Therapeutics

Zagotenemab

Overview

Name: Zagotenemab
Synonyms: LY3303560
Therapy Type: Immunotherapy (passive) (timeline)
Target Type: Tau (timeline), Unknown
Condition(s): Alzheimer's Disease
U.S. FDA Status: Alzheimer's Disease (Phase 2)
Company: Eli Lilly & Co.

Background

Zagotenemab is a humanized anti-tau antibody derived from MCI-1, Peter Davies' mouse monoclonal antibody against an early pathological conformation of tau. Zagotenemab binds and neutralizes soluble tau aggregates.

Preclinical studies in tau transgenic mice showed that immunotherapy with MCI-1 reduced levels of hyperphosphorylated insoluble tau levels and neurofibrillary pathology (Chai et al., 2011).

At the 2017 AAIC meeting, Lilly presented data from surface plasmon resonance binding and ELISA assays to assess LY3303560's selectivity to aggregates over monomer and characterize its epitope. LY3303560 reportedly had high affinity to soluble tau aggregate in vitro, at a KD of below 220 picomolar, compared to monomer, KD of 235 nanomolar. The antibody reportedly recognizes a conformational epitope whose primary epitope is in tau's N-terminal region. Intravenous administration to monkeys indicated clearance of 0.15 ml/h/kg and a half-life of 13 days. SC administration indicated a bioavailability of 79 percent, and rat CSF concentration was 0.1 percent of plasma at 24 hours after IV administration (Alam et al., 2017).

Findings

From April 2016 to July 2018, Lilly ran a first-in-human trial of LY3303560 in 110 people, both healthy volunteers and people whose MCI due to AD or mild to moderate AD was ascertained with a positive amyloid PET scan. This study evaluated a single, escalating intravenous infusion or subcutaneous injection of LY3303560 or placebo. It measured adverse effects up to 85 days after this dose, as well as exposure and maximal achieved drug concentration in both serum and CSF. This study required a four-day stay in a clinical research unit and 10 follow-up visits. It was conducted in California and Maryland. Results were not published.

From January 2017 to June 2019, a second Phase 1 study intravenously delivered multiple escalating doses of LY3303560 or placebo to 24 people with the same diagnosis. Over a treatment period of six months plus four months of follow-up, the trial measured adverse events and pharmacokinetic parameters. Notably, this trial infused LY3303560 or placebo, and amyloid and tau PET tracers, in the same session. The study initially was going to measure change in tau PET as a secondary outcome, but dropped this measure in February 2018. This trial ran at 12 sites in the U.S., the U.K., and Japan.

In April 2018, Phase 2 began with a first efficacy trial enrolling 285 people who have had gradual and progressive decline in memory for at least six months. The study compares two undisclosed intravenous doses to placebo. Change from baseline on Lilly's integrated Alzheimer's Disease Rating Scale (iADRS) two years after baseline is the primary outcome; secondary measures include ADAS-Cog13, ADCS-iADL, CDR-SB, MMSE, the CogState Brief Battery (CBB), as well as tau PET, volumetric MRI, the Columbia Suicide Severity Rating Scale (C-SSRS), and antigenicity of LY3303560, also out to two years. This trial ran at 60 sites in North America and Japan. It finished enrolling in August 2019 and will run until August 2021. 

For all trials, see clinicaltrials.gov.

Clinical Trial Timeline

  • Phase 2
  • Study completed / Planned end date
  • Planned end date unavailable
  • Study aborted
Sponsor Clinical Trial 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031
Eli Lilly & Co. NCT03518073
N=285

Last Updated: 29 Sep 2020

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References

Antibody Citations

  1. Tau (MC1)

News Citations

  1. Peter Davies, Beloved Giant of Alzheimer’s Disease Research, Dies at 72

Paper Citations

  1. . Passive immunization with anti-Tau antibodies in two transgenic models: reduction of Tau pathology and delay of disease progression. J Biol Chem. 2011 Sep 30;286(39):34457-67. PubMed.

External Citations

  1. clinicaltrials.gov
  2. Alam et al., 2017

Further Reading

Papers

  1. . Alzheimer's disease: Recent treatment strategies. Eur J Pharmacol. 2020 Nov 15;887:173554. Epub 2020 Sep 15 PubMed.