week 6 Flashcards

1
Q

Over the years, what does the industry tend to do?

A

Compartmentalise activities

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2
Q

How do we adopt a more integrated thinking approach?

A

Understanding concentration at the active site

e.g. CNS

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3
Q

What is pharmacodynamics?

A

Both efficacy and safety

all part of the same biological continuent

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4
Q

Define pharmacokinetics

A
  1. The study of the effect of the body on the drug

2. medicinal chemistry

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5
Q

Define pharmacodyanmics

A
  1. The study of the effect of the drug on the body

2. biology - good and bad

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6
Q

What impacts half life that drives dose regimens?

A
  1. Volume of distribution

2. Clearance

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7
Q

What defines the oral bioavailibility?

A
  1. Clearance

2. Absorption for oral drugs

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8
Q

What are the key questions for integrated thinking?

A
  1. Can we detect?
  2. Are we achieving?
  3. Can we observe?
  4. Can we measure?
  5. Can we demonstrate
  6. Does all this translate to a disease response?
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9
Q

What is an example of the key questions for integrating thinking?

A
  1. Expression of the target and/or activity of the pathway
  2. Active blood or tissue concentrations
  3. Activity on the desired molecular target
  4. modulation of the desired biochemical pathway
  5. Achievement of the desired biological effect
  6. Disease response
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10
Q

Where do we live in?

A
  1. one-click world
  2. Everything is instant
  3. we order instantly
  4. get decisions instantly
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11
Q

What is important in biology and also designing the safety study?

A
  1. look for a patient response

2. can I get signal efficacy in a week? or is it up to 6 months of dosing?

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12
Q

What is the biological turnover rates of Structure or Functions?

A
  1. Electrical signals (msec)
  2. Neurotransmitters (msec)
  3. Chemical signals (min)
  4. Mediators, Electrolytes (min)
  5. Hormones (hr)
  6. MRNA (hr)
  7. Proteins/enzyme (hr)
  8. Cells (days)
  9. Tissues (months)
  10. Organs (year)
  11. Person (Century)
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13
Q

What does the pharmacodynamics look at?

A
  1. Biological effect over time

2. concentration vs effect - represented in a simple sigmoidal E-max response

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14
Q

What does pharmacokinetics look at ?

A
  1. Integration of concentration over time
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15
Q

What do we need to have an understanding of in terms of PK/PD study?

A

How the magnitude and time scale of biological effect relates to drug concentration in a biophase which is blood/plasma for convenience

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16
Q

What can PK/PD modelling and stimulation be used an?

A
  1. Applied science tool to provide answers on efficacy and safety of new drugs faster and at a lower cost
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17
Q

where can PK/PD modelling be used in?

A

preclinical phase through all clinical phases of drug development

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18
Q

What does optimal use of PK/PD modelling and stimulation lead to?

A
  1. Fewer failed compounds
  2. Fewer study failures
  3. Smaller number of studies needed for registration
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19
Q

How can PK/PD modelling fulfil its potential in drug development?

A

It needs to be embraced across the industry and regulatory agency

more education on this topic is required

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20
Q

What is PK/PD model?

A

combines two classical pharmacologic disciplines of pharmacokinetic and pharmacodynamic

  1. it integrates both these into one set of mathemathical expression that allows decription of time course of effect intensity in response to administration of a drug dose
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21
Q

when can we utilise PK/PD modelling and stimulation?

A

models should be developed early in programme development

during the preclinical phase

such models are continously updated and refined as more data becomes available

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22
Q

when can PK/PD modelling offer the greatest value?

A

if preclinical data can be modelled in combination with existing clinical data on related compounds

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23
Q

what are potential benefits of modelling in preclinical phase?

A
  1. selecting the optimal compound
  2. predicting clinical potency estimates (EC50)
  3. providing the guidance for the dose range to be tested in early clinical trials
  4. providing guidance for optimal sampling
  5. predicting oral bioavailibility
  6. predicting hepatic clearance
  7. assessing the potential for drug-drug interactions
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24
Q

what should PK/PD model include?

