study, we investigated the role of biotic interactions (e.g., competition, facilitation) in fungal endophyte community assembly by examining endophyte species co-occurrences within communities using null models. We used recombinant inbred lines (genotypes) of maize (Zea mays) to examine community assembly at multiple habitat levels, at the individual plant and host genotype levels. Both culture-dependent and culture-independent approaches were used to assess endophyte communities. Communities were analyzed using the complete fungal operational taxonomic unit (OTU) dataset or only the dominant (most abundant) OTUs in order to ascertain whether species co-occurrences were different for dominant members compared to when all members were included. In the culture-dependent approach, we found that for both datasets, OTUs co-occurred on maize genotypes more frequently than expected under the null model of random species co-occurrences. In the culture-independent approach, we found that OTUs negatively co-occurred at the individual plant level but were not significantly different from random at the genotype level for either the dominant or complete datasets. Our results showed that interspecific interactions can affect endophyte community assembly, but the effects can be complex and depend on host habitat level. To our knowledge, this is the first study to examine endophyte community assembly in the same host species at multiple habitat levels. Understanding the processes and mechanisms that shape microbial communities will provide important insights into microbial community structure and the maintenance of microbial biodiversity.

Effects of host plant environment and Ustilago maydis infection on the fungal endophyte community of maize (Zea mays).

The focus of many fungal endophyte studies has been how plants benefit from endophyte infection. Few studies have investigated the role of the host plant as an environment in shaping endophyte community diversity and composition. The effects that different attributes of the host plant, that is, host genetic variation, host variation in resistance to the fungal pathogen Ustilago maydis and U. maydis infection, have on the fungal endophyte communities in maize (Zea mays) was examined. The internal transcribed spacer (ITS) region of the rDNA was sequenced to identify fungi and the endophyte communities were compared in six maize lines that varied in their resistance to U. maydis. It was found that host genetic variation, as determined by maize line, had significant effects on species richness, while the interactions between line and U. maydis infection and line and field plot had significant effects on endophyte community composition. However, the effects of maize line were not dependent on whether lines were resistant or susceptible to U. maydis. Almost 3000 clones obtained from 58 plants were sequenced to characterize the maize endophyte community. These results suggest that the endophyte community is shaped by complex interactions and factors, such as inoculum pool and microclimate, may be important.

Infection by the systemic fungus Epichloë glyceriae alters clonal growth of its grass host, Glyceria striata.

Parasites and pathogens are hypothesized to change host growth, reproduction and/or behaviour to increase their own transmission. However, studies which clearly demonstrate that parasites or pathogens are directly responsible for changes in hosts are lacking. We previously found that infection by the systemic fungus Epichloë glyceriae was associated with greater clonal growth by its host, Glyceria striata. Whether greater clonal growth resulted directly from pathogen infection or indirectly from increased likelihood of infection for host genotypes with greater clonal growth could not be determined because only naturally infected and uninfected plants were used. In this study, we decoupled infection and host genotype to evaluate the role of pathogen infection on host development and clonal growth. We found that total biomass production did not differ for clones of the same genotype, but infected clones allocated more biomass to clonal growth. Disinfected clones had more tillers and a greater proportion of their biomass in the mother ramet. Infected clones produced fewer tillers but significantly more and longer stolons than disinfected clones. These results support the hypothesis that pathogen infection directly alters host development. Parasite alteration of clonal growth patterns might be advantageous to the persistence and spread of host plants in some ecological conditions.