Immunotherapy Regimes Dependent On APOE Status
First Claim
Patent Images
1. A method of treating Alzheimer'"'"'s disease, comprising administering to a patient having zero ApoE4 alleles (“
- ApoE4 non-carrier patient”
) and Alzheimer'"'"'s disease, an effective regime of an antibody that specifically binds to a N-terminal epitope of Aβ
, wherein a dosage of the antibody within a range of about 0.15 mg/kg to about 2 mg/kg is administered by intravenous infusion.
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Abstract
The invention provides methods of immunotherapy of Alzheimer'"'"'s and similar diseases in which the regime administered to a patient depends on the ApoE genotype of the patient.
179 Citations
195 Claims
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1. A method of treating Alzheimer'"'"'s disease, comprising administering to a patient having zero ApoE4 alleles (“
- ApoE4 non-carrier patient”
) and Alzheimer'"'"'s disease, an effective regime of an antibody that specifically binds to a N-terminal epitope of Aβ
, wherein a dosage of the antibody within a range of about 0.15 mg/kg to about 2 mg/kg is administered by intravenous infusion. - View Dependent Claims (2, 4, 5, 6, 7, 8, 9)
- ApoE4 non-carrier patient”
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3. (canceled)
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10. A method of treating Alzheimer'"'"'s disease, comprising administering to an ApoE4 non-carrier patient an antibody that specifically recognizes the N-terminal region of Aβ
- in a regime effective to maintain a mean serum concentration of the antibody in the range of about 0.1 μ
g/ml to about 60 μ
g/ml. - View Dependent Claims (12)
- in a regime effective to maintain a mean serum concentration of the antibody in the range of about 0.1 μ
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11. (canceled)
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13-14. -14. (canceled)
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15. A method of treating Alzheimer'"'"'s disease, comprising administering to an ApoE4 non-carrier patient bapienuzumab in a regime effective to achieve a mean plasma Aβ
- concentration of at least 450 pg/ml.
- View Dependent Claims (16)
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17-18. -18. (canceled)
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19. A method of reducing cognitive decline in a patient having zero ApoE4 alleles (“
- ApoE4 non-carrier patient”
),comprising administering to the patient bapineuzumab in a regime effective to reduce the cognitive decline of the patient relative to a control patient to whom the bapineuzumab is not administered, wherein a dosage of the bapineuzumab within a range of about 0.15 mg/kg to about 2 mg/kg is administered by intravenous infusion wherein; the ApoE4 non-carrier patient and control patient have been diagnosed with mild to moderate Alzheimer'"'"'s disease; and the cognitive decline is measured by ADAS-COG, NTB, MMSE or CDR-SB.
- ApoE4 non-carrier patient”
-
20-22. -22. (canceled)
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23. A method of reducing brain volume decline in a patient having zero ApoE4 alleles (“
- ApoE4 non-carrier patient”
),comprising administering to the ApoE4 non-carrier patient bapineuzumab in a regime effective to reduce the brain volume decline of the ApoE4 non-carrier patient relative to a control patient to whom the bapineuzumab is not administered; wherein the ApoE4 non-carrier patient and control patient have been diagnosed with mild to moderate Alzheimer'"'"'s disease; and
,wherein a dosage of the antibody within a range of about 0.15 mg/kg to about 2 mg/kg is administered by intravenous infusion. - View Dependent Claims (27)
- ApoE4 non-carrier patient”
-
24-26. -26. (canceled)
- 28. A method of treating Alzheimer'"'"'s disease, comprising subcutaneously administering to a patient having the disease and one or two copies of an ApoE4 allele an effective regime of bapineuzumab at a dose of 0.01-0.6 mg/kg and a frequency of between weekly and monthly.
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30-33. -33. (canceled)
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34. A method of treating Alzheimer'"'"'s disease, comprising
administering to a patient having the disease and one or two ApoE4 alleles an effective regime of bapineuzumab; - and
administering a corticosteroid to the patient to treat vasogenic edema arising from the administration of the bapineuzumab. - View Dependent Claims (36, 37)
- and
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35. (canceled)
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38. A method of treating or effecting prophylaxis in a population of patients of an amyloidogenic disease characterized by amyloid deposits of Aβ
- in the brain, comprising;
administering different regimes to different patients in the population depending on which allelic forms of ApoE are present in the patients;
wherein at least one of the regimes comprises administering an antibody to Aβ
to a patient. - View Dependent Claims (39, 40, 41, 42, 43, 44, 45, 47, 48, 51, 55, 57, 60, 61, 64, 69, 70)
- in the brain, comprising;
-
46. (canceled)
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49-50. -50. (canceled)
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52-54. -54. (canceled)
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56. (canceled)
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58-59. -59. (canceled)
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62-63. -63. (canceled)
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65-68. -68. (canceled)
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71-74. -74. (canceled)
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75. A method of monitoring a population of patients undergoing treatment or prophylaxis for Alzheimer'"'"'s disease with an antibody to Aβ
- , the method comprising;
performing different monitoring regimes in different patients in the population for vasogenic edema, wherein the frequency of monitoring is greater for; (a) patients having two copies of ApoE4 relative to patients having zero copies of ApoE4; (b) patients having one copy of an ApoE4 allele relative to patients having zero copies of an ApoE4 allele; and
/or(c) patients having two copies of an ApoE4 allele relative to patients having one copy of an ApoE4 allele.
