General disorders and administration site conditions
4
Ankle edema
2
Erythema
1
Limb edema
1
Infections and infestations
7
Herpes simplex infection
1
1
Hordeolum
1
Inguinal abscess
1
SARS-CoV-2 infection
1
Shingles
1
Vaginal mycosis
1
Injury, poisoning, and procedural complications
1
Sprain
1
Investigations
2
Increased intraocular pressure
1
1
Musculoskeletal and connective tissue disorders
5
Arthralgia
1
2
Groin pain
1
Myalgia
1
Nervous system disorders
22
Autoimmune encephalomyelitis#
1
Dizziness
1
Headache
6
Lethargy
8
4
Paresis
1
Paresthesia
1
Psychiatric disorders
2
Insomnia
1
1
Reproductive system and breast disorders
3
Irregular menstruation
3
Skin and subcutaneous tissue disorders
1
Neurodermatitis
1
Vascular disorders
2
Hypertension
1
1
Total number of adverse events
38
23
Total number of patients with adverse events (%)
15/19 (78.95)
11/12 (91.67)
Total number of patients with serious adverse events (%)
2/19 (10.52)
0/12 (0.00)
# Adverse event classified as serious adverse event. n: number of patients/events. LLT: lower limit term; mAb: monoclonal antibody; MedDRA: Medical Dictionary for Regulatory Activities; SOC: system organ class
GJK consults for Immunovant, Inc., New York City, NY, USA. The other authors declare that they have no conflicts of interest.
Ethical approval
The ASCEND GO 2 study was approved by the leading Ethics Committee (Rhineland Palatinate, 2019-14297-AMG).
Consent to participate
Informed consent to participate in the study was obtained from all participants.
Consent to publication
Not applicable.
Availability of data and materials
The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.
Funding
The JGU Medical Center receives research-associated funding from Immunovant, Inc., New York City, NY, USA [lmmunovant IMV-02524]. The funders had no role in the design of the submitted study, data collection and analysis, decision to publish, or preparation of the manuscript.
Petkova SB, Akilesh S, Sproule TJ, Christianson GJ, Al Khabbaz H, Brown AC, et al. Enhanced half-life of genetically engineered human IgG1 antibodies in a humanized FcRn mouse model: potential application in humorally mediated autoimmune disease.Int Immunol. 2006;18:1759–69. [DOI] [PubMed]
Sockolosky JT, Szoka FC. The neonatal Fc receptor, FcRn, as a target for drug delivery and therapy.Adv Drug Deliv Rev. 2015;91:109–24. [DOI] [PubMed] [PMC]
Aaen KH, Anthi AK, Sandlie I, Nilsen J, Mester S, Andersen JT. The neonatal Fc receptor in mucosal immune regulation.Scand J Immunol. 2020;93:e13017. [DOI] [PubMed]
Brambell FW, Halliday R, Morris IG. Interference by human and bovine serum and serum protein fractions with the absorption of antibodies by suckling rats and mice.Proc R Soc Lond B Biol Sci. 1958;149:1–11. [DOI] [PubMed]
Simister NE, Story CM. Human placental Fc receptors and the transmission of antibodies from mother to fetus.J Reprod Immunol. 1997;37:1–23. [DOI] [PubMed]
Israel EJ, Taylor S, Wu Z, Mizoguchi E, Blumberg RS, Bhan A, et al. Expression of the neonatal Fc receptor, FcRn, on human intestinal epithelial cells.Immunology. 1997;92:69–74. [DOI] [PubMed] [PMC]
