


ILUMYA 替瑞奇珠单抗注射液

通用中文 | 替瑞奇珠单抗注射液 | 通用外文 | Tildrakizumab-asmn |
品牌中文 | 益路取 | 品牌外文 | ILUMYA |
其他名称 | |||
公司 | 默克(Merck) | 产地 | 美国(USA) |
含量 | 100 mg/mL | 包装 | 1瓶/盒 |
剂型给药 | 皮下 注射 | 储存 | 2度-8度(冰箱冷藏,禁止冷冻) |
适用范围 | 适用为成年人,中度-至-严重斑块银屑病患者 |
通用中文 | 替瑞奇珠单抗注射液 |
通用外文 | Tildrakizumab-asmn |
品牌中文 | 益路取 |
品牌外文 | ILUMYA |
其他名称 | |
公司 | 默克(Merck) |
产地 | 美国(USA) |
含量 | 100 mg/mL |
包装 | 1瓶/盒 |
剂型给药 | 皮下 注射 |
储存 | 2度-8度(冰箱冷藏,禁止冷冻) |
适用范围 | 适用为成年人,中度-至-严重斑块银屑病患者 |
ILUMYA(tildrakizumab-asmn)使用说明书
这些重点不包括安全和有效使用ILUMYA所需所有资料。请参阅ILUMYA完整处方资料。
ILUMYA™(tildrakizumab-asmn)注射液,为皮下使用
美国初次批准:2018
适应证和用途
ILUMYA是一种白介素-23拮抗剂适用为成年有中度-至-严重斑块银屑病患者对全身治疗或光治疗为被选者的治疗。(1)
剂量和给药方法
● 通过皮下注射给药。(2.1)
● 推荐剂量为100 mg在周 0,4,和每12周其后.(2.1)
剂型和规格
注射液:100 mg/mL 溶液在一个单-剂量预装注射器.(3)
禁忌证
严重的超敏性反应对tildrakizumab或对赋形剂的任何。(4)
警告和注意事项
● 超敏性:如发生一种严重的过敏反应,终止ILUMYA立即地和开始适当治疗。(5.1)
● 感染:ILUMYA可能增加 的风险感染. 指导患者寻求医学建议为临床上重要慢性或急性感染体征或症状的发生。如一个严重的感染发生考虑终止ILUMYA直至感染解决。(5.2)
● 结核(TB):
治疗开始前评价TB.(5.3)
不良反应
伴随ILUMYA治疗最常见(≥ 1%)不良反应为上呼吸道感染,注射部位反应,和腹泻。(6.1)
报告怀疑不良反应,联系Merck Sharp & Dohme Corp.,一个子公司Merck & Co.,Inc.,电话1-877-888-4231或FDA at 1-800-FDA-1088或www.fda.gov/medwatch.
药物相互作用
活疫苗:避免使用活疫苗在用ILUMYA治疗患者中。(7.1)
完整处方资料
1 适应证和用途
ILUMYA™是适用为成年有中度-至-严重斑块银屑病的治疗患者为对全身治疗或光治疗被选者。
2 剂量和给药方法
2.1 剂量
ILUMYA是通过皮下注射给予。推荐剂量为100 mg在周 0,4,和其后每12周。每注射器含1 mL的100 mg/mL tildrakizumab-asmn。
2.2 ILUMYA开始前结核的评估
开始用ILUMYA治疗前对患者评价结核(TB)感染[见警告和注意事项(5.3)]。
2.3 重要给药指导
ILUMYA应仅被卫生保健提供者给药。皮下给予ILUMYA。每个预装注射器是仅为单-剂量。注射完全量(1 mL),它提供100 mg的tildrakizumab每注射器。入一个剂量被缺失。如可能马上给予。其后,恢复给药在常规时间表间隔。
2.4 ILUMYA的制备和给药
注射前,从冰箱取出ILUMYA纸盒,和让预装注射器(有舌关闭的纸盒ILUMYA)在室温共坐30分钟。遵循在ILUMYA纸盒上指导正确地取出预装注射器,和仅当准备注射时取出。在准备注射前不要拉掉针头盖。给药前视力观察ILUMYA颗粒物质和变色。ILUMYA 是一个透明至略微不透明,无色至略微黄色溶液。不要使用如液体含可见的颗粒或注射器被损。可能存在气泡;不需要取出。选择一个注射部位有清洁皮肤和容易存取(例如腹部大腿,或上臂)。
脐周围2寸或皮肤压痛,瘀伤,红斑,硬皮,或被银屑病侵犯处不要给药。 也不要注射至瘢痕,腹纹,或血管。
● 当握住注射器,拉针头盖直下(不要扭)和遗弃。
● 如推荐皮下地给予LUMYA。[见剂量和给药方法(2.3)].
