IQ Webinar: Therapeutic Protein-Drug Interactions (TP-DIs): An IQ white paper
April 13, 2023
Sponsored by TALG
Presented by Therapeutic Protein Drug Interaction White Paper Working Group
Speaker: David Coutant, Eli Lilly
Moderator: Kathy Cox, Eli Lilly
This webinar, based on the recently published IQ TP-DI white paper, (https://doi.org/10.1002/cpt.2814), discusses the various types of TP-DIs involving mechanisms such as changes in disease state, target-mediated drug disposition, neonatal Fc receptor (FcRn), or antidrug antibodies formation. Typically, therapeutic proteins (TPs) have a low risk for eliciting meaningful drug interactions (DIs). However, there are select instances where TP drug interactions (TP-DIs) of clinical concern can occur. The nature of TP drug interaction being investigated should determine whether the examination is conducted as a standalone TP–DI study in healthy participants, in patients, or assessed via population pharmacokinetic analysis. Dis involving antibody–drug conjugates are discussed briefly, but the primary focus here will be DIs involving cytokine modulation. Cytokine modulation can occur directly by certain TPs, or indirectly due to moderate to severe inflammation, infection, or injury. Disease states that have been shown to result in indirect disease–DIs that are clinically meaningful will be discussed (i.e., typically a twofold change in the systemic exposure of a co-administered sensitive cytochrome P450 substrate drug). Type of disease and severity of inflammation should be the primary drivers for risk assessment for disease–DIs. While more clinical inflammatory marker data needs to be collected, the use of two or more clinical inflammatory markers (such as C-reactive protein, albumin, or interleukin 6) may help broadly categorize whether the predicted magnitude of inflammatory disease–DI risk is negligible, weak, or moderate to strong. Based on current knowledge, clinical DI studies are not necessary for all TPs, and should no longer be conducted in certain disease patient populations such as psoriasis, which do not have sufficient systemic inflammation to cause a meaningful indirect disease–DI.