Zhu X, Meng G, Dickinson BL, Li X, Mizoguchi E, Miao L, et al. MHC class I-related neonatal Fc receptor for IgG is functionally expressed in monocytes, intestinal macrophages, and dendritic cells.J Immunol. 2001;166:3266–76. [DOI] [PubMed] [PMC]
Borvak J, Richardson J, Medesan C, Antohe F, Radu C, Simionescu M, et al. Functional expression of the MHC class I-related receptor, FcRn, in endothelial cells of mice.Int Immunol. 1998;10:1289–98. [DOI] [PubMed]
Rodewald R. pH-dependent binding of immunoglobulins to intestinal cells of the neonatal rat.J Cell Biol. 1976;71:666–9. [DOI] [PubMed] [PMC]
Abrahamson DR, Rodewald R. Evidence for the sorting of endocytic vesicle contents during the receptor-mediated transport of IgG across the newborn rat intestine.J Cell Biol. 1981;91:270–80. [DOI] [PubMed] [PMC]
Raghavan M, Bonagura VR, Morrison SL, Bjorkman PJ. Analysis of the pH dependence of the neonatal Fc receptor/immunoglobulin G interaction using antibody and receptor variants.Biochemistry. 1995;34:14649–57. [DOI] [PubMed]
Kahaly GJ, Wuster C, Olivo PD, Diana T. High Titers of Thyrotropin Receptor Antibodies Are Associated With Orbitopathy in Patients With Graves Disease.J Clin Endocrinol Metab. 2019;104:2561–8. [DOI] [PubMed]
Ponto KA, Kanitz M, Olivo PD, Pitz S, Pfeiffer N, Kahaly GJ. Clinical relevance of thyroid-stimulating immunoglobulins in graves’ ophthalmopathy.Ophthalmology. 2011;118:2279–85. [DOI] [PubMed]
Masuda T, Motomura M, Utsugisawa K, Nagane Y, Nakata R, Tokuda M, et al. Antibodies against the main immunogenic region of the acetylcholine receptor correlate with disease severity in myasthenia gravis.J Neurol Neurosurg Psychiatry. 2012;83:935–40. [DOI] [PubMed]
Langericht J, Kramer I, Kahaly GJ. Glucocorticoids in Graves’ orbitopathy: mechanisms of action and clinical application.Ther Adv Endocrinol Metab. 2020;11:2042018820958335. [DOI] [PubMed] [PMC]
Wolf J, Mitka KI, Hubalewska-Dydejczyk A, Kramer I, Kahaly GJ. Drug safety in thyroid eye disease - a systematic review.Expert Opin Drug Saf. 2022;21:881–912. [DOI] [PubMed]
Ghetie V, Hubbard JG, Kim JK, Tsen MF, Lee Y, Ward ES. Abnormally short serum half-lives of IgG in β2-microglobulin-deficient mice.Eur J Immunol. 1996;26:690–6. [DOI] [PubMed]
Israel EJ, Wilsker DF, Hayes KC, Schoenfeld D, Simister NE. Increased clearance of IgG in mice that lack β2-microglobulin: possible protective role of FcRn.Immunology. 1996;89:573–8. [DOI] [PubMed] [PMC]
Junghans RP, Anderson CL. The protection receptor for IgG catabolism is the beta2-microglobulin-containing neonatal intestinal transport receptor.Proc Natl Acad Sci U S A. 1996;93:5512–6. [DOI] [PubMed] [PMC]
Robak T, Kaźmierczak M, Jarque I, Musteata V, Treliński J, Cooper N, et al. Phase 2 multiple-dose study of an FcRn inhibitor, rozanolixizumab, in patients with primary immune thrombocytopenia.Blood Adv. 2020;4:4136–46. [DOI] [PubMed] [PMC]
Bril V, Benatar M, Andersen H, Vissing J, Brock M, Greve B, et al.; MG0002 Investigators. Efficacy and Safety of Rozanolixizumab in Moderate to Severe Generalized Myasthenia Gravis: A Phase 2 Randomized Control Trial.Neurology. 2021;96:e853–65. [DOI] [PubMed] [PMC]
Howard JF Jr, Bril V, Burns TM, Mantegazza R, Bilinska M, Szczudlik A, et al.; Efgartigimod MG Study Group. Randomized phase 2 study of FcRn antagonist efgartigimod in generalized myasthenia gravis.Neurology. 2019;92:e2661–73. [DOI] [PubMed] [PMC]