● 压下蓝色注射器芯直至它不能进一步移动。这激活安全性机制将确保注射给予后收回。
● 蓝色注射器芯取出前从皮肤全部的取出芯。蓝色注射器释放后,安全性锁将护针头内针头拉出。
● 遗弃任何未使用部分,遗弃使用过注射器。
3 剂型和规格
注射液:100 mg/mL溶液在一个单-剂量预装注射器。ILUMYA是一种透明至略微不透明,无色至略微黄色溶液。
有一个以前对tildrakizumab或对赋形剂的任何严重的超敏性反应患者禁忌ILUMYA[见警告和注意事项(5.1)]。
5 警告和注意事项
5.1 超敏性
在临床试验中在ILUMYA治疗受试者发生血管水肿和荨麻疹的病例。如一种严重的超敏性 反应发生,终止ILUMYA立即地和开始适当治疗[见不良反应(6.1)]
5.2 感染
ILUMYA可能增加感染的风险。尽管感染是略微更常见在ILUMYA组(23%),ILUMYA组和安慰剂组间感染的频数差别为低于1%在安慰剂-对照阶段。但是,受试者有活动性感染或一个复发感染史没有包括在临床试验中。上呼吸感染发生更频在ILUMYA组比安慰剂组[见不良反应(6.1)]。
对ILUMYA组和安慰剂组严重的感染率为≤ 0.3%。有任何临床上重要活动性感染患者直至感染解决或被适当地治疗不应开始用ILUMYA治疗。在患者有一个慢性感染或一个复发感染病史,处方ILUMYA前考虑风险和获益。指导患者寻求医疗帮助如发生临床上慢性或急性感染体征或症状。如一例患者发生一个临床上重要或严重的感染或是对标准治疗不反应,严密监视患者和考虑终止ILUMYA直至感染解决[见不良反应(6.1)]。
5.3 对结核预治疗评价
开始用ILUMYA治疗前评价患者对结核(TB)感染。在临床试验中,给予ILUMYA前开始潜伏性TB的治疗。55例受试者有潜伏TB 患者正在同时用ILUMYA治疗和适当TB预防,没有受试者发生活动性TB(平均随访56.5 周期间)。一例其他受试者发生TB同时当接受ILUMYA。ILUMYA治疗期间和后监视患者活动性TB的体征和症状。考虑抗-TB治疗ILUMYA的开始前在患者有一个潜伏或活性TB的过去病史在患者一个适当疗程的治疗不能被确证。不要给予ILUMYA至患者有活动性TB感染。
5.4 免疫接种
用ILUMYA开始治疗前,考虑完成所有年龄适当的免疫接种按照当前的免疫接种指导原则。在用ILUMYA治疗患者中避免使用活疫苗 。对活或不活的疫苗反应没有数据可得到。
6 不良反应
在说明书其他处讨论以下严重的不良反应:
● 超敏性反应[见警告和注意事项(5.1)]
● 感染[见警告和注意事项(5.2)]
6.1 临床试验经验
因为临床试验是在广泛不同情况下进行的,临床试验观察到不良反应率不能与另一种药临床试验发生率直接比较而且可能不反映在一般患者群观察到的发生率。
在临床试验中,总共1994例有斑块银屑病受试者被用ILUMYA治疗,其中1083例受试者被用ILUMYA 100 mg治疗。这些中,672例受试者被暴露共至少12月,587例共18月,和469例共24月。来自三项安慰剂-对照试验数据(试验1,2,和3)在705例受试者(均数年龄46岁,71%男性,81%白种人)被合并评价ILUMYA的安全性(100 mg皮下给予在周0和4,接着被每12周[Q12W]) [见临床试验(14)]。
安慰剂-对照期(试验1的周0-16和试验2和3的周0-12)。在试验1,2,和3中的100 mg组的安慰剂-对照期中,在 ILUMYA组中在48.2%的受试者发生不良事件,与之比较,在安慰剂组53.8%受试者发生。在ILUMYA组严重不良事件的发生率为1.4%和在安慰剂组1.7%。
表1 总结在ILUMYA组不良反应发生率至少 1%和发生率比安慰剂组较高的不良反应。
包括眩晕和肢体中疼痛。
特异性不良反应
超敏性反应
在临床试验中在ILUMYA-治疗受试者发生血管水肿和荨麻疹病例[见警告和注意事项(5.1)]。
感染
在 ILUMYA组中感染是略微更常见。安慰剂-对照阶段期间ILUMYA组(23%)和安慰剂组间感染频数的差别为低于1%。最常见(≥1%)感染为上呼吸感染。对ILUMYA组和安慰剂组严重感染率为≤ 0.3%。
安全性至周52/64周
周52(试验1和3)和周64(试验2),随ILUMYA使用 无新不良反应被鉴定和不良反应被观察到的频数是与安慰剂-对照阶段期间观察到的频数相似.