A
  1. rate-limiting component from the mechanism of action

2. e.g. receptor binding, protein synthesis

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25
Q

What affects a model predictivity?

A
  1. protein binding
  2. receptor occupancy (species difference)
  3. Active metabolites
  4. Competitive endogenous ligands
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26
Q

What is prediction of PK/PD?

A

look at human efficacy and dose based on data

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27
Q

What is comparison of PK/PD?

A

simple at in-vitro level comparing IC50 across a range of compounds

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28
Q

What is PK/PD?

A

Funneling approach

look very early on a simple IC50 in a cellular expression system

or simple whole blood system

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29
Q

what are the four basic attributes to characterise PK/PD models?

A
  1. link between measured concentration and the pharmacologic response mechanism that mediate observed effect, direct vs indirect response
  2. the response mechanism that mediates the observed effect, direct vs indirect response
  3. the information used to establish link between measured concentration and observed effect
  4. time dependency of involved pharmacodynamic parameters
    e. g. time variants vs time invariant
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30
Q

define disposition

A

What happens to the drug after it enters the body, including distribution and elimination process

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31
Q

What is biosignal?

A

Any signal in human being that can be continually measured and monitored e.g. ECG

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32
Q

What is sensitivity analysis?

A

determines how different values of independent variable affect a particular dependent variable under a given sit of assumptions

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33
Q

What is done in a healthy male volunteers?

A

Studies for a small molecule thats being delivered orally

34
Q

What is the cornerstone of drug registration package?

A
  1. clinical outcome
  2. response
  3. biomarkers that drive response
  4. defining clinical therapeutic index
35
Q

what is PK/PD?

A

Interdisciplinary effort

36
Q

What is pre-clinical PKPD?

A
  1. development of mechanism based models
  2. Evaluation of in-vivo potency vs intrinsic activity
  3. Identification of bio/surrogate markers of efficacy
37
Q

What is Translational PK/PD?

A
  1. extrapolation of preclinical data to humans
  2. prediction/understanding of therapeutic concentration
  3. prediction of human pharmacokinetics
  4. Prediction of clinical dose and dose regimen
38
Q

What is clinical PK/PD?

A
  1. characterise dose/concentration effect relationship
  2. understand clinical risk vs benefit
  3. define clinical therapeutic index
  4. support drug registration
39
Q

What drives pharmacodynamics?

A

pharmacokinetics

40
Q

what drives drug-drug interactions?

A

Huge margins

41
Q

What does a lot of data suggest?

A

The greater the dose the greater the drug-drug interaction

42
Q

what is the PK parameters?

A
  1. Allometric modelling
  2. physiological scaling
  3. In-vitro (mics, s9, heps)
  4. simCYP/Gastroplus
  5. pb/pk modelling
43
Q

what does predicted concentration and dose in man impact?

A
  1. impact on TI
  2. safety
  3. hERG
  4. DDI and reactive metabolites
  5. MABEL
  6. impacts on CoG
  7. impacts on tablet size
44
Q

What is CNS penetration broken down into?

A
  1. Permeability
  2. P-gp liability
  3. Free concentrations
45
Q

How is CNS commonly measured?

A
  1. Caco2
  2. LLC-PK1
  3. MDCK cells
46
Q

What is used for CNS drugs?

A

Papp > 150-200 nm/s (optimal)

47
Q

What is P-gp liability?

A

Efflux transporters in drug transport in many organs

48
Q

What is essential for P-gp liability?

A

P-gp Efflux index < 2.5-3

49
Q

Free concentrations

A
  1. in blood
  2. in brain

link with efficacy

50
Q

Rat brain:blood ratios

A

Intravenous infusions for about 3-4 hours so that the concentration of blood and brain are at a steady state

51
Q

When looking at cascades what do we need to consider?

A

In-vitro potency and selectivity and screen all that and put some functional assays –> developed ability assay

52
Q

What is a classical animal model?

A

Collagen induced arthritis model in a rat

53
Q

how do we define what is needed for a compound?

A

you need 75% receptor occupancy at target coverage

54
Q

What will reduce during drug discovery?