Howard JF Jr, Bril V, Vu T, Karam C, Peric S, Margania T, et al.; ADAPT Investigator Study Group. Safety, efficacy, and tolerability of efgartigimod in patients with generalised myasthenia gravis (ADAPT): a multicentre, randomised, placebo-controlled, phase 3 trial.Lancet Neurol. 2021;20:526–36.Erratum in: Lancet Neurol. 2021;20:e5. [DOI] [PubMed]
Werth VP, Culton D, Blumberg L, Humphries J, Blumberg R, Hall R. 538 FcRn blockade with SYNT001 for the treatment of pemphigus.J Invest Dermatol. 2018;138:S92. [DOI]
Werth VP, Culton DA, Concha JSS, Graydon JS, Blumberg LJ, Okawa J, et al. Safety, Tolerability, and Activity of ALXN1830 Targeting the Neonatal Fc Receptor in Chronic Pemphigus.J Invest Dermatol. 2021;141:2858–65.E4. [DOI] [PubMed]
Ling LE, Hillson JL, Tiessen RG, Bosje T, van Iersel MP, Nix DJ, et al. M281, an Anti-FcRn Antibody: Pharmacodynamics, Pharmacokinetics, and Safety Across the Full Range of IgG Reduction in a First-in-Human Study.Clin Pharmacol Ther. 2019;105:1031–9. [DOI] [PubMed] [PMC]
Kahaly GJ, Dolman PJ, Wolf J, Giers BC, Elflein HM, Jain AP, et al. Proof-of-Concept and Randomized, Placebo-Controlled Trials of an Fcrn Inhibitor, Batoclimab, for Thyroid Eye Disease.J Clin Endocrinol Metab. 2023;108:3122–34. [DOI] [PubMed] [PMC]
Wolf J, Alt S, Kramer I, Kahaly GJ. A Novel Monoclonal Antibody Degrades the Thyrotropin Receptor Autoantibodies in Graves’ Disease.Endocr Pract. 2023;29:553–9. [DOI] [PubMed]
Sinha AA, Lopez MT, McDevitt HO. Autoimmune diseases: the failure of self tolerance.Science. 1990;248:1380–8. [DOI] [PubMed]
Rose NR, Bona C. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited).Immunol Today. 1993;14:426–30. [DOI] [PubMed]
Pisetsky DS. Pathogenesis of autoimmune disease.Nat Rev Nephrol. 2023;19:509–24. [DOI] [PubMed] [PMC]
Collins J, Gough S. Autoimmunity in thyroid disease.Eur J Nucl Med Mol Imaging. 2002;29:S417–24. [DOI] [PubMed]
Hadj-Kacem H, Rebuffat S, Mnif-Féki M, Belguith-Maalej S, Ayadi H, Péraldi-Roux S. Autoimmune thyroid diseases: genetic susceptibility of thyroid-specific genes and thyroid autoantigens contributions.Int J Immunogenet. 2009;36:85–96. [DOI] [PubMed]
Mariotti S, Chiovato L, Vitti P, Marcocci C, Fenzi GF, Del Prete GF, et al. Recent advances in the understanding of humoral and cellular mechanisms implicated in thyroid autoimmune disorders.Clin Immunol Immunopathol. 1989;50:S73–84. [DOI] [PubMed]
Saravanan P, Dayan CM. Thyroid autoantibodies.Endocrinol Metab Clin North Am. 2001;30:315–37. [DOI] [PubMed]
Baldo-Enzi G, Baiocchi MR, Vigna G, Andrian C, Mosconi C, Fellin R. Analbuminaemia: a natural model of metabolic compensatory systems.J Inherit Metab Dis. 1987;10:317–29. [DOI] [PubMed]
Braschi S, Lagrost L, Florentin E, Martin C, Athias A, Gambert P, et al. Increased cholesteryl ester transfer activity in plasma from analbuminemic patients.Arterioscler Thromb Vasc Biol. 1996;16:441–9. [DOI] [PubMed]
Maugeais C, Braschi S, Ouguerram K, Maugeais P, Mahot P, Jacotot B, et al. Lipoprotein kinetics in patients with analbuminemia. Evidence for the role of serum albumin in controlling lipoprotein metabolism.Arterioscler Thromb Vasc Biol. 1997;17:1369–75. [DOI] [PubMed]
