Nipocalimab-aahu

Since late 2021, a bevy of targeted generalized myasthenia gravis therapies has crossed the regulatory finish line in the U.S., beginning with argenx’s FcRn blocker Vyvgart four years ago and most recently culminating in April’s approval of Johnson & Johnson’s Imaavy. Amid a swell of regulatory successes in the myasthenia gravis arena this decade, Amgen is wading into the fray with a new indication for its monoclonal antibody Uplizna.Thursday, the FDA greenlighted Uplizna (inebilizumab) to treat generalized myasthenia gravis (gMG) in adults who are anti-acetylcholine receptor (AChR) and anti-muscle specific tyrosine kinase (MuSK) antibody positive. After two loading doses, Uplizna for gMG is administered just twice a year, Amgen noted in a Dec. 11 press release.Myasthenia gravis is a rare autoimmune disorder that hampers neuromuscular communication, which can in turn cause fluctuating muscle weakness, Amgen explained. The condition—which is estimated to affect about 80,000 to 100,000 people in the U.S. by Amgen’s reckoning—is thought to be primarily driven by AChR and MuSK autoantibodies, which are produced by CD19+B cells, the company added.Since late 2021, a bevy of targeted gMG therapies has crossed the regulatory finish line in the U.S. and beyond, beginning with argenx’s FcRn blocker Vyvgart (efgartigimod) four years ago and most recently culminating in April’s approval of Johnson & Johnson’s Imaavy (nipocalimab), prior to the Uplizna nod."This approval marks a significant advancement for people living with gMG," Jay Bradner, M.D., Amgen’s executive vice president of R&D, said in a statement."By selectively targeting CD19-positive B cells, Uplizna offers a new approach to treatment that addresses a biological root cause of disease,” he continued. “Uplizna is conveniently dosed twice a year and delivers durable efficacy, helping people manage debilitating symptoms that can compromise daily function – including trouble breathing, speaking and seeing." Uplizna’s efficacy in gMG is thought to lie in its “targeted and sustained” depletion of cells essential to the underlying disease process, which Amgen defined in its release as autoantibody-producing CD19+ B cells, including plasmablasts and some plasma cells.The FDA gave Uplizna the thumbs-up after reviewing data from Amgen’s phase 3 Mint trial. At the study’s 26-week mark, treatment with Uplizna was associated with a 1.9-point difference on the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale—a common measure of myasthenia gravis symptoms—versus placebo, Amgen noted in its release. Specifically, Uplizna led to a 4.2-point reduction on the scale versus a 2.2-point reduction in the trial’s control cohort.The drug’s benefits persisted through an entire year in the trial among patients in the AChR-positive subgroup, Amgen pointed out.The California pharma also touted a steroid taper baked into the study’s protocol, noting that by Week 26, 87.4% of patients on Uplizna and 84.6% of those on placebo had curbed their steroid dose to 5 mg or less per day.The approval marks Uplizna’s second this year and third overall. Back in April, the antibody drug was cleared by the FDA to treat adults with immunoglobulin G4-related disease, building on the drug’s original 2020 green light to treat certain neuromyelitis optica spectrum disorder patients.Uplizna is entering the gMG market at a busy time. Aside from argenx’s Vyvgart and J&J’s Imaavy, UCB’s Rystiggo and Zilbrysq and AstraZeneca and Alexion’s Soliris and Ultomiris also carry recent approvals in the indication. Meanwhile, argenx scored a thumbs-up for a subcutaneous version of its drug, dubbed Vyvgart Hytrulo, back in 2023.In terms of competitive advantages, Amgen appears to be leaning heavily on the potential convenience edge that Uplizna’s twice-a-year dosing could provide. The treatment schedules for the other targeted gMG therapies on the market tend to require maintenance dosing every few weeks, with the timing sometimes dependent on factors related to each patient.Moreover, analysts at Citi Research noted on Thursday that Uplizna's CD-19 targeting mechanism, coupled with its efficacy across gMG subgroups, dosing convenience and steroid-sparing potential, could present "unique differentiation" in the crowded market. Uplizna could be looking at a $1.7 billion sales opportunity in gMG by 2030, the Citi team added. With the approval of Imaavy in April, meanwhile, J&J asserted that its label covered the “broadest population of people living with gMG,” banking those claims in large part on the fact that its drug is approved not only in adults but in people ages 12 and up.Elsewhere, argenx recently scored an FDA nod for a prefilled syringe format of Vyvgart Hytrulo that can be administered at home. And the company is homing in on a potential approval in seronegative patients, which describes the minority of people with gMG who lack detectable AChR or MuSK antibodies in their blood, making the already rare autoimmune condition even trickier to diagnose.Editor's note: This story has been updated with commentary from a Dec. 11 analyst note.  

