Limited tests (bacterial mutation, mouse micronucleus) negative; not needed for a monoclonal antibody (ICH S6)
“No genotoxic effects were seen. This is not a complete genotoxicity test battery (see CPMP/ICH/174/95, S2B). However, for a monoclonal antibody, genotoxicity tests are considered to be of limited value and are therefore not needed (CPMP/ICH/302/95, S6).”
Not conducted: no relevant rodent model; no direct carcinogenic signal, but impaired tumour control from immunosuppression cannot be ruled out
“No carcinogenicity study was performed with adalimumab. The lack of such studies is justified because there is no conventional or alternative model available, (i.e adalimumab has low/no affinity for mouse/rat TNFα, and MAHA developed after single doses).”
Stand-alone CNS, cardiovascular (dog), GI, renal studies; no findings of clinical concern
“A number of general pharmacology/safety pharmacology studies were performed focussing on the CNS, cardiovascular system, GI tract, renal function, female uterus, local anaesthesia, and in vitro studies with human blood.”
“The genotoxic potential of adalimumab was tested in vitro by gene mutations in bacteria and in vivo in the mouse micronucleus test. No genotoxic effects were seen.”
Not conducted: incomplete battery accepted, genotoxicity tests not needed for a monoclonal antibody (ICH S6)
“This is not a complete genotoxicity test battery (see CPMP/ICH/174/95, S2B). However, for a monoclonal antibody, genotoxicity tests are considered to be of limited value and are therefore not needed (CPMP/ICH/302/95, S6).”
“The genotoxic potential of adalimumab was tested in vitro by gene mutations in bacteria and in vivo in the mouse micronucleus test. No genotoxic effects were seen.”
Not conducted: no conventional or alternative model available
“No carcinogenicity study was performed with adalimumab. The lack of such studies is justified because there is no conventional or alternative model available, (i.e adalimumab has low/no affinity for mouse/rat TNFα, and MAHA developed after single doses).”
Not required: lack of studies justified by absence of a relevant model
“No carcinogenicity study was performed with adalimumab. The lack of such studies is justified because there is no conventional or alternative model available, (i.e adalimumab has low/no affinity for mouse/rat TNFα, and MAHA developed after single doses).”
No hERG assay; no clinically concerning findings in dog cardiovascular safety pharmacology
“The studies in dogs (CV effects) and with human blood are considered more relevant. There were no findings in these studies that raise any clinical concerns.”