JP4628357B2 - 炎症性腸疾患治療用の組成物及び治療方法 - Google Patents
炎症性腸疾患治療用の組成物及び治療方法 Download PDFInfo
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Description
上述のように、本発明は、一般に、I型インターフェロン拮抗物質を含む組成物、ならびに、この組成物を炎症性腸疾患(IBD)、特に、セリアック病、クローン病、潰瘍性大腸炎の治療に用いられる有用な治療方法に関する。本発明の実施形態におけるI型インターフェロン拮抗物質としては、I型インターフェロン受容体に結合して、そのリガンド(即ち、インターフェロンα、インターフェロンβ又はインターフェロンω)の結合を妨害する、抗IFNAR抗体、及び/又は、この抗体の断片が挙げられる。代替物又は追加物として、I型インターフェロン拮抗物質は、I型インターフェロン(即ち、インターフェロンα、インターフェロンβ又はインターフェロンω)に結合して、受容体(即ち、IFNAR)へのI型インターフェロンの結合を妨害する、抗I型インターフェロン抗体及び/又はこれら抗体の断片でもよい。抗体を介したリガンド結合の阻害は、競合的阻害、非競合的阻害又は不競合的阻害でよい。代替的に、抗体を基盤とする拮抗物質は、I型インターフェロン受容体を介した細胞内シグナル伝達を阻害することによって作用してもよい。
本発明の好適な抗体は、本明細書でCPI−1697と称するヒト化抗体である。この抗体は、H3と称する重鎖と、K1と称する軽鎖と、から構成される。H3重鎖及びK1軽鎖の可変領域のアミノ酸配列は、図14A(配列番号1)及び図14B(配列番号2)に示される。H3重鎖には、マウス抗IFNAR−1抗体64G12の重鎖由来のCDR1、CDR2、CDR3配列が、ヒト免疫グロブリン重鎖のフレームワークの共通配列に移植されたものが含まれ、一方、K1軽鎖には、マウス抗IFNAR−1抗体64G12の軽鎖由来のCDR1、CDR2、CDR3配列がヒト免疫グロブリンκ軽鎖のフレームワークの共通配列に移植されたものが含まれる。CPI−1697抗体は、更に、ヒトIgG4の定常領域を含む。
抗体に基盤をおくI型インターフェロン拮抗物質に加えて、本発明では、例えば、受容体(即ち、IFNAR)へのI型インターフェロンの結合を妨害する小分子といった、一種以上の小分子を含む、I型インターフェロン拮抗物質及びその組成物も考慮される。
追加の実施形態では、本発明は、細胞又は動物への投与用として薬理学的に許容される担体中における、本明細書に開示された一種以上のI型インターフェロン拮抗物質の、単独又は一種以上の他の治療様式と組み合わせた製剤化に関する。例えば、特定の治療投薬計画に応じて、本発明の組成物は、更に、免疫抑制剤、抗炎症剤、ステロイド、免疫調節剤、サイトカイン、TNF拮抗物質等の追加の治療薬を一つ以上含んでもよい。免疫抑制剤としては、アザチオプリン、メトトレキセート、シクロスポリン、FK506、ラパマイシン、ミコフェノール酸モフェチルが挙げられる。抗炎症薬としては、5−アミノサリチル酸、スルファサラジン、オルサラジンが挙げられる。ステロイドとしては、コルチコステロイド、糖質副腎皮質ステロイド、プレドニソン、プレドニソロン、ヒドロコルチゾン、メチルプレドニソロン、デキサメサゾン、ACTHが挙げられる。免疫調節剤としては、PVAC、抗CD40リガンド、抗CD40、ナタリズマブ(AntegrenTM)、抗VCAM1、抗ICAM1が挙げられる。サイトカインとしては、IL−10が挙げられる。TNF拮抗物質としては、インフリキシマブ(Remicade(登録商標))、エタナーセプト(Enbrel(登録商標))、アダリムマブ(HumiraTM)、CDP870が挙げられる。