截至11月底，2025年已有39款新药获批，预计全年总数将少于往年平均50种。本期《药物发现笔记》重点介绍其中部分，包括加速批准、罕见病药物以及具有创新作用机制的首创疗法。这些新药为患者、照护者和医生提供了治疗严重疾病，以及此前治疗选择有限的疾病的新工具。 约有五分之一（20%）的新药批准基于替代终点（而非长期临床结局）获得了加速批准，从而加快了患者可及性。2025年，FDA基于特定生物标志物驱动适应症，对三款治疗局部晚期或转移性非鳞状非小细胞肺癌的药物给予了加速批准： Telisotuzumab vedotin-tllv (Emrelis™)：来自艾伯维的一款抗体偶联药物，靶向c-Met蛋白过度表达的肿瘤。 Zongertinib (Hernexeos®)：来自勃林格殷格翰的一款不可逆、共价HER2选择性（对EGFR无影响）酪氨酸激酶抑制剂，用于治疗具有HER2酪氨酸激酶结构域激活突变的肿瘤。 Sevabertinib (Hyrnuo™)：来自拜耳的一款可逆性HER2/EGFR突变靶向酪氨酸激酶抑制剂，同样用于HER2突变非小细胞肺癌。 这些批准凸显了精准肿瘤学的进步，为既往接受过全身治疗的特定分子亚型非小细胞肺癌患者提供了新颖的靶向疗法——涵盖生物制剂和口服小分子药物。 两款针对免疫球蛋白A肾病（IgAN）的新型疗法也获得了加速批准，代表了不同的机制途径： Atrasentan (Vanrafia®)：来自诺华的一款口服选择性内皮素A（endothelin type A）受体拮抗剂。 Sibeprenlimab-szsi (Voyxact®)：来自大塚制药的一款皮下注射单克隆抗体，可阻断增殖诱导配体(A Proliferation Inducing Ligand)。 两者均适用于降低有快速疾病进展风险的成年原发性IgAN患者的蛋白尿，分别通过抑制内皮素通路和调节B细胞，为减缓肾功能衰退提供了新选择。 2025年新药批准中超过半数（53%）针对罕见病，突显了制药业对特殊患者群体未满足需求的重大关注。今年，FDA批准了三款治疗遗传性血管性水肿（HAE）的新疗法，体现了多样化的治疗策略： Garadacimab-gxii (ANDEMBRY®)：来自CSL Behring的一款单克隆抗体，通过抑制因子XIIa来预防HAE发作。 Donidalorsen (DAWNZERA™)：来自Ionis Pharmaceuticals的一款靶向前激肽释放酶（prekallikrein）的反义寡核苷酸（ASO），用于预防性发作控制。 Sebetralstat (EKTERLY®)：来自KalVista Pharmaceuticals的一款口服血浆激肽释放酶（kallikrein）抑制剂，用于治疗急性发作。 这些批准——涵盖单克隆抗体、RNA靶向和口服小分子药物模式——共同丰富了HAE的治疗格局，为长期预防和按需管理提供了靶向、机制各异的选项。 Mirdametinib (Gomekli™) 是SpringWorks Therapeutics开发的一款小分子激酶抑制剂，是2025年值得关注的一项罕见病批准。它靶向MEK1/2蛋白以抑制下游ERK磷酸化，从而治疗不适合手术的1型神经纤维瘤病相关丛状神经纤维瘤症状性患者（NF1-PN），为该特定遗传疾病的儿童和成人患者提供了一个靶向治疗选择。 在总计39项批准中，约半数（50%）代表了首创疗法（first-in-class），突显了对新作用机制的高度关注。 Suzetrigine (Journavx™) 由Vertex Pharmaceuticals, Inc.开发，是一款首创的非阿片类镇痛药。该小分子选择性阻断NaV1.8电压门控钠通道，这是治疗中重度急性疼痛的一种新机制。 2025年的批准包括两款开创性的首创RNA干扰疗法： Fitusiran (Qfitlia™)：由Alnylam发现并开发（后被赛诺菲收购）的双链siRNA，可降解抗凝血酶（antithrombin）mRNA，预防A型或B型血友病的出血事件。这是首个用于血友病的RNAi疗法。 Plozasiran (Redemplo®)：来自Arrowhead Pharmaceuticals的GalNAc偶联siRNA，靶向并降解apoC-III mRNA以降低家族性乳糜微粒血症综合征患者的甘油三酯，标志着针对这种罕见脂质紊乱的首个且唯一一个RNAi治疗方法。 这两款皮下给药疗法均展示了RNAi向新疾病领域的扩展，提供了新颖的基因沉默干预手段。 