6.2 免疫原性
如同所有治疗性蛋白 存在对免疫原性潜能。抗体形成的检测是高度依赖于分析的灵敏度和特异性。此外,在一个分析中观察点抗体阳性的发生率(包括中和抗体)可能受几种因子影响,包括分析方法学,样品处理,采样时机,同时药物,和所患疾病。由于这些理由,在下面研究中描述的对tildrakizumab抗体的发生率与在其他研究或对其他产品中抗体的发生率的比较可能是误导。
至周64,用ILUMYA 100 mg治疗受试者的大约6.5%发生对tildrakizumab的抗体。受试者对tildrakizumab发生抗体,大约40%(2.5%的所有接受ILUMYA受试者)有抗体被分类为中和。 对tildrakizumab中和抗体的发生为最常见较低血清tildrakizumab浓度和减低疗效。
7 药物相互作用
7.1 活免疫接种
在用ILUMYA治疗患者中避免使用活疫苗[见警告和注意事项(5.4)]。
8 特殊人群中使用
8.1 妊娠
风险总结
有ILUMYA 使用在妊娠妇女有限可得到的数据是不能充分告知一个药物关联的不良发育结局的风险。人IgG是已知跨越胎盘屏障;所以,ILUMYA可能被转运从母亲至胎儿。在妊娠猴中用tildrakizumab进行胚胎胎儿发育研究揭示无治疗-相关效应对发育中胎儿当 tildrakizumab被皮下给予在器官形成期间至接近分娩在剂量至159倍最大推荐人剂量(MRHD)。当给药被继续直至分娩,被观察到一个小增加在新生儿死亡在MRHD 59倍。[见数据]。
不知道这个非临床发现的临床意义。所有妊娠有出生缺陷,缺失,或其他不良结局的背景风险。不知道对适应证人群重大出生缺陷和流产的背景风险。在美国一般人群,重大出生缺陷和临床上认可流产的背景风险分别是2-4%和15-20%。
数据
动物数据
在一项胚胎胎儿发育研究,皮下剂量至300 mg/kg tildrakizumab被给予至妊娠食蟹猴一次每两周在器官形成期间至妊娠天118(22天自分娩)。未观察到母体或胚胎胎儿毒性在剂量至 300 mg/kg(159倍MRHD 100 mg,根据AUC比较)。在猴中Tildrakizumab跨越胎盘。
在一项围产期[pre-和postnatal]发育研究,皮下剂量至100 mg/kg tildrakizumab被给予至妊娠食蟹猴一次每两周从妊娠天50至分娩。新生儿死亡发生在一只对照猴的子代,两只猴在 10 mg/kg剂量(6倍MRHD基于AUC比较),和四只猴在100 mg/kg剂量(59倍MRHD基于AUC比较)。不知道这些非临床发现的临床意义。无tildrakizumab-相关不良效应被注意到在其余婴儿出生至月龄6个月。
8.2 哺乳
风险总结
没有关于tildrakizumab在人乳汁中存在的数据哺乳,对喂养婴儿的影响,或对乳汁产生影响。人IgG是已知存在人乳汁中。Tildrakizumab被检测到在猴乳汁中[见数据]。
应被考虑哺乳喂养婴儿的发育和健康获益与母亲对ILUMYA临床需求,任何潜在不良效应对哺乳喂养儿童来自ILUMYA或来自潜在母亲条件应被一并考虑。.
