Treatment methods for muscular dystrophy
New dosing regimens for treating muscular dystrophy in a patient suffering from Duchenne muscular dystrophy (DMD) with an antisense oligonucleotide conjugate that causes skipping of an exon in the human dystrophin gene are described. Also described is a method of treating a patient with an antisense oligomer CPP conjugate and a magnesium supplement.
1. A method of treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation that is amenable to exon skipping, comprising administering to the patient an antisense oligomer conjugate of Formula (I):
or a pharmaceutically acceptable salt thereof,
wherein:
n is 1-40;
each Nu is a nucleobase, which, taken together, form a targeting sequence complementary to an exon annealing site in the dystrophin pre-mRNA;
T′ is a moiety selected from:
wherein
R 100 a cell-penetrating peptide, R 200 is hydrogen, and R 1 is C 1 -C 6 alkyl,
at a dose equivalent to the dose of the 6HCl salt of the conjugate according to the following schedule:
i) about 300 mg to about 700 mg, or about 900 mg to about 1200 mg, once every four weeks for a patient that weighs from about 10 kg to about 25 kg;
ii) about 600 mg to about 800 mg, or about 1000 mg to about 1300 mg, once every four weeks for a patient that weighs from about 25 kg to about 50 kg; or
iii) about 700 mg to about 900 mg, or about 1200 mg to about 1500 mg, once every four weeks for a patient that weighs from about 50 kg to about 100 kg;
to achieve a mean AUC
about 100 and about 200 ug·h/mL, or is between about 200 and about 500 ug·h/mL, and
wherein the method further comprises administering a magnesium supplement to the patient.
2. A method of treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation that is amenable to exon 51 skipping, comprising administering to the patient an antisense oligomer conjugate of Formula (I):
or a pharmaceutically acceptable salt thereof,
wherein:
n is 1-40;
each Nu is a nucleobase, which, taken together, form a targeting sequence complementary to an exon annealing site in the dystrophin pre-mRNA;
T′ is a moiety selected from:
wherein
R 100 a cell-penetrating peptide, R 200 is hydrogen, and R 1 is C 1 -C 6 alkyl,
at a dose equivalent to the dose of the 6HCl salt of the conjugate according to the following schedule:
i) about 300 mg to about 700 mg, or about 900 mg to about 1200 mg, once every four weeks for a patient that weighs from about 10 kg to about 25 kg;
ii) about 600 mg to about 800 mg, or about 1000 mg to about 1300 mg, once every four weeks for a patient that weighs from about 25 kg to about 50 kg; or
iii) about 700 mg to about 900 mg, or about 1200 mg to about 1500 mg, once every four weeks for a patient that weighs from about 50 kg to about 100 kg;
to achieve a mean AUC
about 100 and about 200 ug· h/mL, or between about 200 and about 500 ug·h/mL, and
wherein the method further comprises administering a magnesium supplement to the patient.
3. The method of claim 1 , wherein the conjugate, or a pharmaceutically acceptable salt thereof, is administered at a dose effective to provide a mean AUC of between about 100 and about 200 ug·h/mL.
4. The method of claim 1 , wherein the conjugate, or a pharmaceutically acceptable salt thereof, is administered at a dose effective to provide a mean AUC of between about 200 and about 500 ug·h/mL.
5. The method of claim 1 , wherein the cell-penetrating peptide is chosen from RXRRXRRXRRXR (SEQ ID NO: 18), RFFRFFRFFR (SEQ ID NO: 19), RXRRXRRXRRXRXB (SEQ ID NO: 20), RFFRFFRFFRG (SEQ ID NO: 21), RRRRRRG (SEQ ID NO: 22), RRRRRR (SEQ ID NO: 23), RRRRRG (SEQ ID NO: 24), or RRRRR (SEQ ID NO: 25), wherein R is arginine, X is 6-aminohexanoic acid, B is β-alanine, F is phenylalanine, and G is glycine.
6. The method of claim 5 , wherein the cell-penetrating peptide is chosen from RRRRRRG (SEQ ID NO: 22), RRRRRR (SEQ ID NO: 23), RRRRRG (SEQ ID NO: 24), or RRRRR (SEQ ID NO: 25), wherein R is arginine and G is glycine.
7. The method of claim 6 , wherein the cell-penetrating peptide is RRRRRRG (SEQ ID NO: 22), wherein R is arginine and G is glycine.
8. The method of claim 1 , wherein the antisense oligomer conjugate causes skipping of an exon in the human dystrophin gene.
9. The method of claim 8 , wherein the exon is chosen from exon 44, 45, 50, 51, 52, or 53.
10. The method of claim 9 , wherein the exon is chosen from exon 45, 51, or 53.
11. The method of claim 1 , wherein the antisense oligomer conjugate has Formula (III):
or a pharmaceutically acceptable salt thereof,
wherein each Nu is a nucleobase, which, taken together, form a targeting sequence that is complementary to an exon annealing site in the dystrophin pre-mRNA.
12. The method of claim 1 or claim 2 , wherein the antisense oligomer conjugate, or a pharmaceutically acceptable salt thereof, is administered at a dose equivalent to about 600 mg, or about 1100 mg, of the 6HCl salt of the conjugate once every four weeks to a patient that weighs from about 10 kg to about 25 kg.
13. The method of claim 1 or claim 2 , wherein the antisense oligomer conjugate, or a pharmaceutically acceptable salt thereof, is administered at a dose equivalent to about 650 mg, or about 1200 mg, of the 6HCl salt of the conjugate once every four weeks to a patient that weighs from about 25 kg to about 50 kg.
14. The method of claim 1 or claim 2 , wherein the antisense oligomer conjugate, or a pharmaceutically acceptable salt thereof, is administered at a dose equivalent to about 750 mg, or about 1400 mg, of the 6HCl salt of the conjugate once every four weeks to a patient that weighs from about 50 kg to about 100 kg.
15. The method of claim 1 or claim 2 , wherein the magnesium supplement is administered in an amount effective to provide a normal serum magnesium level.
16. The method of claim 1 or claim 2 , wherein the magnesium supplement is administered at a dose equivalent to about 100 to about 2400 mg magnesium oxide per day.
17. The method of claim 1 or claim 2 , wherein the magnesium supplement is administered at a dose equivalent to about 400 to about 2400 mg magnesium oxide per day.
18. The method of claim 1 or claim 2 , further comprising measuring serum magnesium level of said patient at two or more weeks from said administration.
19. The method of claim 1 or claim 2 , further comprising administering a second dose of magnesium supplement, at a dose based upon the measured serum magnesium level.
20. The method of claim 1 or claim 2 , wherein the magnesium supplement is chosen from magnesium oxide, magnesium citrate, magnesium carbonate, magnesium hydrogen phosphate, magnesium glycerophosphate, magnesium trisilicate, magnesium hydroxide, magnesium hydroxide carbonate, magnesium acetate, magnesium citrate, magnesium lactate, magnesium gluconate, magnesium chloride, magnesium aspartate, magnesium caprilate, magnesium ascorbate; magnesium taurate, magnesium malate, and magnesium diglycinate, magnesium pidulate, or magnesium sulfate.
21. The method of claim 1 or claim 2 , wherein the magnesium supplement is from magnesium oxide.
22. The method of claim 1 or claim 2 , wherein the antisense oligomer conjugate, or a pharmaceutically acceptable salt thereof, is administered in a pharmaceutical formulation, wherein the concentration of the conjugate in the formulation is about 50 mg/ml.