培妥罗凝血素α (Esperoct)

概览

Turoctocog alfa pegol is a pegylated version of turoctocog alfa. Novo Nordisk's brand name Esperoct (turoctocog alfa pegol, N8-GP) was approved by the US FDA on February 19, 2019. Fundamentally, the N8-GP moiety is identical to turoctocog alfa, a recombinant human clotting factor VIII (rFVIII) with a truncated B-domain made from the sequence coding for 10 amino acids from the N-terminus and 11 amino acids from the C-terminus of the naturally occurring B-domain . Turoctocog alfa is produced in Chinese hamster ovary (CHO) cells without addition of any human or animal-derived materials . During secretion, some rFVIII molecules are cleaved at the C-terminal of the heavy chain (HC) at amino acid 720, and a monoclonal antibody binding C-terminal to this position is used in the purification process allowing isolation of the intact rFVIII . It was developed by Novo Nordisk and approved by the US FDA on October 16, 2013 . The essential difference between turoctocog alfa and N8-GP, however, is the specific attachment of a 40-kDa polyethylene glycol (PEG) group to a specific O-glycan in the truncated B-domain of the general turoctocog alfa rFVIII structure . This modification to the general turoctocog alfa rFVIII structure makes N8-GP an extended half-life factor VIII molecule for factor VIII replacement therapy in patients with factor VIII deficiency, or hemophilia A . As such, turoctocog alfa pegol is a valuable expansion to the drug therapies available for treating hemophilia A as it ultimately provides a less burdensome and more convenient dosing regimen for patients that is less frequent than that for turoctocog alfa.

作用机制

The principal characteristic that defines hemophilia A is the limited presence or complete deficiency of human clotting factor VIII in the body . Subsequently, because factor VIII is a critical component that is essential for the extrinsic tissue factor pathway of the blood coagulation cascade process to proceed, individuals with hemophilia A ultimately experience increased bleeding - in comparison to individuals without a factor VIII deficiency - after injury or any kind of medical procedure . Such increased bleeding can be heavy and/or fatal and may occur due to minimal injury or even when there is no injury whatsoever - in which case the bleeding is spontaneous . Furthermore, excessive bleeds that bleed into muscles, organs, and joints are also associated with dangerous complications and regular pain . The turoctocog alfa pegol (N8-GP) drug is consequently recombinant factor VIII (rFVIII) in which specific site-directed glycoPEGylation has been performed in an effort to increase the half-life of the rFVIII moiety without altering its hemostatic activity . In particular, the general rFVIII component of N8-GP is turoctocog alfa, a human coagulation factor VIII (rDNA), with a truncated B-domain . This glycoprotein has the same structure as human clotting factor VIII when activated, and also possesses post-translational modifications that are similar to those of the plasma-derived molecule . In blood, factor VIII predominantly circulates in a stable non-covalent complex with von Willebrand factor (vWF) . Concurrently, the tyrosine sulfation site present at the Tyr1680 (native full length) position, which is important for binding to vWF, has been found to be fully sulfated in the turoctocog alfa molecule . Subsequently, when infused into a hemophilia patient, this rFVIII binds to endogenous vWF in the patient’s circulation . The resultant factor VIII/vWF complex consists of two molecules (factor VIII and vWF) with different physiological functions . Factor VIII is activated by thrombin (factor IIa) . Activated factor VIII acts as a co-factor for activated factor IX, accelerating the conversion of factor X to activated factor X . Activated factor X converts prothrombin into thrombin . Thrombin then converts fibrinogen into fibrin and a clot can be formed . Turoctocog alfa pegol consequently functions predominantly as factor VIII replacement therapy for patients with factor VIII deficient hemophilia A. Finally, the particular N8-GP molecule has a 40-kDa polyethylene glycol (PEG) attached to a specific O-glycan in the truncated B-domain of the general turoctocog alfa rFVIII structure . Upon activation by thrombin, this B-domain possessing the pegylation is cleaved away, leaving active rFVIIIa - which as discussed above, is highly similar to and elicits the same blood clotting activities as native factor VIII . Subsequently, the PEG group of N8-GP ultimately serves to extend the half-life of the overall drug molecule in the body. As an inert chemical, the PEG group prolongs N8-GP's half-life by acting like an obstructive 'cloud' around the rFVIII molecule to which it is attached . Since the PEG group is generally too large to be cleared by the kidneys and does not bind particularly well with the clearance receptors that typically eliminate endogenous factor VIII, N8-GP demonstrates a longer half-life than the general turoctocog alfa rFVIII structure .

适应症

Turoctocog alfa pegol is indicated for use in adults and children with hemophilia A for on-demand treatment and control of bleeding episodes, perioperative management of bleeding, and routine prophylaxis to reduce the frequency of bleeding episodes. It is not indicated for the treatment of von Willebrand disease.

• Bleeding caused by Hemophilia A