本明細書で上述したように、本発明は、セリアック病、クローン病、潰瘍性大腸炎等の炎症性腸疾患の処置のための治療法を提供する。この方法は、炎症性腸疾患に罹患した患者に、上述した抗体に基盤を置くI型インターフェロン拮抗物質のうちの一つ等のI型インターフェロン拮抗物質を含有する組成物を治療有効量投与する手順を備える。本発明は、更なる実施形態において、炎症性腸疾患処置のための治療方法を提供し、これらの方法は、(a)IBDに罹患した患者に、寛容量のI型インターフェロン拮抗物質を投与する手順と、(b)この患者に、治療有効量のI型インターフェロン拮抗物質を投与する手順とを備える。更に、一種以上のI型インターフェロン拮抗物質を、上述したような免疫抑制剤、抗炎症剤、ステロイド、免疫調節剤、サイトカイン、TNF拮抗物質等の、他の治療剤と組み合わせて投与することが好ましいこともある。
新世界の霊長類種であるワタボウシタマリン(CTT;Sanguinus oedips)における特発性大腸炎は、この分野において、ヒトにおける炎症性腸疾患(IBD)のモデルとして認められている。罹患動物は潰瘍性大腸炎と同様の病態生理を呈し、結腸に同様の組織学的変化が観察され、ヒトとCTTに共通の後遺症は、結腸癌である。CTTにおける結腸炎は、結腸炎相における、また結腸癌による、罹患率及び死亡率に関連する。結腸炎の特徴は、緩解を伴う症状の反復突発である。病気の期間は、個体間での変動がかなりあるものの、一般に約4週間続く。臨床的症状としては、便に出血、消化不良/吸収不良症候群を伴う下痢が挙げられる。この疾病の特徴は、組織学的には、大腸の粘膜上皮細胞への好中球の浸潤であり、この浸潤には、腸管陰窩の形態に対する進行性退化性変化が伴い、この変化によって、この疾病の進行段階の診断できる。原因は不明であるが、おそらく食餌性及び感染性の作用因子が一役を果たしており、ほぼ確実に状態の悪化につながる。
生存動物の、個々及びグループの平均体重変化ならびにグループ平均体重を、パーセント表示でプロットした。処理区及び対照区に対して、すべての時点について統計分析(一元配置分散分析)を行った。**は、第1段階試験の55週目において、処理動物が対照動物と比べて、統計的に有意の体重変化を示した(p<0.01)ことを表す。矢印は投薬スケジュールを表す。
対照区及び処理区について、生存動物の毎週の平均下痢スコア(5週日(5平日)の平均)をプロットした。対照区及び処理区について、毎週の平均下痢スコアのグループ平均、及び毎週の下痢スコアのグループ平均を、投薬開始直前の1週目を基線としてプロットした。矢印は投薬スケジュールを表す。
対照区及び処理区について、生存動物の好中球の浸潤(3病理生体組織検査試料の平均)を表す活性スコアをプロットした。活性スコアのグループ平均、及び毎週の活性スコア変化のグループ平均のパーセント表示を、第1段階については投薬開始前の1週目を、第2段階については2週目を基線としてプロットした。矢印は投薬スケジュールを表す。
対照区及び処理区について、生存動物の陰窩の喪失及び腺状構造における変化(3生体組織検査試料の平均)を含む結腸形態の恒久的変化の程度を表す慢性化スコアを、プロットした。グループ平均活性スコア、及びグループ平均の毎週の慢性化スコア変化のパーセント表示を、第1段階については投薬開始前の1週目を、第2段階については投薬開始前の2週目を、基線としてプロットした。矢印は投薬スケジュールを表す。
対照区及び処理区について、生存動物の細胞組織及び間質組織を含む粘膜組織の厚さの異常増大(3生体組織検査試料の平均)を表す過形成スコアをプロットした。グループ平均活性スコア、及びグループ平均の毎週の過形成スコア変化のパーセント表示を、第1段階については投薬開始前の1週目を、第2段階については投薬開始前の2週目を、基線としてプロットした。矢印は投薬スケジュールを表す。
図12Aは第1段階試験、図12Bは第2段階試験、におけるCPI−1697処理動物のPAHA応答相対レベルを示すグラフである。
Claims (64)
- ヒト化抗体又は完全ヒト抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害する抗I型インターフェロン受容体抗体を含む、炎症性腸疾患の治療薬。
- 前記抗I型インターフェロン受容体抗体がCPI−1697である、請求項1に記載の治療薬。