- , the method comprising;
-
76-84. -84. (canceled)
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85. A method of treating or effecting prophylaxis of a patient for Alzheimer'"'"'s disease, comprising
administering to a patient with at least one ApoE4 allele a humanized form of a mouse 3D6 antibody (ATCC accession number PTA-5130), and positions 234, 235 and 237 in the heavy chain constant region are occupied by Ala, Ala and Ala respectively, wherein positions are numbered by the EU numbering system, and monitoring the patient for vasogenic edema by MRI.
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86-87. -87. (canceled)
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89-96. -96. (canceled)
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97. A method of treating or effecting prophylaxis of Alzheimer'"'"'s disease in a patient, comprising
administering an antibody to the patient in a regime in which 0.15-2 mg/kg of antibody is administered quarterly by intravenous administration, or at a dose frequency and route of administration that generates an equivalent average serum concentration or area under the curve, wherein the antibody is an L234A, L235A, G237A variant of bapineuzumab comprising a humanized light chain having an amino acid sequence comprising SEQ ID NO: - 48 and a humanized heavy chain having an amino acid sequence comprising SEQ ID NO;
66 or 67.
- 48 and a humanized heavy chain having an amino acid sequence comprising SEQ ID NO;
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98-105. -105. (canceled)
-
106. A method of treating or effecting prophylaxis of Alzheimer'"'"'s disease in a population of patients, comprising
administering an antibody that specifically binds to an epitope within residues 1-11 of Aβ - to the patients, wherein the antibody is administered at a dose of 0.15-1 mg/kg in patients of the population having one or two ApoE4 alleles and a dose of 0.5-2.5 mg/kg in patients of the population having zero ApoE4 alleles, and the mean dose is higher in the patients having zero ApoE4 alleles.
- View Dependent Claims (107, 108, 109, 110)
-
111. A method of effecting prophylaxis of Alzheimer'"'"'s disease in a patient comprising
administering an effective regime of an agent that is an antibody to Aβ - or an agent that induces an antibody to Aβ
on administration to a patient, wherein the patient has at least one ApoE4 allele, wherein the patient has a mini-mental test score of 27 or higher.
- or an agent that induces an antibody to Aβ
-
112-117. -117. (canceled)
-
118. A method of treating or effecting prophylaxis of a disease characterized by amyloid deposits of Aβ
- in the brain in a patient comprising
administering a first regime and a second regime each comprises administering an antibody to Aβ
to the patient;monitoring the patient for vasogenic edema; maintaining the first regime if vasogenic edema does not appear; and administering a second regime to the patient if vasogenic edema does appear, wherein the second regime differs relative to the first regime in at least one of (i)-(v) below; (i) the dose of the antibody is reduced; (ii) the frequency of administration of the antibody is reduced; (iii) a different antibody with reduced capacity to bind an Fcγ
receptor;(iv) a different antibody with reduced capacity to bind C1q; (v) the antibody to Aβ
is not administered;wherein the second regime is maintained at least for the duration of the vasogenic edema. - View Dependent Claims (120)
- in the brain in a patient comprising
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119. (canceled)
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121. A method of treating or effecting prophylaxis of Alzheimer'"'"'s disease in a patient population, comprising
administering an antibody that specifically binds to an epitope within residues 1-11 of Aβ - and has mutations in the constant region that reduce binding to an Fcγ
receptor and/or C1q to the patient, wherein the antibody is administered at the same dose and/or frequency to each patient regardless of the number of ApoE4 alleles in the patient. - View Dependent Claims (122)
- and has mutations in the constant region that reduce binding to an Fcγ
-
123. (canceled)
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124. A method of treating or effecting prophylaxis of Alzheimer'"'"'s disease in a patient population, comprising
administering an antibody to Aβ - to some of the patients in the population, wherein patients in the population having zero ApoE4 alleles receive the antibody and patients in the population having one or two ApoE4 alleles do not receive the antibody.
