Exposure-Response Analysis of Vamorolone (VBP15) in Boys With Duchenne Muscular Dystrophy

Exposure-response relationships of vamorolone, a novel dissociative steroidal anti-inflammatory drug, were investigated in clinical trials in boys with Duchenne muscular dystrophy. Variables were clinical outcome measures, Fridericia-corrected QT (QTcF) duration, and pharmacodynamic (PD) biomarkers. Exposure metrics were area under the plasma concentration time curve (AUC) and maximum plasma concentration (C-max), with a sigmoid E-max model applied. Significant improvement in clinical efficacy outcomes was observed after 24 weeks of daily dosing. The primary outcome, time to stand from supine velocity, exhibited the highest sensitivity to vamorolone, with the lowest AUC value providing 50% of maximum effect (E-50 = 186 ng center dot h/mL), followed by time to climb 4 stairs (E-50 = 478 ng center dot h/mL), time to run/walk 10 m (E-50 = 1220 ng center dot h/mL), and 6-minute walk test (E-50 = 1770 ng center dot h/mL). Week 2 changes of proinflammatory PD biomarkers showed exposure-dependent decreases. The E-50 was 260 ng center dot h/mL for insulin-like growth factor-binding protein 2, 1200 ng center dot h/mL for matrix metalloproteinase 12, 1260 ng center dot h/mL for lymphotoxin alpha 1/beta 2, 1340 ng center dot h/mL for CD23, 1420 ng center dot h/mL for interleukin-22-binding protein, and 1600 ng center dot h/mL for macrophage-derived chemokine/C-C motif chemokine 22. No relationship was found between QTcF interval changes from baseline and C-max in week 2 or 24. This analysis showed that improvements in clinical efficacy end points in week 24 and PD biomarkers in week 2 were achieved at typical vamorolone exposure of 2 mg/kg daily dose with a median AUC dose of 6 mg/kg (3651 ng center dot h/mL), corresponding to approximately 95% of maximum effects for most response variables.