数据
动物数据
在8.1节描述的围产期[ pre-和postnatal]发育研究猴的哺乳乳汁中检测到tildrakizumab的非常低水平。在乳汁中均数tildrakizumab浓度为大约分娩后天28和91血清中0.09 – 0.2%。
8.4 儿童使用
尚未确定在儿童患者(<18岁)中ILUMYA的安全性和有效性。
8.5 老年人使用
在2和3期试验期间总共1083例受试者被暴露至ILUMYA 100 mg。总共92例受试者为65 岁或以上,和17例受试者为75岁或以上。尽管老年人和较年轻受试者间尽管未观察到在安全性或疗效中无差别,年龄65和以上受试者的数量是不够充分以确定是否他们反应不同于较年轻受试者[见临床药理学(12.3)]。
10 药物过量
在药物过量的事件中,监视患者对不良反应的任何体征或症状和立即地给予适当对症治疗。
11 一般描述
Tildrakizumab-asmn是一种人源化IgG1/k抗体特异性地结合至白介素-23(IL-23)的p19亚单位。Tildrakizumab-asmn是在一种重组中国仓鼠卵巢(CHO)细胞系中生产和有一个接近分子质量147千道尔顿。ILUMYA(tildrakizumab-asmn)注射液,为皮下使用,是一种无菌,透明至略微不透明,无色至略微黄色溶液。ILUMYA被供应在一个单-剂量预装注射器有一个玻璃筒和29-号固定的,1/2-英寸针头。注射器被与一个护装置和一个针头盖匹配。每个1 mL单-剂量预装注射器含100 mg的tildrakizumab-asmn被制剂化在:L-组氨酸(0.495 mg),L-组氨酸盐酸单水化物(1.42 mg),聚山梨醇80(0.5 mg),蔗糖(70.0 mg),和注射用水,USP有一个pH 为5.7-6.3。
12 临床药理学
12.1 作用机制
Tildrakizumab是一种人源化IgG1/k单克隆抗体选择性地结合至IL-23的p19亚单位和抑制它与IL-23受体的相互作用。IL-23是一种天然存在的细胞因子涉及在炎症和免疫反应。Tildrakizumab抑制促炎性细胞因子和趋化因子的释放。
12.2 药效动力学
未曽用ILUMYA进行的正规药效动力学研究。
12.3 药代动力学
在有斑块银屑病受试者跨越一个剂量范围从50 mg至200 mg(0.5至2倍被批准的推荐剂量)皮下皮下给药后Tildrakizumab药代动力学正比例地增加。在周0,4,和其后每12 周皮下给予tildrakizumab后至周16实现稳态浓度。在100 mg剂量在周16时,均数(± SD)稳态谷浓度范围从1.22 ± 0.94 µg/mL至1.47 ± 1.12 µg/mL。几何均数(CV%)稳态Cmax为8.1 µg/mL(34%)。
吸收
皮下注射后tildrakizumab的绝对生物利用度被估算将为73-80%。约在6天达到峰浓度(Cmax)。
分布
几何均数(CV%)分布容积为10.8 L(24%)。
消除
几何均数(CV%)全身清除率为0.32 L/day(38%)和半衰期大约为23天(23%).
代谢
Tildrakizumab的代谢途径特征尚未被描述。作为一种人源化IgG1/k单克隆抗体,tildrakizumab被预期将被降解至小肽和氨基酸通过降解通路在一种方式与内源性IgG相似。.
特殊人群
根据年龄(≥18岁)在tildrakizumab的药代动力学未观察到临床意义的显著差别。未进行专门研究确定肾或肝受损对tildrakizumab药代动力学的影响。
体重
在有较高体重受试者中Tildrakizumab浓度较低。
药物相互作用研究
细胞色素P450底物 有斑块银屑病受试者中,tildrakizumab 200 mg(被批准推荐剂量的两倍)与右美沙芬[dextromethorphan] 在周 0和4同时使用皮下给药时,右美沙芬的AUCinf (CYP2D6底物)增加20%。未观察到咖啡因[caffeine](CYP1A2底物),华法林(CYP2C9底物),奥美拉唑[omeprazole](CYP2C19底物),和米达唑仑[midazolam](CYP3A4 底物) AUCinf的临床意义变化。
13 非临床毒理学
13.1 癌发生,突变发生,生育率受损
未进行动物研究评价ILUMYA的致癌性或致突变性潜能.
在雄性或雌性食蟹猴中给予tildrakizumab在皮下或静脉剂量至140 mg/kg 一次每两周共3个月(分别133或155倍MRHD,根据AUC比较),未观察到对生育力参数的影响。猴没有交配评价生育力。
14 临床试验
在两项多中心,随机化,双盲,安慰剂-对照试验(试验2[NCT01722331]和试验3 [NCT01729754]),926例受试者被用ILUMYA 100 mg(N=616)或安慰剂(N=310)治疗。受试者有一个医生全面评估(PGA)评分≥3(中度)在一个5-点等级的总体疾病严重程度。银屑病面积和严重性指数(PASI)评分 ≥12,和一个最小机体表面面积(BSA)改善10%。受试者有水滴状的,红皮型的,或脓泡性银屑病被排除。在两项试验中,受试者被随机化至或安慰剂或ILUMYA(100 mg在周0,周4,和每12周其后[Q12W])至64周。试验 2和3评估从基线至周12变化在两个共-主要终点:
● PASI 75,在PASI组合评分中实现至少一个75%减低的受试者比例。
● PGA的0(“清除”)或1(“很小”),有一个PGA为0或1和至少 2-点改善受试者的比例。
在试验2和3其他被评价结局包括实现在PASI评分从基线减低至少90%(PASI 90)的受试者比例和在周12 PASI评分中一个减低100%(PASI 100)和维持疗效直至周64。在两项试验中,在ILUMYA 100 mg和安慰剂治疗组受试者为主要地男性(69%)和白种人(80%),有一个均数年龄46岁。在基线时,这些受试者有一个中位数被影响的BSA 27%,一个中位数PASI 评分17.8,,和大约33%有一个PGA评分4(“明显”)或5(“严重”)。大约34% 曽接受以前光治疗,39%曽接受以前常规全身治疗,和18%曽接受以前生物学治疗对银屑病的治疗。
大约16% 的受试者有银屑病关节炎病史。
在周12时临床反应
在表2中展示试验2和3在周12时临床反应结果.