- 前記炎症性腸疾患がセリアック病である、請求項1又は2に記載の治療薬。
- 前記炎症性腸疾患がクローン病である、請求項1又は2に記載の治療薬。
- 前記炎症性腸疾患が潰瘍性大腸炎である、請求項1又は2に記載の治療薬。
- 静脈内大量瞬時投与、静脈内大量低速投与、注入からなる群より選ばれる経路によって投与される、請求項1から5いずれか記載の治療薬。
- 皮下、筋肉内、経皮、皮内、静脈内からなる群より選ばれる経路によって投与される、請求項1から5いずれか記載の治療薬。
- 粘膜送達により投与される、請求項1から5いずれか記載の治療薬。
- 吸入により投与される、請求項1から5いずれか記載の治療薬。
- 鼻咽頭より投与される、請求項1から5いずれか記載の治療薬。
- 経口により投与される、請求項1から5いずれか記載の治療薬。
- 前記抗I型インターフェロン受容体抗体が、体重1kgあたり、0.1mg以上50mg以下の投与量で投与される、請求項1から11いずれか記載の治療薬。
- 前記抗I型インターフェロン受容体抗体が、体重1kgあたり、0.5mg以上10mg以下の投与量で投与される、請求項12記載の治療薬。
- 前記抗I型インターフェロン受容体抗体が、体重1kgあたり、2mg以上5mg以下の投与量で投与される、請求項13記載の治療薬。
- 1回/日以上1回/月以下の頻度で投与される、請求項1から14いずれか記載の治療薬。
- 2回/週以上2回/隔週以下の頻度で投与される、請求項15記載の治療薬。
- 1回/週程度の頻度で投与される、請求項15記載の治療薬。
- アザチオプリン、メトトレキセート、シクロスポリン、FK506、ラパマイシン、及びミコフェノール酸モフェチルからなる群より選ばれる免疫抑制剤、5−アミノサリチル酸、スルファサラジン、及びオルサラジンからなる群より選ばれる抗炎症剤、PVAC、抗CD40リガンド、抗CD40、ナタリズマブ、抗VCAM1、及び抗ICAM1からなる群より選ばれる免疫調整剤、インフリキシマブ、エタナーセプト、アダリムマブ、及びCDP870からなる群より選ばれるTNF拮抗物質、ステロイド、並びにサイトカインからなる群より選ばれる第二治療薬と同時に又は連続して投与される、請求項1から17いずれか記載の治療薬。
- (a)第一薬剤が、第一の時点で寛容量投与される抗I型インターフェロン受容体抗体を含む薬剤であり、(b)第二薬剤が、第二の時点で治療有効量投与される抗I型インターフェロン抗体を含む薬剤である、第一薬剤及び第二薬剤からなる炎症性腸疾患の治療用の薬剤の組み合わせ。
- 治療有効量の抗I型インターフェロン抗体を含む第二薬剤の投与の前に、抗I型インターフェロン受容体抗体を含む第一薬剤が寛容量投与される、第一薬剤及び第二薬剤からなる炎症性腸疾患の治療用の薬剤の組み合わせ。
- 前記抗I型インターフェロン受容体抗体がCPI−1697である、請求項19又は20に記載の薬剤の組み合わせ。
- 前記第一薬剤が、前記抗I型インターフェロン受容体抗体の反復投与に対するIgG抗体応答の誘導を阻害又は低減可能な充分量の抗I型インターフェロン受容体抗体を含む請求項19から21いずれか記載の治療用の薬剤の組み合わせ。
- 前記抗I型インターフェロン受容体抗体の前記寛容量は、体重1kgあたり、10mg以上50mg以下である請求項19から22いずれか記載の治療用の薬剤の組み合わせ。
- 前記抗I型インターフェロン受容体抗体の前記寛容量は、体重1kgあたり、20mg以上40mg以下である請求項23記載の治療用の薬剤の組み合わせ。
- 前記抗I型インターフェロン受容体抗体の前記寛容量は、体重1kgあたり、20mg以上25mg以下である請求項24記載の治療用の薬剤の組み合わせ。
- 前記抗I型インターフェロン抗体の前記治療有効量は、体重1kgあたり、0.1mg以上10mg以下である請求項19から25いずれか記載の治療用の薬剤の組み合わせ。
- 前記抗I型インターフェロン抗体の前記治療有効量は、体重1kgあたり、0.2mg以上5mg以下である請求項26記載の治療用の薬剤の組み合わせ。
