Upadacitinib hemihydrate

London: A class of drugs known as Janus kinase, or JAK, inhibitors, which work by slowing down the immune system, should be the first-line therapy for patients hospitalized for COVID-19, researchers reported in The Lancet Respiratory Medicine. The researchers analyzed individual outcomes of nearly 13,000 adults hospitalized for COVID who participated in 16 randomized trials comparing JAK inhibitors to other drugs or placebos between May 2020 and March 2022. Overall, 11.7 per cent of patients who received JAK inhibitors died by day 28, compared with 13.2 per cent of those who received other treatments such as the steroid dexamethasone or medications that block the signaling of the inflammatory protein IL-6. After accounting for individual risk factors, the odds of death by day 28 were 33 per cent lower in the JAK inhibitor group. "These results should inform World Health Organization COVID-19 treatment guidelines, both in the USA and Europe," an editorial published with the study said. "Although the pandemic has passed and COVID-19 is not nearly as rampant as it was previously, delays in disseminating and adopting best-evidence treatment practices can only be harmful." JAK inhibitors include Pfizer's Xeljanz (tofacitinib), Eli Lilly's Olumiant (baricitinib), and AbbVie's Rinvoq (upadacitinib). JAK inhibitors also decreased the need for new mechanical ventilation or other respiratory support, and allowed for faster discharge from hospital by about 1 day, with fewer serious adverse events. The findings were true regardless of patients' COVID vaccination status. "The certainty of the authors' conclusion that JAK inhibitory therapy for the treatment of patients admitted to hospital for COVID-19 provides a significant mortality benefit is further supported when the analysis is limited to placebo-controlled studies," the editorial says. FOR VERY LARGE FETUSES, EARLY INDUCTION MAY BE BENEFICIAL When a near-term fetus is expected to be larger than most other newborns at birth, it might be safer to induce labor a bit ahead of the due date, new data suggest. Births of large babies can be complicated by shoulder dystocia, an emergency situation in which their shoulders become impacted on the mother's pubic bones after their head has emerged, preventing the rest of the body from being delivered spontaneously. To see if inducing labor ahead of schedule would reduce the risk of shoulder dystocia, researchers recruited 2,893 women whose fetuses appeared on ultrasound to be larger than 90 per cent of other similarly-aged fetuses. They randomly assigned the women to receive standard care or induction between 38 weeks and 38-weeks-and-four-days of gestation. Induction was expected to result in an earlier birth and a lower birth weight than standard care. Overall, in the so-called Big Baby Trial, there was no difference between the groups in rates of shoulder dystocia, probably because many of the women in the standard care group delivered before 38 weeks, and so their babies