A

Therapeutic index

55
Q

What are the candidate selection criteria?

A
  1. Where do we need the compound to get to
  2. How fast do we need it to get there
  3. How long do we need to keep it there
  4. How much do we need
  5. Can we do it safely
56
Q

What 3 fundamental element need to be demonstrated for a development candidate to have a potential to elicit the desired effect over period of time?

A
  1. Exposure at target site of action over a desired period of time
  2. Binding to the pharmacological target as expected for its mode of action
  3. Expression of pharmacological activity
57
Q

Exposure at the target site of action

A

Demonstration of free drug exposure at the target site of action at a level that exceeds pharmacological potency over desired period of time

drug exposure is measured using blood samples

58
Q

Binding to the pharmacological target

A

The highest level of confidence and direct evidence at site of action required levels of target binding

59
Q

What is stated in the literature?

A

The industry is very poor for selecting drug targets to work on

60
Q

What treats a small number of patients with cystic fibrosis with a G551D mutation?

A

Drug Caladako

61
Q

Why has the value of animal experiments for predicting effectiveness of treatment strategies in clinical trials remained controversial?

A
  1. recurrent failure of interventions to translate to the clinic
62
Q

How can translational failure be explained by?

A
  1. methodological flaws in animal studies
  2. lead to systematic bias and thereby inadequate data
  3. incorrect conclusions and efficacy
63
Q

What may aid the selection of the most promising treatment strategies for clinical trials?

A
  1. systemic review

2. meta analysis of animal studies

64
Q

What is Ceff?

A

the drug concentration or that exposure on which the compound is predicted to be unequivocally efficacious

65
Q

What should Ceff provide?

A

near maximal clinical efficacy

clinically differentiated profile

66
Q

What are examples of understanding the drive which drives the critical decisions?

A
  1. doses for preclinical safety studies
  2. Therapeutic index
  3. predicted first in human doses
  4. drug-drug interaction potential
  5. drug delivery factors
67
Q

Where is there no pre-clinical model for?

A

Alzheimer’s disease

68
Q

What is the default to no-regrets approach?

A
  1. maintain 80-90% target engagement at C-trough (antagonist) sometimes even higher (chemokines)
  2. Understanding pharmacology and concentration vs response is essential
  3. majority of compounds are well described by a sigmoidal Emax model
69
Q

What obeys a sigmoidal condition?

A
  1. Safety

2. Efficacy

70
Q

What is Rheumatoid Arthritis?

A

Chronic autoimmune disease affecting the joints

swelling of the synovial membrane

71
Q

What does RA affect?

A

1% of the population

reduces life expectancy by 10 years

72
Q

What is SoC of RA?

A

pain – NDSAIDs, steroids
disease modifying: sulfasalazine, methotrexate, anti-TNF’s (Embrel,
Humara)

73
Q

What is Janus Kinases (JAK’S)?

A

soluble cytokines play a major role in controlling immune
response and inflammation
JAKs (1,2,3 and TYK2) critical components of cytokine
mediated effects via the JAK-STAT (Signal Transducers and
Activators of Transcription) pathway
selective interruption of this signalling could be beneficial
- “shut down the immune system”

74
Q

What was CP-690550: toacitinib developed as ?

A

immune suppression

shuts down immune system to prevent tissue rejection

75
Q

What is CP-690550 selective and non-selective for?

A
  1. It is very selective for JAK1/3 with IC50 = 56nM

4. It Is very non-selective for JAK2/2 – It is a pathway you do not want to interfere with

76
Q

what is ARC70 score?

A

you want 70% of response in patient population

77
Q

What drives the effect?

A

Average concentration

78
Q

What is the problem with Tofacitinib?

A

it is more efficacious at more higher dosage

79
Q

What is proof of concept?

A
  1. Appropriate patient group identified
  2. Correct dose used
  3. Appropriate endpoints measured
80
Q

What is proof of mechanism? (PoM)?

A
  1. Incontrovertible and conclusive proof of target engagement
  2. Defined dose response: safety and efficacy