在周12时,对年龄,性别,种族,和以前治疗用生物制剂的检查,不能鉴定出这些亚组中对ILUMYA反应中差别。
反应的维持和反应的持久性
在试验2中,受试者原始被随机化至ILUMYA和在周28时为有反应者(即,PASI 75)被再次-随机化至一个另外附加 36周的或维持相同剂量的ILUMYA Q12W(每12周)或安慰剂。在周28,229(74%)受试者用ILUMYA 100 mg治疗为PASI 75 反应者。在周64时,84%的受试者,患者继续用ILUMYA 100 mg Q12W维持的PASI 75 阈值 与 22%的受试者患者被再次-随机化至安慰剂。此外,对受试者 who 被再次-随机化和还有一个PGA评分为0或1在周28,69%的受试者继续用ILUMYA 100 mg Q12W维持这个反应(PGA 0或1)在周64 与之比较,被再次-随机化至安慰剂为14%的受试者。.
在在周28时PASI 75 反应者被再次-随机化至治疗 撤去(即,安慰剂),至丧失PASI 75the 中位时间为大约20 周。此外,对受试者被再次-随机化至安慰剂和也有一个 PGA评分为0或1 在周28,至丧失 PGA评分 0或1中位时间为大约16 周。
16 任何供应/贮存和处置
16.1如何供应
ILUMYA(tildrakizumab-asmn)注射液是一种无菌,无防腐剂,透明至略微不透明,无色至略微黄色溶液。ILUMYA是供应如单-剂量预装注射器每纸盒输送1 mL的100 mg/mL溶液。
● NDC 0006-4241-00
每个预装注射器装备有一个护装置和一个针盖。
16.2 贮存和处置
冰箱贮存在2°C至8°C(36°F至46°F)在原始纸盒避光保护直至使用。不同冻结。不要摇晃。 ILUMYA可被保持在室温在 25°C(77°F)共至30天在原始纸盒避光保护。一旦贮存在室温,不要放回冰箱。.
如在30天内不使用,遗弃ILUMYA。不要贮存ILUMYA在25°C(77°F)以上。
17 患者咨询资料
建议患者和/或护理人员阅读FDA-批准的患者说明书(用药指南)。
指导患者和/或护理人员开始ILUMYA治疗前阅读用药指南和每次制备时再次阅读用药指南。忠告患者ILUMYA 的获益和潜在风险。
超敏性
建议患者如他们经受严重超敏性反应的任何症状寻求立即医学关注[见警告和注意事项(5.1)]。
感染
指导患者如他们发生感染任何症状和联系他们的医生与医生交流感染的任何史的重要性 [见警告和注意事项(5.2)]。
ILUMYA™
(tildrakizumab-asmn) Injection, for Subcutaneous Use
Tildrakizumab-asmn is a humanized IgG1/k antibody that specifically binds to the p19 subunit of interleukin-23 (IL-23).
Tildrakizumab-asmn is produced in a recombinant Chinese hamster ovary (CHO) cell line and has an approximate molecular mass of 147 kilodaltons.
ILUMYA (tildrakizumab-asmn) injection, for subcutaneous use, is a sterile, clear to slightly opalescent, colorless to slightly yellow solution. ILUMYA is supplied in a single-dose prefilled syringe with a glass barrel and 29-gauge fixed, ½-inch needle.
The syringe is fitted with a passive needle guard and a needle cover.
Each 1 mL single-dose prefilled syringe contains 100 mg of tildrakizumab-asmn formulated in: Lhistidine (0.495 mg), L-histidine hydrochloride monohydrate (1.42 mg), polysorbate 80 (0.5 mg), sucrose (70.0 mg), and Water for Injection, USP with a pH of 5.7-6.3.
Indications & Dosage
INDICATIONSILUMYA™ is indicated for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
DOSAGE AND ADMINISTRATIONDosageILUMYA is administered by subcutaneous injection. The recommended dose is 100 mg at Weeks 0, 4, and every twelve weeks thereafter. Each syringe contains 1 mL of 100 mg/mL tildrakizumab-asmn.
Tuberculosis Assessment Prior To Initiation Of ILUMYAEvaluate patients for tuberculosis (TB) infection prior to initiating treatment with ILUMYA
Important Administration InstructionsILUMYA should only be administered by a healthcare provider. Administer ILUMYA subcutaneously. Each pre-filled syringe is for single-dose only. Inject the full amount (1 mL), which provides 100 mg of tildrakizumab per syringe. If a dose is missed, administer the dose as soon as possible. Thereafter, resume dosing at the regularly scheduled interval.
