Phase IIa trial in Duchenne muscular dystrophy shows vamorolone is a first-in-class dissociative steroidal anti-inflammatory drug

Laurie S. Conklin, Jesse M. Damsker, Eric P. Hoffman, William J. Jusko, Panteleimon D. Mavroudis, Benjamin D. Schwartz, Laurel J. Mengle-Gaw, Edward C. Smith, Jean K. Mah, Michela Guglieri, Yoram Nevo, Nancy Kuntz, Craig M. McDonald, Mar Tulinius, Monique M. Ryan, Richard Webster, Diana Castro, Richard S. Finkel, Andrea L. Smith, Lauren P. MorgenrothAdrienne Arrieta, Maya Shimony, Mark Jaros, Phil Shale, John M. McCall, Yetrib Hathout, Kanneboyina Nagaraju, John van den Anker, Leanne M. Ward, Alexandra Ahmet, Michaelyn R. Cornish, Paula R. Clemens

Research output: Contribution to journalArticle

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Abstract

We report a first-in-patient study of vamorolone, a first-in-class dissociative steroidal anti-inflammatory drug, in Duchenne muscular dystrophy. This 2-week, open-label Phase IIa multiple ascending dose study (0.25, 0.75, 2.0, and 6.0 mg/kg/day) enrolled 48 boys with Duchenne muscular dystrophy (4 to <7 years), with outcomes including clinical safety, pharmacokinetics and pharmacodynamic biomarkers. The study design included pharmacodynamic biomarkers in three contexts of use: 1. Secondary outcomes for pharmacodynamic safety (insulin resistance, adrenal suppression, bone turnover); 2. Exploratory outcomes for drug mechanism of action; 3. Exploratory outcomes for expanded pharmacodynamic safety. Vamorolone was safe and well-tolerated through the highest dose tested (6.0 mg/kg/day) and pharmacokinetics of vamorolone were similar to prednisolone. Using pharmacodynamic biomarkers, the study demonstrated improved safety of vamorolone versus glucocorticoids as shown by reduction of insulin resistance, beneficial changes in bone turnover (loss of increased bone resorption and decreased bone formation only at the highest dose level), and a reduction in adrenal suppression. Exploratory biomarkers of pharmacodynamic efficacy showed an anti-inflammatory mechanism of action and a beneficial effect on plasma membrane stability, as demonstrated by a dose-responsive decrease in serum creatine kinase activity. With an array of pre-selected biomarkers in multiple contexts of use, we demonstrate the development of the first dissociative steroid that preserves anti-inflammatory efficacy and decreases steroid-associated safety concerns. Ongoing extension studies offer the potential to bridge exploratory efficacy biomarkers to clinical outcomes.

Original languageEnglish (US)
Pages (from-to)140-150
Number of pages11
JournalPharmacological Research
Volume136
DOIs
StatePublished - Oct 1 2018

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Duchenne Muscular Dystrophy
Anti-Inflammatory Agents
Biomarkers
Safety
Pharmaceutical Preparations
Bone Remodeling
Insulin Resistance
Pharmacokinetics
Steroids
Creatine Kinase
Bone Resorption
Prednisolone
Osteogenesis
Glucocorticoids
Cell Membrane
Serum

ASJC Scopus subject areas

  • Pharmacology

Cite this

Conklin, L. S., Damsker, J. M., Hoffman, E. P., Jusko, W. J., Mavroudis, P. D., Schwartz, B. D., ... Clemens, P. R. (2018). Phase IIa trial in Duchenne muscular dystrophy shows vamorolone is a first-in-class dissociative steroidal anti-inflammatory drug. Pharmacological Research, 136, 140-150. https://doi.org/10.1016/j.phrs.2018.09.007

Phase IIa trial in Duchenne muscular dystrophy shows vamorolone is a first-in-class dissociative steroidal anti-inflammatory drug. / Conklin, Laurie S.; Damsker, Jesse M.; Hoffman, Eric P.; Jusko, William J.; Mavroudis, Panteleimon D.; Schwartz, Benjamin D.; Mengle-Gaw, Laurel J.; Smith, Edward C.; Mah, Jean K.; Guglieri, Michela; Nevo, Yoram; Kuntz, Nancy; McDonald, Craig M.; Tulinius, Mar; Ryan, Monique M.; Webster, Richard; Castro, Diana; Finkel, Richard S.; Smith, Andrea L.; Morgenroth, Lauren P.; Arrieta, Adrienne; Shimony, Maya; Jaros, Mark; Shale, Phil; McCall, John M.; Hathout, Yetrib; Nagaraju, Kanneboyina; van den Anker, John; Ward, Leanne M.; Ahmet, Alexandra; Cornish, Michaelyn R.; Clemens, Paula R.

In: Pharmacological Research, Vol. 136, 01.10.2018, p. 140-150.