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125-127. -127. (canceled)
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128. A method of treating or effecting prophylaxis of a disease characterized by Aβ
- deposits in the brain of patient comprising administering an effective regime of a humanized antibody to the patient;
wherein the humanized antibody comprises a mature light chain variable region sequence of SEQ ID NO;
2 and a mature heavy chain variable region sequence of SEQ ID NO;
3, and a human heavy chain constant of IgG1 isotype with L234A, L235A, and G237A mutations, wherein position are numbered by the EU numbering system. - View Dependent Claims (129, 131, 132)
- deposits in the brain of patient comprising administering an effective regime of a humanized antibody to the patient;
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130. (canceled)
-
133. (canceled)
- 134. A humanized form of a 10D5 antibody (ATCC accession number PTA-5129) comprising a human heavy chain constant region with L234A, L235A and G237A mutations, wherein positions are numbered by the EU numbering system.
-
136. (canceled)
- 137. A humanized form of a 12A11 antibody (ATCC accession number PTA-7271) comprising a human heavy chain constant region with L234A, L235A and G237A mutations, wherein positions are numbered by the EU numbering system.
-
139. (canceled)
- 140. A humanized form of a 3D6 antibody (ATCC accession number PTA-5130) comprising a human heavy chain constant region with L234A, L235A and G237A mutations, wherein positions are numbered by the EU numbering system.
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141. (canceled)
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143. (canceled)
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144. An isolated nucleic acid having a sequence comprising SEQ ID NO:
- 68 provided that residues 1-57 encoding a signal sequence may or may not be present.
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145. An isolated humanized antibody comprising a mature light chain variable region sequence of SEQ ID NO:
- 2 and a mature heavy chain variable region sequence of SEQ ID NO;
3, and a human heavy chain constant region of IgG isotype with L234A, L235A, and G237A mutations, wherein positions are numbered by the EU numbering system.
- 2 and a mature heavy chain variable region sequence of SEQ ID NO;
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146. (canceled)
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147. An isolated humanized form of a 12B4 antibody, wherein the 12B4 antibody is characterized by a light chain variable region sequence of SEQ ID NO:
- 31, and heavy chain variable region sequence of SEQ ID NO;
32, and a human heavy chain constant region of IgG isotype with L234A, L235A, and G237A mutations, wherein positions are numbered by the EU numbering system.
- 31, and heavy chain variable region sequence of SEQ ID NO;
-
148. (canceled)
- 149. A humanized form of a 266 antibody (ATCC accession number PTA-6123) comprising a human heavy chain constant region with L234A, L235A and G237A mutations, wherein positions are numbered by the EU numbering system.
-
151. (canceled)
- 152. An isolated antibody comprising a human heavy chain constant region of isotype IgG1, wherein amino acids at positions 234, 235, and 237 (EU numbering) are each alanine.
-
157. (canceled)
-
160. (canceled)
- 161. A method of determining a regime for bapineuzumab administration comprising providing instructions to a healthcare professional that assists the healthcare professional determine a regime of bapineuzumab to administer to a patient having zero copies of an ApoE4 allele, wherein the regime is characterized by administering 0.5-2 mg/kg of bapineuzumab quarterly by intravenous administration, further comprising monitoring the patient for vasogenic edema.
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162-165. -165. (canceled)
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166. A method of determining a regime for bapineuzumab administration comprising providing instructions to a healthcare professional that assists the healthcare professional determine a regime of bapineuzumab to administer to a patient having one or two copies of an ApoE4 allele, wherein the instructions specify a regime is characterized by administering bapineuzumab at a dose of 0.15-1 mg/kg quarterly by intravenous administration, or at a dose frequency and route of administration and further comprising monitoring the patient for vasogenic edema.
-
167-170. -170. (canceled)
-
172-177. -177. (canceled)
- 178. A kit for bapineuzumab administration comprising instructions to a healthcare professional that assist the healthcare professional determine which regime of bapineuzumab to administer to a patient having zero, one or two copies of an ApoE4 allele.
-
179-181. -181. (canceled)
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183-193. -193. (canceled)
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194. A method for improving the safety of bapineuzumab in patients having one or two ApoE4 alleles, comprising advising the physician to administer a lower dose of bapineuzumab to a patient having one or two ApoE alleles relative to that of a patient having zero ApoE alleles.
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195. A method for improving the safety of bapineuzumab in patients having one or two ApoE4 alleles, comprising advising the physician to monitor the patient by MRI more frequently than a patient having one or two ApoE alleles relative to that of a patient having zero ApoE alleles.
Specification