Imlifidase
Identification
- Summary
Imlifidase is a cysteine protease that specifically cleaves human IgG antibodies, facilitating kidney transplantation in HLA sensitized patients.
- Brand Names
- Idefirix
- Generic Name
- Imlifidase
- DrugBank Accession Number
- DB15258
- Background
Chronic kidney disease (CKD) is a progressive and irreversible disease that represents a significant burden for both the individual and healthcare system at large.2 Currently available treatments for end-stage renal disease are limited to dialysis and renal transplantation, with the former associated with significant costs and lower quality of life.1,2
Patients who have developed human leukocyte antigen (HLA) sensitization from prior exposure to blood products, pregnancy, or any other circumstance which may have resulted in exposure to non-self HLA antigens, face additional barriers to transplantation.1,3 Highly sensitized individuals carry high levels of anti-HLA antibodies and are at significant risk for antibody-mediated rejection which occurs mainly through complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicity (ADCC).1 High levels of anti-HLA antibodies also contribute to poor graft survival.1 As a result, highly sensitized individuals experience marked delays on transplant lists due to the challenges associated with procuring an HLA compatible donor graft.1,3
Imlifidase is a cysteine protease and eliminates Fc-dependent effector functions such as CDC and ADCC by cleaving the heavy chains of human immunoglobulin G (IgG) antibodies.6 As a result, the risk of antibody-mediated rejection is reduced allowing kidney transplantation in highly sensitized patients to proceed.1,6
- Type
- Biotech
- Groups
- Approved, Investigational
- Biologic Classification
- Protein Based Therapies
Recombinant Enzymes - Protein Chemical Formula
- C1575H2400N422O477S6
- Protein Average Weight
- Not Available
- Sequences
- Not Available
- Synonyms
- HMED-IdeS
- IdeS
- IdeS recombinant
- Imlifidase
Pharmacology
- Indication
Imlifidase is indicated for desensitization of highly sensitized adult kidney transplant patients with a positive crossmatch against an available deceased donor.6 The treatment is reserved for patients unlikely to receive a transplant under the available kidney allocation system including prioritization programs for highly sensitized patients.6
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- Contraindications & Blackbox Warnings
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- Pharmacodynamics
Imlifidase is highly specific to all four human IgG subclasses and does not cleave any other immunoglobulins (IgM, IgA, IgE, IgD).1,7 The inactivation of human IgG antibodies occurs rapidly and efficiently after administration of imlifidase, with the effect lasting for several weeks.5
- Mechanism of action
Imlifidase is a cysteine protease derived from Streptococcus pyogenes which degrades immunoglobulin G (IgG) in a multistep process.4,6 In the first step, imlifidase cleaves one of the two IgG heavy chains at the lower hinge leaving the other intact, resulting in a single cleaved IgG molecule. In the second step, the second heavy chain is cleaved yielding one homodimeric Fc fragment and one F(ab’)2 fragment.4,5,6
This process removes the ability of the F(ab’)2 fragments to participate in Fc-mediated functions including antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC).6,7 Ultimately, by degrading the entire IgG pool, imlifidase reduces donor-specific antibodies (DSA) and allows transplantation to occur.1,6
Target Actions Organism AIgG heavy chain cleavage- Absorption
Given that imlifidase is administered intravenously, it is fully absorbed and bioavailable; imlifidase exposure is dose-proportional and predictable.1,6 After a dose of 0.25 mg/kg, the mean Cmax of imlifidase was 5.8 (4.2-8.9) ug/mL.6 Tmax occurs once infusion is complete or soon after.1 Food is not expected to impact the effectiveness or absorption of imlifidase.6
- Volume of distribution
The volume of distribution of imlifidase is reported to be 0.2 L/kg in the elimination phase.1
- Protein binding
There is currently no evidence to suggest that imlifidase binds to any other protein besides its primary target - immunoglobulin G (IgG).7 Studies have demonstrated that imlifidase is highly specific for IgG and does not bind to any other human immunoglobulins.7
- Metabolism
There is currently no imlifidase metabolism data available; however, it is thought to be eliminated via proteolysis.7
- Route of elimination
Not Available
- Half-life
The mean distribution half-life of imlifidase is reported to be 1.8 hours, while the mean elimination half-life is reported to be 89 hours.1
- Clearance
The mean clearance value of imlifidase is reported to be 1.8 mL/h/kg.1
- Adverse Effects
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- Toxicity
There is currently no data for imlifidase administered at supra-therapeutic doses; therefore, toxicity information is not readily available.6 In cases of overdose, the patient should be carefully monitored and symptomatic treatment should be initiated as needed.6 Although there is no antidote to imlifidase, administration of intravenous IgG may correct depleted IgG levels.6
- Pathways
- Not Available
- Pharmacogenomic Effects/ADRs
- Not Available
Interactions
- Drug Interactions
- This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction Integrate drug-drug
interactions in your softwareAbciximab The therapeutic efficacy of Abciximab can be decreased when used in combination with Imlifidase. Adalimumab The therapeutic efficacy of Adalimumab can be decreased when used in combination with Imlifidase. Aducanumab The therapeutic efficacy of Aducanumab can be decreased when used in combination with Imlifidase. Alemtuzumab The therapeutic efficacy of Alemtuzumab can be decreased when used in combination with Imlifidase. Alirocumab The therapeutic efficacy of Alirocumab can be decreased when used in combination with Imlifidase. - Food Interactions
- No interactions found.
