Qfitlia: how was the first human dose set?
fitusiran · Antithrombin / SERPINC1 (siRNA)
First-in-human starting dose
Not stated in public reviews
Why it's blank
The public FDA and EMA reviews of Qfitlia don't say how the first human dose was chosen. That rationale is in the IND, which is confidential, so it is missing for most approved products.
How it's usually set for oligonucleotides outside oncology
Find the highest dose with no adverse effects (NOAEL) in each animal species, convert it to a human equivalent dose, usually by body surface area, pick the most appropriate species, then divide by a safety factor (default 10) to get the maximum recommended starting dose.
“In general, one should consider using a safety factor of at least 10. The MRSD should be obtained by dividing the HED by the safety factor.”
This product's starting point
NOAEL / key findings: Rat 26-wk NOAEL 1 mg/kg/wk females, 0.5 mg/kg/wk males (fatal clotting at 1); monkey 39-wk 0.5 mg/kg/wk tolerated; thrombosis, hepatic necrosis, injection-site findings (FDA integrated review, p. 153)
NOAEL / key findings
Rat 26-wk NOAEL 1 mg/kg/wk females, 0.5 mg/kg/wk males (fatal clotting at 1); monkey 39-wk 0.5 mg/kg/wk tolerated; thrombosis, hepatic necrosis, injection-site findings
“The no observed adverse effect level (NOAEL) was the high dose (HD) of 1 mg/kg/week in females, based on the absence of toxicity, and the MD of 0.5 mg/kg/week in males, based on severe clotting.”
Same question, other oligonucleotides
Applicant estimated safe starting dose from nonclinical results; method not specified
Zanvastro
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