Preparation And Administration Of ILUMYABefore injection, remove ILUMYA carton from the refrigerator, and let the prefilled syringe (in the ILUMYA carton with the lid closed) sit at room temperature for 30 minutes.
Follow the instructions on the ILUMYA carton to remove the prefilled syringe correctly, and remove only when ready to inject. Do not pull off the needle cover until you are ready to inject.
Inspect ILUMYA visually for particulate matter and discoloration prior to administration. ILUMYA is a clear to slightly opalescent, colorless to slightly yellow solution. Do not use if the liquid contains visible particles or the syringe is damaged. Air bubbles may be present; there is no need to remove them.
Choose an injection site with clear skin and easy access (such as abdomen, thighs, or upper arm). Do not administer 2 inches around the navel or where the skin is tender, bruised, erythematous, indurated, or affected by psoriasis. Also do not inject into scars, stretch marks, or blood vessels.
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· While holding the body of the syringe, pull the needle cover straight off (do not twist) and discard.
· Inject ILUMYA subcutaneously as recommended [see Important Administration Instructions].
· Press down the blue plunger until it can go no further. This activates the safety mechanism that will ensure full retraction of the needle after the injection is given.
· Remove the needle from the skin entirely before letting go of the blue plunger. After the blue plunger is released, the safely lock will draw the needle inside the needle guard.
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· Discard of any unused portion. Dispose of used syringe.
Dosage Forms And StrengthsInjection: 100 mg/mL solution in a single-dose prefilled syringe. ILUMYA is a clear to slightly opalescent, colorless to slightly yellow solution.
ILUMYA (tildrakizumab-asmn) Injection is a sterile, preservative-free, clear to slightly opalescent, colorless to slightly yellow solution. ILUMYA is supplied as one single-dose prefilled syringe per carton that delivers 1 mL of a 100 mg/mL solution.
NDC 0006-4241-00
Each prefilled syringe is equipped with a passive needle guard and a needle cover.
Storage And HandlingStore refrigerated at 2°C to 8°C (36°F to 46°F) in the original carton to protect from light until the time of use. Do not freeze. Do not shake. ILUMYA can be kept at room temperature at 25°C (77°F) for up to 30 days in the original carton to protect from light. Once stored at room temperature, do not place back in the refrigerator. If not used within 30 days, discard ILUMYA. Do not store ILUMYA above 25°C (77°F).
Manufactured by: Merck Sharp & Dohme Corp., a subsidiary of MERCK & CO., INC., Whitehouse Station, NJ 08889, USA. Revised: Mar 2018
Side Effects & Drug Interactions
SIDE EFFECTSThe following serious adverse reactions are discussed elsewhere in the labeling:
· Hypersensitivity Reactions [see WARNINGS AND PRECAUTIONS]
· Infections [see WARNINGS AND PRECAUTIONS]
Clinical Trials ExperienceBecause clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
In clinical trials, a total of 1994 subjects with plaque psoriasis were treated with ILUMYA, of which 1083 subjects were treated with ILUMYA 100 mg. Of these, 672 subjects were exposed for at least 12 months, 587 for 18 months, and 469 for 24 months.
Data from three placebo-controlled trials (Trials 1, 2, and 3) in 705 subjects (mean age 46 years, 71% males, 81% white) were pooled to evaluate the safety of ILUMYA (100 mg administered subcutaneously at Weeks 0 and 4, followed by every 12 weeks [Q12W]) [see Clinical Studies].
Placebo-Controlled Period (Weeks 0-16 Of Trial 1 And Weeks 0-12 Of Trials 2 And 3)In the placebo-controlled period of Trials 1, 2, and 3 in the 100 mg group, adverse events occurred in 48.2% of subjects in the ILUMYA group compared to 53.8% of subjects in the placebo group. The rates of serious adverse events were 1.4% in the ILUMYA group and 1.7% in the placebo group.
Table 1 summarizes the adverse reactions that occurred at a rate of at least 1% and at a higher rate in the ILUMYA group than in the placebo group.
Table 1: Adverse Reactions Occurring in ≥1% of Subjects in the ILUMYA Group and More Frequently than in the Placebo Group in the Plaque Psoriasis Trials 1, 2, and 3
Adverse Reaction |
ILUMYA 100 mg |
Placebo |
Upper respiratory infections* |
98 (14) |
41 (12) |
Injection site reactions† |
24 (3) |
7 (2) |
Diarrhea |
13 (2) |
5 (1) |
* Upper respiratory infections include nasopharyngitis, upper respiratory tract infection, viral upper respiratory tract infection, and pharyngitis. |
During the placebo-controlled period of Trials 1, 2, and 3, adverse reactions that occurred at rates less than 1% but greater than 0.1% in the ILUMYA group and at a higher rate than in the placebo group included dizziness and pain in extremity.