Research output: Contribution to journalArticle

Conklin, LS, Damsker, JM, Hoffman, EP, Jusko, WJ, Mavroudis, PD, Schwartz, BD, Mengle-Gaw, LJ, Smith, EC, Mah, JK, Guglieri, M, Nevo, Y, Kuntz, N, McDonald, CM, Tulinius, M, Ryan, MM, Webster, R, Castro, D, Finkel, RS, Smith, AL, Morgenroth, LP, Arrieta, A, Shimony, M, Jaros, M, Shale, P, McCall, JM, Hathout, Y, Nagaraju, K, van den Anker, J, Ward, LM, Ahmet, A, Cornish, MR & Clemens, PR 2018, 'Phase IIa trial in Duchenne muscular dystrophy shows vamorolone is a first-in-class dissociative steroidal anti-inflammatory drug', Pharmacological Research, vol. 136, pp. 140-150. https://doi.org/10.1016/j.phrs.2018.09.007
Conklin, Laurie S. ; Damsker, Jesse M. ; Hoffman, Eric P. ; Jusko, William J. ; Mavroudis, Panteleimon D. ; Schwartz, Benjamin D. ; Mengle-Gaw, Laurel J. ; Smith, Edward C. ; Mah, Jean K. ; Guglieri, Michela ; Nevo, Yoram ; Kuntz, Nancy ; McDonald, Craig M. ; Tulinius, Mar ; Ryan, Monique M. ; Webster, Richard ; Castro, Diana ; Finkel, Richard S. ; Smith, Andrea L. ; Morgenroth, Lauren P. ; Arrieta, Adrienne ; Shimony, Maya ; Jaros, Mark ; Shale, Phil ; McCall, John M. ; Hathout, Yetrib ; Nagaraju, Kanneboyina ; van den Anker, John ; Ward, Leanne M. ; Ahmet, Alexandra ; Cornish, Michaelyn R. ; Clemens, Paula R. / Phase IIa trial in Duchenne muscular dystrophy shows vamorolone is a first-in-class dissociative steroidal anti-inflammatory drug. In: Pharmacological Research. 2018 ; Vol. 136. pp. 140-150.
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abstract = "We report a first-in-patient study of vamorolone, a first-in-class dissociative steroidal anti-inflammatory drug, in Duchenne muscular dystrophy. This 2-week, open-label Phase IIa multiple ascending dose study (0.25, 0.75, 2.0, and 6.0 mg/kg/day) enrolled 48 boys with Duchenne muscular dystrophy (4 to <7 years), with outcomes including clinical safety, pharmacokinetics and pharmacodynamic biomarkers. The study design included pharmacodynamic biomarkers in three contexts of use: 1. Secondary outcomes for pharmacodynamic safety (insulin resistance, adrenal suppression, bone turnover); 2. Exploratory outcomes for drug mechanism of action; 3. Exploratory outcomes for expanded pharmacodynamic safety. Vamorolone was safe and well-tolerated through the highest dose tested (6.0 mg/kg/day) and pharmacokinetics of vamorolone were similar to prednisolone. Using pharmacodynamic biomarkers, the study demonstrated improved safety of vamorolone versus glucocorticoids as shown by reduction of insulin resistance, beneficial changes in bone turnover (loss of increased bone resorption and decreased bone formation only at the highest dose level), and a reduction in adrenal suppression. Exploratory biomarkers of pharmacodynamic efficacy showed an anti-inflammatory mechanism of action and a beneficial effect on plasma membrane stability, as demonstrated by a dose-responsive decrease in serum creatine kinase activity. With an array of pre-selected biomarkers in multiple contexts of use, we demonstrate the development of the first dissociative steroid that preserves anti-inflammatory efficacy and decreases steroid-associated safety concerns. Ongoing extension studies offer the potential to bridge exploratory efficacy biomarkers to clinical outcomes.",
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AU - Hoffman, Eric P.

AU - Jusko, William J.

AU - Mavroudis, Panteleimon D.

AU - Schwartz, Benjamin D.

AU - Mengle-Gaw, Laurel J.

AU - Smith, Edward C.

AU - Mah, Jean K.

AU - Guglieri, Michela

AU - Nevo, Yoram

AU - Kuntz, Nancy

AU - McDonald, Craig M.

AU - Tulinius, Mar

AU - Ryan, Monique M.

AU - Webster, Richard

AU - Castro, Diana

AU - Finkel, Richard S.

AU - Smith, Andrea L.

AU - Morgenroth, Lauren P.

AU - Arrieta, Adrienne

AU - Shimony, Maya

AU - Jaros, Mark

AU - Shale, Phil

AU - McCall, John M.

AU - Hathout, Yetrib

AU - Nagaraju, Kanneboyina

AU - van den Anker, John

AU - Ward, Leanne M.

AU - Ahmet, Alexandra

AU - Cornish, Michaelyn R.

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