The development of cardiovascular disorders associated with atherosclerotic vascular lesions is a common complication of autoimmune rheumatic diseases (AIRDs), leading to a life expectancy decrease. Rheumatoid arthritis (RA) has a special place among the AIRDs, and the incidence of atherosclerotic vascular disease is 1.5-fold higher than in the general population, which is comparable to type 2 diabetes mellitus. This difference is due to the shared immunopathogenetic mechanisms of RA and atherosclerosis. The aim of the study was to identify predictors of cardiovascular adverse events (CAE) during therapy with the interleukin 6 (IL-6) inhibitor olokizumab (OKZ) and to evaluate the cardioprotective potential of this monoclonal antibody. In a pooled retrospective analysis of data from randomized and open-label, long-term clinical trials of the OKZ efficacy in patients with RA, we evaluated the effects of OKZ therapy on the incidence of CAE and the following lipid profile parameters: apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1), lipoprotein-a (Lp(a)), adiponectin, homocysteine, and albumin. During treatment with OKZ, an increased risk of CAE was independently associated with age over 60 years (hazard ratio (HR) – 1.59; 95% confidence interval (95% CI): 1.12–2.26), elevated (>30) body mass index (HR=1.75; 95% CI: 1.26–2.45), hypertention (HR=2.44; 95% CI: 1.46–4.06) and ApoA1 (>2.25 g/L) (OR=2.23; 95% CI: 1.05–4.72). During treatment with OKZ, an increase in adiponectin levels, a decrease in homocysteine, Lp(a), and no changes of the ApoB/ApoA1 ratio were noted. Favorable dynamics of cardiovascular risk biomarkers in patients receiving active therapy compared to placebo indicate a likely positive effect of OKZ on the cardiovascular system.

The aim of the article is to study pharmacokinetic characteristics of intravenous olokizumab in patients with moderate COVID-19 to relieve a hyperinflammation syndrome.Materials and methods. The pharmacokinetic study was conducted as a part of a phase III clinical study (RESET, NCT05187793) on the efficacy and safety of a new olokizumab regimen (intravenous, at the doses of 128 mg or 256 mg) in COVID-19 patients. Plasma concentrations of olokizumab were determined by the enzyme immunoassay. The population analysis was performed using a previously developed pharmacokinetic model based on a linear two compartment.Results. The pharmacokinetic analysis included the data from 8 moderate COVID-19 patients who had been administrated with olokizumab intravenously at the dose of 128 mg. According to the analysis results in this population, there was an increase in the drug clearance, compared with the data obtained in healthy volunteers and the patients with rheumatoid arthritis: 0.435, 0.178 and 0.147 l/day, respectively. The parameters analysis within the framework of a population pharmacokinetic model showed that the main factors for the increased olokizumab clearance are a high body mass index. In addition, the presence of COVID-19 itself is an independent factor in increasing the drug clearance.Conclusion. After the intravenous olokizumab administration, an increase in the drug clearance is observed in moderate COVID-19 patients against the background of the disease course. The main contribution to the increased clearance is made by the characteristics of the population of COVID-19 patients associated with the risk of a severe disease and inflammation. When administered intravenously at the dose of 128 mg, a therapeutically significant olokizumab level was maintained throughout the acute disease phase for 28 days.

Finding effective and safe medicines to fight SARS-CoV-2 infection is an urgent task. RPH-137 is an original trap fusion protein against SARS-CoV-2 virus. It comprises the angiotensin-converting enzyme type 2 extracellular domain and the human IgG1 Fc fragment.The aim of the study was to carry out a preclinical evaluation of the efficacy of RPH-137 and molnupiravir against SARS-CoV-2 infection.Materials and methods: the authors analysed RPH-137 expressed in a stable CHO cell line and molnupiravir used as an active pharmaceutical ingredient. Drug-mediated inhibition of virus-induced cytotoxicity was assessed in Vero cell culture. In vivo efficacy assessments were performed in Syrian hamsters. The animals were infected intranasally with SARS-CoV-2 (PIK35 clinical isolate) in the dose of 5 log TCID₅₀. The authors evaluated body weight measurements, lung–body weight ratios, and lung histopathology findings and determined viral RNA levels in oropharyngeal swabs by RT-PCR using the amplification cycle threshold (Ct). The statistical analyses involved one- and two-way ANOVA, Student's t-test, and Mann–Whitney test.Results: RPH-137 and molnupiravir inhibited the cytopathic effect of SARS-CoV-2 in Vero cells; the EC₅₀ values of RPH-137 amounted to 4.69 μg/mL (21.3 nM) and 16.24 μg/mL (73.8 nM) for 50 TCID₅₀ and 200 TCID₅₀, respectively, whereas the EC₅₀ values of molnupiravir were 0.63 μg/mL (1900 nM) for both doses. Intramuscular RPH-137 (30 and 80 mg/kg) had no effect on the infection process in Syrian hamsters. The comparison with the challenge control group showed that intraperitoneal RPH-137 (100 mg/kg) had statistically significant effects on a number of parameters, including a 27% reduction in inflammation and a 30% reduction in the total lesion area of the lungs by Day 7. Intragastric molnupiravir (300 mg/kg twice daily) significantly inhibited SARS-CoV-2 infection.Conclusions: both RPH-137 and molnupiravir inhibited the cytopathic effect of SARS-CoV-2 in Vero cells. In Syrian hamsters, molnupiravir demonstrated a more pronounced inhibition of SARS-CoV-2 infection than RPH-137. However, RPH-137 had statistically significant effects on a range of parameters. This offers additional perspectives for further research.

Background/Objectives: Olokizumab (OKZ) is a humanized monoclonal antibody targeting interleukin-6 (IL-6). OKZ demonstrated efficacy in subjects with active rheumatoid arthritis (RA) in randomized controlled trials versus adalimumab (ADLM) and placebo over 24 weeks, with sustained efficacy confirmed through 106 weeks in an open-label single-arm extension study (OLE). This analysis aimed to predict 1-year efficacy of OKZ 64 mg administered every two weeks (q2w) and every four weeks (q4w) compared with ADLM and placebo through virtual clinical trial simulations based on population pharmacokinetic/pharmacodynamic (PK/PD) models. Methods: Nonlinear mixed-effects models were developed using pooled data from phase III studies. Turnover models with a maximum inhibition I_max-type relationship between OKZ concentrations and clinical scores were applied. Simulated clinical trials were performed to estimate 52-week response rates, defined as proportions of patients achieving low disease activity (DAS28-CRP ≤ 3.2) and remission (CDAI ≤ 2.8). The reliability of the simulated extrapolations was validated against published data. Results: Log-transformed C-reactive protein (CRP) baseline levels and region were identified as significant covariates, influencing the dynamics of RA activity scores. OKZ and ADLM showed comparable predicted efficacy profiles, with overlapping 95% prediction intervals, and both were superior to placebo. Model predictions showed strong agreement with published long-term data for ADLM and placebo and closely reproduced the actual 1-year response profiles from the OKZ OLE. Conclusions: The developed PK/PD models showed good agreement with observed long-term efficacy outcomes for OKZ, ADLM, and placebo in MTX-IR RA patients. Both OKZ dosing regimens sustained low disease activity and remission rates comparable with those for ADLM over 52 weeks, supporting their use as effective treatment options.