Minchiotti L, Caridi G, Campagnoli M, Lugani F, Galliano M, Kragh-Hansen U. Diagnosis, Phenotype, and Molecular Genetics of Congenital Analbuminemia.Front Genet. 2019;10:336. [DOI] [PubMed] [PMC]
Appel GB, Blum CB, Chien S, Kunis CL, Appel AS. The hyperlipidemia of the nephrotic syndrome. Relation to plasma albumin concentration, oncotic pressure, and viscosity.N Engl J Med. 1985;312:1544–8. [DOI] [PubMed]
Joven J, Espinel E, Simó JM, Vilella E, Camps J, Oliver A. The influence of hypoalbuminemia in the generation of nephrotic hyperlipidemia.Atherosclerosis. 1996;126:243–52. [DOI] [PubMed]
Joven J, Villabona C, Vilella E, Masana L, Albertí R, Vallés M. Abnormalities of lipoprotein metabolism in patients with the nephrotic syndrome.N Engl J Med. 1990;323:579–84. [DOI] [PubMed]
Wheeler DC, Bernard DB. Lipid abnormalities in the nephrotic syndrome: causes, consequences, and treatment.Am J Kidney Dis. 1994;23:331–46. [DOI] [PubMed]
Vaziri ND. Disorders of lipid metabolism in nephrotic syndrome: mechanisms and consequences.Kidney Int. 2016;90:41–52. [DOI] [PubMed] [PMC]
Liang K, Vaziri ND. HMG-CoA reductase, cholesterol 7α-hydroxylase, LCAT, ACAT, LDL receptor, and SRB-1 in hereditary analbuminemia.Kidney Int. 2003;64:192–8. [DOI] [PubMed]
Kumar D, Behal S, Bhattacharyya R, Banerjee D. Pseudoesterase activity of albumin: A probable determinant of cholesterol biosynthesis.Med Hypotheses. 2018;115:42–5. [DOI] [PubMed]
Zhao Y, Marcel YL. Serum albumin is a significant intermediate in cholesterol transfer between cells and lipoproteins.Biochemistry. 1996;35:7174–80. [DOI] [PubMed]
Roopenian DC, Low BE, Christianson GJ, Proetzel G, Sproule TJ, Wiles MV. Albumin-deficient mouse models for studying metabolism of human albumin and pharmacokinetics of albumin-based drugs.MAbs. 2015;7:344–51. [DOI] [PubMed] [PMC]
Chaudhury C, Brooks CL, Carter DC, Robinson JM, Anderson CL. Albumin binding to FcRn: distinct from the FcRn-IgG interaction.Biochemistry. 2006;45:4983–90. [DOI] [PubMed]
Baker K, Qiao SW, Kuo T, Kobayashi K, Yoshida M, Lencer WI, et al. Immune and non-immune functions of the (not so) neonatal Fc receptor, FcRn.Semin Immunopathol. 2009;31:223–36. [DOI] [PubMed] [PMC]
Patel DA, Puig-Canto A, Challa DK, Perez Montoyo H, Ober RJ, Ward ES. Neonatal Fc receptor blockade by Fc engineering ameliorates arthritis in a murine model.J Immunol. 2011;187:1015–22. [DOI] [PubMed] [PMC]
Latvala S, Jacobsen B, Otteneder MB, Herrmann A, Kronenberg S. Distribution of FcRn Across Species and Tissues.J Histochem Cytochem. 2017;65:321–33. [DOI] [PubMed] [PMC]
Schlachetzki F, Zhu C, Pardridge WM. Expression of the neonatal Fc receptor (FcRn) at the blood-brain barrier.J Neurochem. 2002;81:203–6. [DOI] [PubMed]
Cooper PR, Ciambrone GJ, Kliwinski CM, Maze E, Johnson L, Li Q, et al. Efflux of monoclonal antibodies from rat brain by neonatal Fc receptor, FcRn.Brain Res. 2013;1534:13–21. [DOI] [PubMed]
Newland AC, Sánchez-González B, Rejtő L, Egyed M, Romanyuk N, Godar M, et al. Phase 2 study of efgartigimod, a novel FcRn antagonist, in adult patients with primary immune thrombocytopenia.Am J Hematol. 2020;95:178–87. [DOI] [PubMed] [PMC]