Products
- Drug product information from 10+ global regionsOur datasets provide approved product information including:dosage, form, labeller, route of administration, and marketing period.Access drug product information from over 10 global regions.
- International/Other Brands
- Idefirix
- Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Idefirix Injection 11 mg Intravenous Hansa Biopharma Ab 2020-12-16 Not applicable EU Idefirix Injection, powder, for solution 11 mg Intravenous Hansa Biopharma Ab 2020-12-16 Not applicable EU
Categories
- ATC Codes
- L04AA41 — Imlifidase
- Drug Categories
- Chemical TaxonomyProvided by Classyfire
- Description
- Not Available
- Kingdom
- Organic Compounds
- Super Class
- Organic Acids
- Class
- Carboxylic Acids and Derivatives
- Sub Class
- Amino Acids, Peptides, and Analogues
- Direct Parent
- Peptides
- Alternative Parents
- Not Available
- Substituents
- Not Available
- Molecular Framework
- Not Available
- External Descriptors
- Not Available
- Affected organisms
- Not Available
Chemical Identifiers
- UNII
- UVJ7NL8S2P
- CAS number
- 1947415-68-0
References
- General References
- Al-Salama ZT: Imlifidase: First Approval. Drugs. 2020 Nov;80(17):1859-1864. doi: 10.1007/s40265-020-01418-5. [Article]
- Fraser SD, Blakeman T: Chronic kidney disease: identification and management in primary care. Pragmat Obs Res. 2016 Aug 17;7:21-32. doi: 10.2147/POR.S97310. eCollection 2016. [Article]
- Rees L, Kim JJ: HLA sensitisation: can it be prevented? Pediatr Nephrol. 2015 Apr;30(4):577-87. doi: 10.1007/s00467-014-2868-6. Epub 2014 Jul 26. [Article]
- Lorant T, Bengtsson M, Eich T, Eriksson BM, Winstedt L, Jarnum S, Stenberg Y, Robertson AK, Mosen K, Bjorck L, Backman L, Larsson E, Wood K, Tufveson G, Kjellman C: Safety, immunogenicity, pharmacokinetics, and efficacy of degradation of anti-HLA antibodies by IdeS (imlifidase) in chronic kidney disease patients. Am J Transplant. 2018 Nov;18(11):2752-2762. doi: 10.1111/ajt.14733. Epub 2018 Apr 17. [Article]
- Winstedt L, Jarnum S, Nordahl EA, Olsson A, Runstrom A, Bockermann R, Karlsson C, Malmstrom J, Palmgren GS, Malmqvist U, Bjorck L, Kjellman C: Complete Removal of Extracellular IgG Antibodies in a Randomized Dose-Escalation Phase I Study with the Bacterial Enzyme IdeS--A Novel Therapeutic Opportunity. PLoS One. 2015 Jul 15;10(7):e0132011. doi: 10.1371/journal.pone.0132011. eCollection 2015. [Article]
- EMA Summary of Product Characteristics - Idefirix (imlifidase) powder for concentrate for solution for infusion [Link]
- EMA Assessment Report - Idefirix (imlifidase) [Link]
- External Links
- KEGG Drug
- D11470
- Wikipedia
- Imlifidase
Clinical Trials
- Clinical Trials
Phase Status Purpose Conditions Count 4 Recruiting Treatment Chronic Hepatitis B Infection 1 4 Unknown Status Treatment Viral Hepatitis B 1 3 Recruiting Other Long Term Efficacy and Safety 1 3 Recruiting Treatment Anti-Glomerular Basement Membrane Antibody Disease / Anti-Glomerular Basement Membrane Disease / Good Pasture Syndrome 1 3 Recruiting Treatment Kidney Transplantation in Highly Sensitized Patients 2
Pharmacoeconomics
- Manufacturers
- Not Available
- Packagers
- Not Available
- Dosage Forms
Form Route Strength Injection Intravenous 11 mg Injection, powder, for solution Intravenous 10 MG/ml Injection, powder, for solution Intravenous 11 mg - Prices
- Not Available
- Patents
- Not Available
Properties
- State
- Liquid
- Experimental Properties
- Not Available
Targets
- Kind
- Protein group
- Organism
- Not Available
- Pharmacological action
- Yes
- Actions
- Cleavage
- General Function
- Immunoglobulin receptor binding
- Specific Function
- Not Available
Components:
Name | UniProt ID |
---|---|
Ig gamma-1 chain C region | P01857 |
Ig gamma-2 chain C region | P01859 |
Ig gamma-4 chain C region | P01861 |
Immunoglobulin heavy constant gamma 3 | P01860 |
References
- Al-Salama ZT: Imlifidase: First Approval. Drugs. 2020 Nov;80(17):1859-1864. doi: 10.1007/s40265-020-01418-5. [Article]
Drug created at May 20, 2019 15:05 / Updated at February 21, 2021 18:55