were smaller than predicted. When the analysis was limited to women who did not deliver before 38 weeks, shoulder dystocia occurred in 2.3% of babies in the induction group versus 3.7 per cent of those in the standard care group. The induction group delivered on average about 8 days earlier, and their babies weighed about 8 ounces (213 grams) less, compared to the usual-care group. After accounting for individual risk factors, the odds of shoulder dystocia were 38% lower in the induction group versus usual care in women whose pregnancies lasted beyond 38 weeks. Induction of labor was also associated with a lower likelihood of cesarean delivery and fewer maternal complications, researchers reported in The Lancet. An editorial published with the report notes, "The Big Baby Trial joins an accumulating body of literature... indicating that induction of labor either does not alter or might reduce the risk for needing cesarean delivery" when a larger fetus is suspected. NEW BED NET TREATMENT TARGETS MALARIA PARASITES IN MOSQUITOES Bed nets may once again become useful against malaria in endemic regions, with use of a chemical that targets the malaria-causing parasite in mosquitoes rather than the mosquitoes themselves, researchers reported on Wednesday in Nature. The use of long-lasting insecticides in bed nets significantly reduced malaria cases and deaths between 2000 and 2015, but the method eventually became less effective due to the rise of insecticide resistance. The researchers from the Harvard T. H. Chan School of Public Health in Boston screened 81 endochin-like quinolones (ELQs), a class of experimental antimalarial agents, and identified two that block the development of the malaria parasite by targeting a key protein in the parasite. The ELQs were effective even against mosquitoes that were resistant to traditional insecticides. "Malaria control desperately needs innovation," study co-author Dr. Flaminia Catteruccia said in a statement. "Our chemistry collaborators at Oregon Health and Science University were able to generate these compounds inexpensively, which would allow this approach to be integrated into existing bed net infrastructure at a competitive cost," study leader Alexandra Probst said in a statement. (Reporting by Nancy Lapid; additional reporting by Shawana Alleyne-Morris; Editing by Bill Berkrot)

艾伯维，作为昔日药王的拥有者，面临专利悬崖压境，举起拳头挥向新战场！自免领域并购提速、神经科学重金押注、ADC赛道连出重拳，艾伯维以一场战略大突围，向市场宣告：断腕求生，只为更凶猛的进攻。   01  深陷泥潭艾伯维近年来深陷多重危机，修美乐（阿达木单抗）作为艾伯维的“现金牛”，曾连续十一年蝉联全球药品销售冠军，累计销售额超2000亿美元。然而，随着其在主流市场的专利保护陆续到期，生物类似药的冲击导致其收入断崖式下滑。2024年修美乐销售额同比骤降37.6%至89.93亿美元，较2023年的144亿美元大幅缩水。表1.艾伯维免疫领域核心产品这一颓势直接拖累艾伯维2024年净利润下跌12.03%。尽管艾伯维通过加速推广Rinvoq（乌帕替尼）和Skyrizi（利生奇珠单抗）等自免新药试图填补缺口（表1），但其市场表现仍难以匹敌修美乐的巅峰水平，还要面临强生、赛诺菲等巨头的激烈竞争。在血液瘤领域，艾伯维依赖的BTK抑制剂Imbruvica（伊布替尼）同样陷入增长困境。作为全球首个上市的BTK抑制剂，伊布替尼曾以先发优势占据市场主导地位，2021年销售额高达111.68亿美元。表2.艾伯维肿瘤领域核心产品然而，随着百济神州的泽布替尼、阿斯利康的阿卡替尼等二代BTK抑制剂通过“头对头”试验证明更优疗效与安全性，伊布替尼市场份额被快速瓜分。2024年，伊布替尼销售额同比下滑6.9%至33.47亿美元。尽管Bcl-2抑制剂Venclexta（维奈克拉）仍保持12.9%的增速，但其作为全球唯一获批产品的优势即将被打破，百济神州、亚盛医药等企业的同类药物已进入临床后期，竞争格局日趋严峻（图1）。 