- 前記抗I型インターフェロン抗体の前記治療有効量は、体重1kgあたり、0.5mg以上2mg以下である請求項26記載の治療用の薬剤の組み合わせ。
- ヒト化抗体又は完全ヒト抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害する抗I型インターフェロン受容体抗体を含み、薬剤の投与の結果、対照区と比較した場合に好中球の浸潤が減少する、炎症性腸疾患の治療薬。
- ヒト化抗体又は完全ヒト抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害する抗I型インターフェロン受容体抗体を含み、薬剤の投与の結果、対照区と比較した場合に結腸形態が改善する、炎症性腸疾患の治療薬。
- ヒト化抗体又は完全ヒト抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害する抗I型インターフェロン受容体抗体を含み、薬剤の投与の結果、対照区と比較した場合に粘膜組織の厚さが減少する、炎症性腸疾患の治療薬。
- ヒト化抗体又は完全ヒト抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害する抗I型インターフェロン受容体抗体を含み、薬剤の投与の結果、対照区と比較した場合に体重増加を示す、炎症性腸疾患の治療薬。
- 前記抗I型インターフェロン受容体抗体がCPI−1697である、請求項29から32いずれか記載の治療薬。
- 抗I型インターフェロン受容体抗体が、ヒト化抗体又は完全ヒト化抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害するものである、
炎症性腸疾患に罹患している患者における炎症性腸疾患治療用の薬剤の調製のための抗I型インターフェロン受容体抗体の使用。 - 前記炎症性腸疾患がセリアック病である、請求項34に記載の使用。
- 前記炎症性腸疾患がクローン病である、請求項34に記載の使用。
- 前記炎症性腸疾患が潰瘍性大腸炎である、請求項34に記載の使用。
- 前記薬剤が、静脈内大量瞬時投与、静脈内大量低速投与、注入からなる群より選ばれる経路によって投与される、請求項34から37いずれか記載の使用。
- 前記薬剤が、皮下、筋肉内、経皮、静脈内からなる群より選ばれる経路によって投与される、請求項34から37いずれか記載の使用。
- 前記薬剤が、粘膜送達により投与される、請求項34から37いずれか記載の使用。
- 前記薬剤が、吸入により投与される、請求項34から37いずれか記載の使用。
- 前記薬剤が、鼻咽頭より投与される、請求項34から37いずれか記載の使用。
- 前記薬剤が、経口により投与される、請求項34から37いずれか記載の使用。
- 前記抗I型インターフェロン受容体抗体が、体重1kgあたり、0.1mg以上50mg以下の投与量で投与される、請求項34から43いずれか記載の使用。
- 前記抗I型インターフェロン受容体抗体が、体重1kgあたり、0.5mg以上10mg以下の投与量で投与される、請求項44記載の使用。
- 前記抗I型インターフェロン受容体抗体が、体重1kgあたり、2mg以上5mg以下の投与量で投与される、請求項45記載の使用。
- 前記薬剤が、1回/日以上1回/月以下の頻度で投与される、請求項34から46いずれか記載の使用。
- 前記薬剤が、2回/週以上2回/隔週以下の頻度で投与される、請求項47記載の使用。
- 前記薬剤が、1回/週程度の頻度で投与される、請求項47記載の使用。
- 前記薬剤が、アザチオプリン、メトトレキセート、シクロスポリン、FK506、ラパマイシン、及びミコフェノール酸モフェチルからなる群より選ばれる免疫抑制剤、5−アミノサリチル酸、スルファサラジン、及びオルサラジンからなる群より選ばれる抗炎症剤、PVAC、抗CD40リガンド、抗CD40、ナタリズマブ、抗VCAM1、及び抗ICAM1からなる群より選ばれる免疫調整剤、インフリキシマブ、エタナーセプト、アダリムマブ、及びCDP870からなる群より選ばれるTNF拮抗物質、ステロイド、並びにサイトカインからなる群より選ばれる第二治療薬と同時に又は連続して投与される、請求項34から49いずれか記載の使用。
