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Emapalumab Overview

Introduction of Emapalumab

Emapalumab (trade name Gamifant, also known as NI-0501), is a fully human monoclonal antibody discovered and developed by NovImmune SA as a potent inhibitor of neutralizes interferon gamma (IFNγ). It is under investigation as a treatment for primary hemophagocytic lymphohistiocytosis, a hyperinflammatory condition. NovImmune SA has received a variety of designations for emapalumab that are intended to facilitate the development of drugs, including Priority Medicines and orphan drug designations in the EU, and Breakthrough Therapy, rare pediatric disease, and orphan drug designations in the US. On November 20, 2018, the Food and Drug Administration approved this drug for adult and pediatric (newborn and older) patients with primary hemophagocytic lymphohistiocytosis (HLH) with refractory, recurrent or progressive disease or intolerance with conventional HLH therapy.

Mechanism of Action of Emapalumab

Hemophagocytic lymphohistiocytosis (HLH) is a severe immune system disorder, the genetic underpinnings of which are becoming clear. HLH is caused by a severe impairment of cytotoxic T cell function that triggers aberrant activation of the immune system. This is mediated to a large degree by dramatic increase in levels of IFNγ. In preclinical studies, it has demonstrated that neutralizing IFNγ in animal models of HLH reversed organ pathology and normalized key clinical parameters to protect animals from death, whereas inhibition of other cytokines did not provide such protection. Interferon-gamma (IFN-gamma or IFNγ) is a cytokine secreted by cells of the immune system to help regulate immune functions. Both the innate and adaptive immune systems use IFN-gamma to fight viral and intracellular bacterial infections. IFNγ is produced by natural killer (NK) and natural killer T (NKT) cells, as well as by CD4± and CD8± Cytotoxic T-lymphocyte (CTL) cells in response to specific pathogens. This particular cytokine is important to the immune system, in part, because it can directly inhibit the ability of viruses to replicate and it helps to both stimulate as well as regulate other immune responses in the body, particularly inflammation. However, abnormal levels of IFNγ are associated with a number of autoinflammatory and autoimmune diseases including lupus, insulin-dependent diabetes, arthritis, and hemophagocytic lymphohistiocytosis, among others. Emapalumab, a fully human monoclonal antibody, is a potent inhibitor of IFNγ. It can bind and neutralize IFN-γ, preventing it from inducing pathological effects.

Mechanism of Action of EmapalumabFig 1. Mechanism of Action of Emapalumab

Table 1. Clinical Projects of Emapalumab*

NCT ID Status Conditions Lead Sponsor Update Time
NCT03312751 Recruiting Primary Hemophagocytic Hymphohistiocytosis NovImmune SA October 18, 2017
NCT01818492 Recruiting Primary Haemophagocytic Lymphohistiocytosis NovImmune SA March 26, 2013
NCT02069899 Recruiting Hemophagocytic Lymphohistiocytosis NovImmune SA February 24, 2014
NCT03311854 Recruiting Macrophage Activation Syndrome; Lymphohistiocytosis, Hemophagocytic; Arthritis, Juvenile NovImmune SA October 17, 2017

Table 2. Approved Drugs of Emapalumab**

INN (trade name) Therapeutic area Dose Strength Route Company Marketing start Market
Gamifant hemophagocytic lymphohistiocytosis (HLH) Solution for injection 5 mg/mL / vial Intravenous infusion NOVIMMUNE S.A. November 20, 2018

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Reference
* The table was excerpted from the following website
https://clinicaltrials.gov/ct2/results?cond=&term=Emapalumab

** Information presented in the table were collected from the following website:
https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&;ApplNo=761107


For research use only. Not intended for any clinical use.

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