Belumosudil

Belumosudil
Names
Trade namesRezurock, Rholistiq
Other namesKD025, SLx-2119
IUPAC name
  • 2-[3-[4-(1H-Indazol-5-ylamino)quinazolin-2-yl]phenoxy]-N-propan-2-ylacetamide
Clinical data
Main usesChronic graft versus host disease (cGvHD)[1]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Pregnancy
category
    Routes of
    use    		By mouth
    Typical dose200 mg OD[1]
    External links
    AHFS/Drugs.comMonograph
    Legal
    License data
    Legal status
    Chemical and physical data
    FormulaC26H24N6O2
    Molar mass452.518 g·mol−1
    3D model (JSmol)
    SMILES
    • CC(C)NC(=O)COC1=CC=CC(=C1)C2=NC3=CC=CC=C3C(=N2)NC4=CC5=C(C=C4)NN=C5
    InChI
    • InChI=InChI=1S/C26H24N6O2/c1-16(2)28-24(33)15-34-20-7-5-6-17(13-20)25-30-23-9-4-3-8-21(23)26(31-25)29-19-10-11-22-18(12-19)14-27-32-22/h3-14,16H,15H2,1-2H3,(H,27,32)(H,28,33)(H,29,30,31) checkY
    • Key:GKHIVNAUVKXIIY-UHFFFAOYSA-N checkY

    Belumosudil, sold under the brand name Rezurock among others, is a medication used to treat chronic graft versus host disease (cGvHD).[1] It is used in those who are at least 12 years of age who do not improve after other treatments.[1] It is taken by mouth.[1]

    Common side effects include infections, weakness, nausea, diarrhea, shortness of breath, cough, swelling, bleeding, abdominal pain, musculoskeletal pain, headache, low phosphate, low lymphocytes, and high blood pressure.[1] Use in pregnancy may harm the baby.[1] It is a kinase inhibitor; specifically of Rho-associated coiled-coil kinase 2 (ROCK2).[6][7]

    Belumosudil was approved for medical use in the United States in 2021.[1] While it is approved in the United Kingdom, it is not in the rest of Europe as of 2022.[7] In the United States it costs about 17,000 USD per month as of 2022.[8] In the UK, a one month supply costs the NHS around £6,700 as of 2023.[9]

    Medical uses

    Belumosudil is used to treat people aged 12 years and older with chronic graft-versus-host disease (chronic GVHD) after failure of at least two prior lines of systemic therapy.[1][6]

    Dosage

    It is generally taken at a dose of 200 mg once per day.[1]

    Mechanism

    Belumosudil binds to and inhibits the serine/threonine kinase activity of ROCK2. This inhibits ROCK2-mediated signaling pathways which play major roles in pro- and anti-inflammatory immune cell responses. A genomic study in human primary cells demonstrated that the drug also has effects on oxidative phosphorylation, WNT signaling, angiogenesis, and KRAS signaling.[10]

    History

    Originally developed by Surface Logix, Inc,[11] belumosudil was later acquired by Kadmon Corporation. By July 2020, the drug completed Phase II clinical studies for cGvHD, IPF, and psoriasis.[12]

    cGvHD is a complication that can follow allogeneic stem cell or hematopoietic stem cell transplantation where the transplanted cells (graft) attack healthy cells (host). This causes inflammation and fibrosis in multiple tissues. Two cytokines controlled by the ROCK2 signaling pathway, IL-17 and IL-21, have a major role in the cGvHD response. In a 2016 report using both mouse models and a limited human clinical trial ROCK2 inhibition with belumosudil targeted both the immunologic and fibrotic components of cGvHD and reversed the symptoms of the disease.[13]

    In October 2017, belumosudil was granted orphan drug status in the United States for treatment of patients with cGvHD.[14]

    Efficacy of belumosudil was evaluated in clinical trial NCT03640481,[15] a randomized, open-label, multicenter dose-ranging trial that included 65 patients with chronic GVHD who were treated with belumosudil 200 mg taken orally once daily.[6]

    On 16 July 2021, the U.S. Food and Drug Administration (FDA) approved belumosudil for adult and pediatric patients 12 years and older with chronic graft-versus-host disease (chronic GVHD) after failure of at least two prior lines of systemic therapy.[6]

    Research

    IPF is a progressive fibrotic disease where the lining of the lungs become thickened and scarred.[16] Increased ROCK activity has been found in the lungs of humans and animals with IPF. Treatment with belumosudil reduced lung fibrosis in a bleomycin mouse model study.[17]