- (a)第一薬剤が、第一の時点で寛容量投与される抗I型インターフェロン受容体抗体を含む薬剤であり、(b)第二薬剤が、第二の時点で治療有効量投与される抗I型インターフェロン抗体を含む薬剤である、第一薬剤及び第二薬剤からなる炎症性腸疾患に罹患している患者における炎症性腸疾患治療用の薬剤の組み合わせの調製のための抗I型インターフェロン受容体抗体の使用。
- 治療有効量の抗I型インターフェロン抗体を含む第二薬剤の投与の前に、抗I型インターフェロン受容体抗体を含む第一薬剤が寛容量投与される、第一薬剤及び第二薬剤からなる炎症性腸疾患の治療用の薬剤の組み合わせの調製のための抗I型インターフェロン受容体抗体の使用。
- 前記第一薬剤が、前記抗I型インターフェロン受容体抗体の反復投与に対するIgG抗体応答の誘導を阻害又は低減可能な充分量の抗I型インターフェロン受容体抗体を含む、請求項51又は52記載の使用。
- 前記抗I型インターフェロン受容体抗体の前記寛容量は、体重1kgあたり、10mg以上50mg以下である請求項51から53いずれか記載の使用。
- 前記抗I型インターフェロン受容体抗体の前記寛容量は、体重1kgあたり、20mg以上40mg以下である請求項54記載の使用。
- 前記抗I型インターフェロン受容体抗体の前記寛容量は、体重1kgあたり、20mg以上25mg以下である請求項55記載の使用。
- 前記抗I型インターフェロン抗体の前記治療有効量は、体重1kgあたり、0.1mg以上10mg以下である請求項51から56いずれか記載の使用。
- 前記抗I型インターフェロン抗体の前記治療有効量は、体重1kgあたり、0.2mg以上5mg以下である請求項57記載の使用。
- 前記抗I型インターフェロン抗体の前記治療有効量は、体重1kgあたり、0.5mg以上2mg以下である請求項57記載の使用。
- 抗I型インターフェロン受容体抗体が、ヒト化抗体又は完全ヒト化抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害するものであり、
薬剤の投与の結果、対照区と比較した場合に好中球の浸潤が減少する、
炎症性腸疾患に罹患している患者における炎症性腸疾患治療用の前記薬剤の調製のための抗I型インターフェロン受容体抗体の使用。 - 抗I型インターフェロン受容体抗体が、ヒト化抗体又は完全ヒト化抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害するものであり、
薬剤の投与の結果、対照区と比較した場合に結腸形態が改善する、
炎症性腸疾患に罹患している患者における炎症性腸疾患治療用の前記薬剤の調製のための抗I型インターフェロン受容体抗体の使用。 - 抗I型インターフェロン受容体抗体が、ヒト化抗体又は完全ヒト化抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害するものであり、
薬剤の投与の結果、対照区と比較した場合に粘膜組織の厚さが減少する、
炎症性腸疾患に罹患している患者における炎症性腸疾患治療用の前記薬剤の調製のための抗I型インターフェロン受容体抗体の使用。 - 抗I型インターフェロン受容体抗体が、ヒト化抗体又は完全ヒト化抗体であり、且つ、インターフェロンα、インターフェロンβ、及び、インターフェロンωのI型インターフェロン受容体への結合を阻害するものであり、
薬剤の投与の結果、対照区と比較した場合に体重増加を示す、
炎症性腸疾患に罹患している患者における炎症性腸疾患治療用の前記薬剤の調製のための抗I型インターフェロン受容体抗体の使用。 - 抗I型インターフェロン受容体抗体がCPI−1697である、請求項34、51、52、60、61、62、又は63記載の使用。
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