2025年，两款首创的布鲁顿酪氨酸激酶抑制剂（BTKi）被批准用于不同的自身免疫性疾病： Rilzabrutinib (Wayrilz™)：赛诺菲开发的一款共价可逆BTK抑制剂，是首个获批治疗持续性或慢性免疫性血小板减少症（ITP）的药物。 Remibrutinib (Rhapsido®)：诺华开发的一款选择性共价BTK抑制剂，是首个FDA批准用于治疗对H1抗组胺药无反应的慢性自发性荨麻疹（CSU）的BTK抑制剂。 这两款口服小分子药物通过靶向BTK来应对免疫介导的病理过程，代表了一种新的治疗策略。 Brensocatib (Brinsupri™)是Insmed Incorporated的一款口服二肽基肽酶1（DPP1）抑制剂，Nerandomilast (Jascayd®)是勃林格殷格翰的一款口服磷酸二酯酶4B（PDE4B）抑制剂，两者都是针对严重进展性呼吸道疾病的首创疗法。Brensocatib是首个通过抑制中性粒细胞丝氨酸蛋白酶活化来减少非囊性纤维化支气管扩张急性加重的获批疗法；而Nerandomilast是首个获批通过靶向纤维化通路中的环磷酸腺苷（cAMP）信号来减缓特发性肺纤维化疾病进展的PDE4B抑制剂。这两款药物为既往治疗手段有限的疾病提供了新颖、机制特异的口服选择。 爱尔康公司的Acoltremon (Tryptyr®)和LENZ Therapeutics, Inc.的Aceclidine (Vizz™)是两款首创的眼科小分子药物，通过新机制应对常见的年龄相关性视力障碍。Acoltremon是一种TRPM8受体激动剂，是首个此类干眼病疗法。Aceclidine是一种胆碱能毒蕈碱受体激动剂，是首个获批的基于Aceclidine的滴眼液，用于改善老花眼的近视力。两者均代表了开创性的局部治疗方法——以滴眼液形式给药——为先前使用更宽泛或特异性较低疗法的疾病提供了新的靶向药理学途径。 拜耳开发的Elinzanetant (Lynkuet®)代表了女性健康领域的重大进展，它是首个也是唯一一个双重神经激肽1和神经激肽3受体拮抗剂。这款口服疗法专门获批用于治疗因绝经引起的中重度血管舒缩症状，提供了一个新颖的非激素选择。 2025年获批的针对神经病学、传染病、皮肤病学、血液学和肿瘤学等领域严重、难治性疾病的其它值得关注的首创疗法还包括： 阿斯利康和第一三共的Datopotamab deruxtecan-dlnk (Datroway®)：一款靶向Trop-2的抗体偶联药物，可递送拓扑异构酶I抑制剂有效载荷，用于治疗HR+/HER2-转移性乳腺癌。 葛兰素史克的Gepotidacin (Blujepa™)是一种小分子抗生素，通过抑制细菌拓扑异构酶II和IV来治疗单纯性尿路感染，代表了近30年来首个用于单纯性尿路感染的新型口服抗生素类别。 强生公司的Nipocalimab-aahu (Imaavy™)：首个通过阻断FcRn来减少全身性重症肌无力患者致病性IgG的单克隆抗体。 再生元制药的Linvoseltamab-gcpt (Lynozyfic™)：一款BCMAxCD3双特异性T细胞衔接器，用于治疗复发/难治性多发性骨髓瘤患者。 利奥制药的Delgocitinib (Anzupgo®)：首个用于治疗中重度慢性手部湿疹的泛JAK抑制剂外用软膏。 Copyright Notice: Proper citation must include: “WeChat Public Account: 药物发现笔记 (Drug Discovery Notes) + [Article Title] + [Publication Date]”. Disclaimer: This platform is dedicated to sharing and discussing scientific research in drug discovery. Content herein does not constitute clinical treatment recommendations. The opinions expressed are solely those of the authors and do not represent the opinions of any affiliated organizations. This article is not investment advice. 引用时须注明：“微信公众号：药物发现笔记（Drug Discovery Notes）+ [文章标题] + [发表日期]”。 声明：本公众号平台仅限于药物发现科学研究内容分享和讨论，不作为临床治疗方案推荐。本文仅代表个人观点，不代表公司立场，不作为投资建议。