Specific Adverse ReactionsHypersensitivity ReactionsCases of angioedema and urticaria occurred in ILUMYA-treated subjects in clinical trials [see WARNINGS AND PRECAUTIONS].
InfectionsInfections were slightly more common in the ILUMYA group. The difference in frequency of infections between the ILUMYA group (23%) and the placebo group was less than 1% during the placebo-controlled period. The most common (≥1%) infections were upper respiratory infections. The rates of severe infections for the ILUMYA group and the placebo group were ≤0.3%.
Safety Through Week 52/64Through Week 52 (Trials 1 and 3) and Week 64 (Trial 2), no new adverse reactions were identified with ILUMYA use and the frequency of the adverse reactions was similar to that observed during the placebo-controlled period.
ImmunogenicityAs with all therapeutic proteins there is the potential for immunogenicity. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of incidence of antibodies to tildrakizumab in the studies described below with the incidences of antibodies in other studies or to other products may be misleading.
Up to Week 64, approximately 6.5% of subjects treated with ILUMYA 100 mg developed antibodies to tildrakizumab. Of the subjects who developed antibodies to tildrakizumab, approximately 40% (2.5% of all subjects receiving ILUMYA) had antibodies that were classified as neutralizing. Development of neutralizing antibodies to tildrakizumab was associated with lower serum tildrakizumab concentrations and reduced efficacy.
DRUG INTERACTIONSLive VaccinationsAvoid use of live vaccines in patients treated with ILUMYA [see WARNINGS AND PRECAUTIONS].
Warnings & Precautions
WARNINGSIncluded as part of the PRECAUTIONS section.
PRECAUTIONSHypersensitivityCases of angioedema and urticaria occurred in ILUMYA treated subjects in clinical trials. If a serious hypersensitivity reaction occurs, discontinue ILUMYA immediately and initiate appropriate therapy [see ADVERSE REACTIONS].
InfectionsILUMYA may increase the risk of infection. Although infections were slightly more common in the ILUMYA group (23%), the difference in frequency of infections between the ILUMYA group and the placebo group was less than 1% during the placebo-controlled period. However, subjects with active infections or a history of recurrent infections were not included in clinical trials. Upper respiratory infections occurred more frequently in the ILUMYA group than in the placebo group [see ADVERSE REACTIONS].
The rates of serious infections for the ILUMYA group and the placebo group were ≤0.3%. Treatment with ILUMYA should not be initiated in patients with any clinically important active infection until the infection resolves or is adequately treated.
In patients with a chronic infection or a history of recurrent infection, consider the risks and benefits prior to prescribing ILUMYA. Instruct patients to seek medical help if signs or symptoms of clinically important chronic or acute infection occur. If a patient develops a clinically important or serious infection or is not responding to standard therapy, monitor the patient closely and consider discontinuation of ILUMYA until the infection resolves [see ADVERSE REACTIONS].
Pretreatment Evaluation For TuberculosisEvaluate patients for tuberculosis (TB) infection prior to initiating treatment with ILUMYA. Initiate treatment of latent TB prior to administering ILUMYA. In clinical trials, of 55 subjects with latent TB who were concurrently treated with ILUMYA and appropriate TB prophylaxis, no subjects developed active TB (during the mean follow-up of 56.5 weeks). One other subject developed TB while receiving ILUMYA. Monitor patients for signs and symptoms of active TB during and after ILUMYA treatment. Consider anti- TB therapy prior to initiation of ILUMYA in patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed. Do not administer ILUMYA to patients with active TB infection.
ImmunizationsPrior to initiating therapy with ILUMYA, consider completion of all age appropriate immunizations according to current immunization guidelines. Avoid the use of live vaccines in patients treated with ILUMYA. No data are available on the response to live or inactive vaccines.
Patient Counseling InformationAdvise the patient and/or caregiver to read the FDA-approved patient labeling (Medication Guide). Instruct patients and/or caregivers to read the Medication Guide before starting ILUMYA therapy and to reread the Medication Guide each time the prescription is renewed. Advise patients of the potential benefits and risks of ILUMYA.
HypersensitivityAdvise patients to seek immediate medical attention if they experience any symptoms of serious hypersensitivity reactions [see WARNINGS AND PRECAUTIONS].
InfectionsInstruct patients of the importance of communicating any history of infections to the doctor and contacting their doctor if they develop any symptoms of infection [see WARNINGS AND PRECAUTIONS].
Nonclinical ToxicologyCarcinogenesis, Mutagenesis, Impairment Of FertilityAnimal studies have not been conducted to evaluate the carcinogenic or mutagenic potential of ILUMYA.