图1.各BTK抑制剂产品上市时间及销售情况更为严峻的是，艾伯维在血液瘤领域长达七年的产品空窗期进一步加剧了危机。继2016年维奈克拉上市后，直至2023年5月才推出第三款血液瘤产品Epkinly（CD3/CD20双抗），但其上市一年半仅实现1.46亿美元收入（表2），且需直面罗氏同类产品Glofitamab的竞争。与此同时，艾伯维在CAR-T疗法领域的布局屡屡受挫，2023年终止与Caribou Biosciences的通用型CAR-T合作，被诺华、强生等对手拉开差距。尽管2024年初以14.4亿美元与Umoja Biopharma合作开发原位生成CAR-T疗法，试图通过技术创新弯道超车，但其错失CAR-T第一波商业化红利的现实已难以逆转。  02  频繁动刀为了走出“泥潭”，艾伯维在肿瘤领域多次挥刀，转而瞄准自免与神经科学等赛道。2023年以来，艾伯维在肿瘤领域接连终止多个外部合作与内部管线，涉及ADC、CAR-T、CD47等多个前沿技术方向。仅ADC领域，艾伯维便终止了包括ABBV-154、ABBV-011和ABBV-647在内的7款候选药物开发，其中ABBV-011虽在I期临床中显示出25%的客观缓解率，但其疗效未达差异化优势，最终被战略性放弃。此外，艾伯维还终止了与Caribou Biosciences的通用CAR-T合作项目，退回Harpoon Therapeutics的BCMA三抗HPN217及天境生物的CD47单抗，反映出其对高风险前沿疗法的谨慎态度。这一系列调整的背后，是艾伯维对肿瘤领域资源投入的重新评估。其肿瘤管线当前聚焦于血液肿瘤领域，依赖BTK抑制剂Imbruvica（伊布替尼）和BCL-2抑制剂Venclexta（维奈克拉）两大成熟产品；而外部合作项目的终止则暴露出其在实体瘤领域协同联用方案的短板，其与加科思合作的SHP2抑制剂因缺乏内部KRAS或PD-1抑制剂等联用搭档而终止，凸显了管线协同性的不足。艾伯维通过“减法”策略，将资源集中于确定性更高的领域，规避早期项目的高失败率与长周期风险。面对修美乐（Humira）专利悬崖的压力，艾伯维加速通过并购与许可合作扩充自免管线（表3）。2022年至2024年，其自免领域交易频繁，包括以17.1亿美元获得明济生物临床前TL1A抗体FG-M701的全球权益，收购Nimble Therapeutics的口服多肽IL-23R抑制剂，以及2.5亿美元收购Celsius Therapeutics的TREM1抗体CEL383。TL1A靶点因其在炎症性肠病（IBD）等领域的广谱治疗潜力成为布局重点，艾伯维试图通过差异化工程化改造建立竞争优势。表3 艾伯维在自免领域license-in交易汇总数据来源：公开资料整理更为关键的是，神经科学领域则成为艾伯维的第二增长引擎。2024年以87亿美元收购Cerevel Therapeutics后，其神经科学管线覆盖精神分裂症、阿尔茨海默病精神病等适应症，尽管核心资产emraclidine的II期临床数据不及预期，但该领域整体收入仍实现16.6%增长，成为业绩重要支撑。此外，艾伯维持续剥离非核心资产，如将囊性纤维化（CF）项目转让给Sionna Therapeutics，进一步聚焦优势赛道。  03  ADC亮剑与此同时，艾伯维聚焦ADC领域，两次“亮剑”。2023年11月，艾伯维以101亿美元收购ADC领域先驱ImmunoGen，核心目标是其重磅产品Elahere（mirvetuximab soravtansine）。Elahere是全球首个靶向叶酸受体α（FRα）的ADC药物，于2022年11月获FDA加速批准用于铂类耐药卵巢癌（PROC）治疗，并于2024年3月获得完全批准。Elahere填补了PROC治疗的空白，其在III期临床试验中显示出显著的总生存期（OS）获益，为FRα阳性患者提供了首个有效治疗方案（图2）。 图2.Elahere 的作用机制（左）及NCT04296890临床数据（右）Elahere的商业表现同样亮眼，2023年前三季度销售额达2.12亿美元，2024年销售额增至4.79亿美元，全年增长潜力强劲。此外，ImmunoGen的研发管线还包括十余项ADC项目（图3），如针对CD123的血液瘤药物IMGN-632及下一代FRα ADC药物IMGN-151，进一步丰富了艾伯维在实体瘤和血液瘤领域的布局。 图3.ImmunoGen管线图5月14日，艾伯维的c-Met靶向ADC药物Telisotuzumab Vedotin（ABBV-399）获FDA加速批准上市（图4），用于治疗c-Met高表达、EGFR野生型晚期非小细胞肺癌（NSCLC）患者。该药物是全球首个获批的c-Met ADC，针对约占NSCLC患者18%的c-Met高表达群体，解决了此类患者缺乏有效靶向治疗的难题。 图4.Telisotuzumab Vedotin（ABBV-399）获FDA批准上市临床数据显示，ABBV-399在II期试验中对高表达患者的客观缓解率（ORR）达34.6%，中位无进展生存期（PFS）为5.7个月，尽管总生存期（OS）提升有限（高表达组14.6个月）（图5），但其差异化定位，避开EGFR突变耐药的内卷市场，专注于野生型患者，为其赢得了独特的市场空间。 图5.ABBV-399的LUMINOSITY 临床II期的数据此外，艾伯维还推进了下一代c-Met ADC药物ABBV-400的研发，该药物采用新型TOP1抑制剂载荷，在结直肠癌和胃癌的早期临床试验中表现出更高缓解率（ORR≥35%），进一步拓展了c-Met靶点的应用场景。目前，c-Met靶点在ADC领域的开发尚处早期，艾伯维凭借先发优势及ABBV-400的多适应症布局，有望在未来进一步确立领导地位。与此同时，全球c-Met ADC领域竞争加剧，罗氏就曾以10.5亿美元引进宜联生物的c-Met ADC项目，但艾伯维凭借成熟的商业化表现与临床推进效率，仍占据显著优势。  结语  从专利悬崖的泥潭中跃起，艾伯维用减法聚焦核心，以加法拓宽边界。尽管前路强敌环伺，但巨头的拳头既已挥出，便注定要重塑战场规则！参考资料[1]https://news.abbvie.com/2025-05-14-U-S-FDA-Approves-EMRELIS-TM-telisotuzumab-vedotin-tllv-for-Adults-With-Previously-Treated-Advanced-Non-Small-Cell-Lung-Cancer-NSCLC-With-High-c-Met-Protein-Overexpression[2] https://ascopubs.org/doi/pdfdirect/10.1200/JCO.24.00720[3]艾伯维官网、中信建投证券、各种公开资料等识别微信二维码，添加生物制品圈小编，符合条件者即可加入生物制品微信群！请注明：姓名+研究方向！版权声明本公众号所有转载文章系出于传递更多信息之目的，且明确注明来源和作者，不希望被转载的媒体或个人可与我们联系(cbplib@163.com)，我们将立即进行删除处理。所有文章仅代表作者观点，不代表本站立场。