The PK of raxibacumab is linear over the dose range of 1 to 40 mg/kg following single intravenous dosing in humans; raxibacumab was not tested at doses higher than 40 mg/kg in humans. Following single intravenous administration of raxibacumab 40 mg/kg in healthy male and female human subjects, the mean Cmax and AUCinf were 1,020.3 ± 140.6 mcg/mL and 15,845.8 ± 4,333.5 mcg•day/mL, respectively. Mean raxibacumab steady-state volume of distribution was greater than plasma volume, suggesting some tissue distribution. Clearance values were much smaller than the glomerular filtration rate indicating that there is virtually no renal clearance of raxibacumab.

Because the effectiveness of raxibacumab cannot be tested in humans, a comparison of raxibacumab exposures achieved in healthy human subjects to those observed in animal models of inhalational anthrax in therapeutic efficacy studies is necessary to support the dosage regimen of 40 mg/kg intravenously as a single dose for the treatment of inhalational anthrax in humans. Humans achieve similar or greater systemic exposure (Cmax and AUCinf) to raxibacumab following a single 40 mg/kg intravenous dose compared with New Zealand White rabbits and cynomolgus macaques receiving the same dosage regimen.

Effects of Gender, Age, and Race

Raxibacumab PK was evaluated via a population PK analysis using serum samples from 322 healthy subjects who received a single 40 mg/kg intravenous dose across 3 clinical trials. Based on this analysis, gender (female versus male), race (non-white versus white), or age (elderly versus young) had no meaningful effects on the PK parameters for raxibacumab.

Raxibacumab PK has not been evaluated in children [see Dosage and Administration (2.2), Use in Specific Populations (8.4)].

Repeat Dosing

Although raxibacumab is intended for single-dose administration, the PK of raxibacumab following a second administration of 40 mg/kg given intravenously 14 days after the first 40 mg/kg intravenous dose was assessed in 23 healthy subjects (Trial 3). The mean raxibacumab concentration at 28 days after the second dose was approximately twice the mean raxibacumab concentration at 14 days following the first dose. In the human trial assessing the immunogenicity of raxibacumab (Trial 2), 20 healthy subjects who had initially received a single dose of raxibacumab 40 mg/kg intravenously received a second 40 mg/kg intravenous dose at ≥4 months following their first dose. No statistically significant differences in mean estimates of AUCinf, CL, or half-life of raxibacumab between the 2 doses administered ≥4 months apart were observed. The mean Cmax following the second dose was 15% lower than the Cmax following the first dose.

Ciprofloxacin Interaction Trial

In an open-label trial evaluating the effect of raxibacumab on ciprofloxacin PK in healthy adult male and female subjects (Trial 1), the administration of 40 mg/kg raxibacumab intravenously following ciprofloxacin intravenous infusion or ciprofloxacin oral tablet ingestion did not alter the PK of ciprofloxacin administered orally and/or intravenously. Likewise, ciprofloxacin did not alter the PK of raxibacumab [see Drug Interactions (7.1)].

Co-Administration with AVA Trial

The effect of a single 40 mg/kg infusion of raxibacumab on the immunogenicity of a three-dose regimen of AVA administered (SC) was assessed in an open-label randomized trial in healthy adult male and female subjects (Trial 4). The trial included two treatment arms. In the combination arm, the first dose of AVA was administered immediately following the raxibacumab infusion (Day 1), while the second and third doses were administered on Days 15 and 29. In the AVA-alone arm, these SC AVA doses were administered on Days 1, 15 and 29. Overall immune response to AVA in the combination arm was found to be similar to the AVA-alone arm.