Idarucizumab, a Specific Reversal Agent for Dabigatran: Mode of Action, Pharmacokinetics and Pharmacodynamics, and Safety and Efficacy in Phase 1 Subjects

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Presentation transcript:

Idarucizumab, a Specific Reversal Agent for Dabigatran: Mode of Action, Pharmacokinetics and Pharmacodynamics, and Safety and Efficacy in Phase 1 Subjects Paul A. Reilly, PhD, Joanne van Ryn, PhD, Oliver Grottke, MD, PhD, Stephan Glund, PhD, Joachim Stangier, PhD The American Journal of Medicine Volume 129, Issue 11, Pages S64-S72 (November 2016) DOI: 10.1016/j.amjmed.2016.06.007 Copyright © 2016 Terms and Conditions

Figure 1 Structure and relative sizes of thrombin (FIIa), dabigatran, and idarucizumab. Reprinted with permission from Pollack et al.14 The American Journal of Medicine 2016 129, S64-S72DOI: (10.1016/j.amjmed.2016.06.007) Copyright © 2016 Terms and Conditions

Figure 2 Effects of posttrauma idarucizumab on blood loss in animals treated with dabigatran. Reprinted with permission from Elsevier from Grottke et al.18 The dashed vertical line (t = 0) indicates time of liver injury, and the dotted vertical line indicates the time of intervention (t = 15 minutes). Data are shown as mean ± SD, n = 6 per group; *P < .05 versus all groups. IDA = idarucizumab. The American Journal of Medicine 2016 129, S64-S72DOI: (10.1016/j.amjmed.2016.06.007) Copyright © 2016 Terms and Conditions

Figure 3 (A) Effect of increasing doses of prothrombin complex concentrate (PCC) on reducing dabigatran-associated bleeding. (B) Thrombin-antithrombin complex (TAT) was also measured over time. Data shown as mean ± SD, n = 8 per group; *P < .05. The American Journal of Medicine 2016 129, S64-S72DOI: (10.1016/j.amjmed.2016.06.007) Copyright © 2016 Terms and Conditions

Figure 4 Geometric mean idarucizumab plasma concentration-time profiles from the start of a single infusion of 1 g to 4 g idarucizumab for 5 minutes on (A) a linear scale and (B) a semi-log scale. Reprinted with permission from Glund et al.21 The American Journal of Medicine 2016 129, S64-S72DOI: (10.1016/j.amjmed.2016.06.007) Copyright © 2016 Terms and Conditions

Figure 5 Effect of idarucizumab or placebo infusion on coagulation variables, (A) dTT, (B) ECT, (C) aPTT and (D) TT, by dose group Reprinted with permission from Elsevier from Glund et al.15 Dotted horizontal lines show upper limit of normal. “0 h” and the arrows on x axes show when the idarucizumab or placebo infusion ended. Solid horizontal lines show the mean baseline measurement. Data points show mean; error bars show standard error. aPTT = activated partial thromboplastin time; DE = dabigatran etexilate; dTT = diluted thrombin time; ECT = ecarin clotting time. The American Journal of Medicine 2016 129, S64-S72DOI: (10.1016/j.amjmed.2016.06.007) Copyright © 2016 Terms and Conditions

Figure 6 Plasma concentration of unbound dabigatran after infusion of placebo or idarucizumab. Reprinted with permission from Elsevier from Glund et al.15 Dabigatran etexilate was administered at −2 hours (arrows) on the x axis on days 3 and 4. Placebo or idarucizumab infusion ended at 0 h (arrow) on the x axis on day 4 (end of first infusion for the 5-g + 2.5-g group). Data points show geometric mean values. DE = dabigatran etexilate. The American Journal of Medicine 2016 129, S64-S72DOI: (10.1016/j.amjmed.2016.06.007) Copyright © 2016 Terms and Conditions