    Psoriasis is an inflammatory skin condition where patients experiences eruptions and remissions of thickened, erythematous, and scaly patches of skin. Down-regulation of pro-inflammatory responses was observed with KD025 treatment in Phase 2 clinical studies in patients with moderate to severe psoriasis.[18]

    References

    1. 1 2 3 4 5 6 7 8 9 10 11 "Rezurock- belumosudil tablet". DailyMed. Archived from the original on 21 August 2021. Retrieved 20 August 2021.
    2. 1 2 "Rholistiq". Therapeutic Goods Administration (TGA). 26 November 2021. Archived from the original on 28 December 2021. Retrieved 28 December 2021.
    3. 1 2 "AusPAR: Belumosudil". Therapeutic Goods Administration (TGA). 10 May 2022. Archived from the original on 10 May 2022. Retrieved 10 May 2022.
    4. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 29 June 2022. Retrieved 29 June 2022.{{cite web}}: CS1 maint: archived copy as title (link)
    5. ↑ "Summary Basis of Decision - Rholistiq". Health Canada. 23 October 2014. Archived from the original on 6 August 2022. Retrieved 6 August 2022.
    6. 1 2 3 4 5 "FDA approves belumosudil for chronic graft-versus-host disease". U.S. Food and Drug Administration (FDA). 16 July 2021. Archived from the original on 16 July 2021. Retrieved 16 July 2021. Public Domain This article incorporates text from this source, which is in the public domain.
    7. 1 2 "Belumosudil". SPS - Specialist Pharmacy Service. 23 April 2021. Archived from the original on 27 October 2022. Retrieved 29 October 2022.
    8. ↑ "Rezurock Prices, Coupons, Copay & Patient Assistance". Drugs.com. Retrieved 29 October 2022.
    9. ↑ "8. Immune system and malignant disease". BNF 86: September 2023 - March 2024. BMJ Group and the Pharmaceutical Press. 2023. pp. 933–934. ISBN 978-0857114617.
    10. ↑ Park J, Chun KH (5 May 2020). "Identification of novel functions of the ROCK2-specific inhibitor KD025 by bioinformatics analysis". Gene. 737: 144474. doi:10.1016/j.gene.2020.144474. PMID 32057928. S2CID 211111888.
    11. ↑ Boerma M, Fu Q, Wang J, Loose DS, Bartolozzi A, Ellis JL, et al. (October 2008). "Comparative gene expression profiling in three primary human cell lines after treatment with a novel inhibitor of Rho kinase or atorvastatin". Blood Coagulation & Fibrinolysis. 19 (7): 709–18. doi:10.1097/MBC.0b013e32830b2891. PMC 2713681. PMID 18832915.
    12. ↑ "KD025 - Clinical Trials". ClinicalTrials.gov. Archived from the original on 25 July 2020. Retrieved 25 July 2020.
    13. ↑ Flynn R, Paz K, Du J, Reichenbach DK, Taylor PA, Panoskaltsis-Mortari A, et al. (April 2016). "Targeted Rho-associated kinase 2 inhibition suppresses murine and human chronic GVHD through a Stat3-dependent mechanism". Blood. 127 (17): 2144–54. doi:10.1182/blood-2015-10-678706. PMC 4850869. PMID 26983850.
    14. ↑ Shanley M (6 October 2017). "Therapy to Treat Transplant Complications Gets Orphan Drug Designation". RareDiseaseReport. Archived from the original on 14 February 2019. Retrieved 25 July 2018.
    15. ↑ Clinical trial number NCT03640481 for "Efficacy and Safety of KD025 in Subjects With cGVHD After At Least 2 Prior Lines of Systemic Therapy" at ClinicalTrials.gov
    16. ↑ "Pulmonary Fibrosis". The Mayo Clinic. Archived from the original on 15 July 2014. Retrieved 25 July 2018.
    17. ↑ Semedo D (5 June 2016). "Phase 2 Study of Molecule Inhibitor for Idiopathic Pulmonary Fibrosis Begins". Lung Disease News. BioNews Services, LLC. Archived from the original on 8 July 2016. Retrieved 25 July 2018.
    18. ↑ Zanin-Zhorov A, Weiss JM, Trzeciak A, Chen W, Zhang J, Nyuydzefe MS, et al. (May 2017). "Cutting Edge: Selective Oral ROCK2 Inhibitor Reduces Clinical Scores in Patients with Psoriasis Vulgaris and Normalizes Skin Pathology via Concurrent Regulation of IL-17 and IL-10". Journal of Immunology. 198 (10): 3809–3814. doi:10.4049/jimmunol.1602142. PMC 5421306. PMID 28389592.
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