Open AccessA Semi‐Mechanistic Population Pharmacokinetic Model of Nusinersen: An Antisense Oligonucleotide for the Treatment of Spinal Muscular Atrophy
Author(s) -
Biliouris Konstantinos,
Gaitonde Puneet,
Yin Wei,
Norris Daniel A.,
Wang Yanfeng,
Henry Scott,
Fey Robert,
Nestorov Ivan,
Schmidt Stephan,
Rogge Mark,
Lesko Lawrence J.,
Trame Mirjam N.
Publication year - 2018
Publication title -
cpt: pharmacometrics and systems pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 37
ISSN - 2163-8306
DOI - 10.1002/psp4.12323
Subject(s) - spinal muscular atrophy , cerebrospinal fluid , pharmacokinetics , volume of distribution , spinal cord , pons , population , atrophy , medicine , sma* , anesthesia , biology , neuroscience , disease , environmental health , mathematics , combinatorics
A pharmacokinetic ( PK ) model was developed for nusinersen, an antisense oligonucleotide ( ASO ) that is the first approved treatment for spinal muscular atrophy (SMA). The model was built with data from 92 nonhuman primates (NHPs) following intrathecal doses (0.3–7 mg) and characterized the PK in cerebrospinal fluid ( CSF ), plasma, total spinal cord, brain, and pons. The estimated volumes were 13.6, 937, 4.5, 53.8, and 2.11 mL, respectively. Global sensitivity analysis demonstrated that the CSF ‐to‐plasma drug distribution rate (0.09 hour −1 ) is a major determinant of the maximum nusinersen concentration in central nervous system (CNS) tissues. Physiological age‐based and body weight‐based allometric scaling was implemented with exponent values of −0.08 and 1 for the rate constants and the volume of distribution, respectively. Simulations of the scaled model were in agreement with clinical observations from 52 pediatric phase I PK profiles. The developed model can be used to guide the design of clinical trials with ASO s.