Population Modeling of Factor IX Activity Following Administration of Fidanacogene Elaparvovec Gene Therapy in Participants with Hemophilia B

Abstract

Background and Objective: Fidanacogene elaparvovec (BEQVEZ™), an adeno-associated virus-based gene therapy approved for the treatment of hemophilia B, enables endogenous production of factor IX (FIX), preventing bleeding and reducing the need for FIX replacement. Nonlinear mixed-effects models are routinely used for population pharmacokinetic analyses of FIX replacement therapies but have not previously been applied to FIX activity observations from gene therapy trials. A nonlinear mixed-effects modeling approach was used to characterize FIX activity following fidanacogene elaparvovec and/or FIX replacement, identify covariates affecting FIX activity, and estimate the longer-term durability of FIX activity after a single dose of fidanacogene elaparvovec. Methods: Population modeling using NONMEM® was performed with FIX activity data pooled from 11 clinical trials in participants with hemophilia B (three fidanacogene elaparvovec studies [n = 63]; eight nonacog alfa studies [n = 274]). FIX activity was assessed by one-stage clotting assays. Results: FIX activity was described by a compartmental model for gene and protein expression and a three-compartment model for FIX disposition. Covariates included age and body weight on gene-therapy-related parameters. Following fidanacogene elaparvovec administration, model-predicted FIX activity reached a median (90% prediction interval) peak of 13.5 (3.12–41.3) IU/dL and remained within 50% of the peak for a median of 8.67 (0.411–15.0) years. At 15 years post-infusion, median predicted FIX activity was 4.11 (1.15–17.6) IU/dL. Conclusions: Model-based estimates showed that a single dose of fidanacogene elaparvovec elicited long-lasting elevations in FIX activity, suggesting most individuals would not require prophylactic FIX replacement for at least 15 years post-infusion. ClinicalTrials.gov Identifier: NCT00364182, NCT01335061, NCT00037557, NCT00093171, NCT00093210, NCT03861273, NCT03307980, NCT02484092