No effects on fertility parameters were observed in male or female cynomolgus monkeys that were administered tildrakizumab at subcutaneous or intravenous doses up to 140 mg/kg once every two weeks for 3 months (133 or 155 times the MRHD, respectively, based on AUC comparison). The monkeys were not mated to evaluate fertility.
Use In Specific PopulationsPregnancyRisk SummaryLimited available data with ILUMYA use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes. Human IgG is known to cross the placental barrier; therefore, ILUMYA may be transferred from the mother to the fetus. An embryofetal developmental study conducted with tildrakizumab in pregnant monkeys revealed no treatment-related effects to the developing fetus when tildrakizumab was administered subcutaneously during organogenesis to near parturition at doses up to 159 times the maximum recommended human dose (MRHD). When dosing was continued until parturition, a small increase in neonatal death was observed at 59 times the MRHD [see Data]. The clinical significance of this nonclinical finding is unknown.
All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.
DataAnimal Data
In an embryofetal developmental study, subcutaneous doses up to 300 mg/kg tildrakizumab were administered to pregnant cynomolgus monkeys once every two weeks during organogenesis to gestation day 118 (22 days from parturition). No maternal or embryofetal toxicities were observed at doses up to 300 mg/kg (159 times the MRHD of 100 mg, based on AUC comparison). Tildrakizumab crossed the placenta in monkeys.
In a pre- and postnatal developmental study, subcutaneous doses up to 100 mg/kg tildrakizumab were administered to pregnant cynomolgus monkeys once every two weeks from gestation day 50 to parturition. Neonatal deaths occurred in the offspring of one control monkey, two monkeys at 10 mg/kg dose (6 times the MRHD based on AUC comparison), and four monkeys at 100 mg/kg dose (59 times the MRHD based on AUC comparison). The clinical significance of these nonclinical findings is unknown. No tildrakizumab-related adverse effects were noted in the remaining infants from birth through 6 months of age.
LactationRisk SummaryThere are no data on the presence of tildrakizumab in human milk, the effects on the breastfed infant, or the effects on milk production. Human IgG is known to be present in human milk. Tildrakizumab was detected in the milk of monkeys [see Data].
The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for ILUMYA and any potential adverse effects on the breastfed child from ILUMYA or from the underlying maternal condition.
DataAnimal Data
Very low levels of tildrakizumab were detected in breast milk of monkeys in the pre- and postnatal developmental study described in 8.1. The mean tildrakizumab concentrations in milk were approximately 0.09 – 0.2% of that in serum on postpartum days 28 and 91.
Pediatric UseSafety and effectiveness of ILUMYA in pediatric patients (<18 years of age) have not been established.
Geriatric UseA total of 1083 subjects were exposed to ILUMYA 100 mg during Phase 2 and 3 trials. A total of 92 subjects were 65 years or older, and 17 subjects were 75 years or older. Although no differences in safety or efficacy were observed between older and younger subjects, the number of subjects aged 65 and over is not sufficient to determine whether they respond differently from younger subjects [see CLINICAL PHARMACOLOGY].
Overdosage & Contraindications
OVERDOSEIn the event of overdosage, monitor the patient for any signs or symptoms of adverse reactions and administer appropriate symptomatic treatment immediately.
CONTRAINDICATIONSILUMYA is contraindicated in patients with a previous serious hypersensitivity reaction to tildrakizumab or to any of the excipients [see WARNINGS AND PRECAUTIONS].
Clinical Pharmacology
CLINICAL PHARMACOLOGYMechanism Of ActionTildrakizumab is a humanized IgG1/k monoclonal antibody that selectively binds to the p19 subunit of IL-23 and inhibits its interaction with the IL-23 receptor. IL-23 is a naturally occurring cytokine that is involved in inflammatory and immune responses. Tildrakizumab inhibits the release of proinflammatory cytokines and chemokines.
PharmacodynamicsNo formal pharmacodynamics studies have been conducted with ILUMYA.
PharmacokineticsTildrakizumab pharmacokinetics increases proportionally over a dose range from 50 mg to 200 mg (0.5 to 2 times the approved recommended dosage) following subcutaneous administration in subjects with plaque psoriasis. Steady-state concentrations were achieved by Week 16 following subcutaneous administration of tildrakizumab at Weeks 0, 4, and every 12 weeks thereafter. At the 100 mg dose at Week 16, the mean (± SD) steady-state trough concentrations ranged from 1.22 ± 0.94 mcg/mL to 1.47 ± 1.12 mcg/mL. The geometric mean (CV%) steady-state Cmax was 8.1 mcg/mL (34%).
AbsorptionThe absolute bioavailability of tildrakizumab was estimated to be 73-80% following subcutaneous injection. The peak concentration (Cmax) was reached by approximately 6 days.
DistributionThe geometric mean (CV%) volume of distribution is 10.8 L (24%).
EliminationThe geometric mean (CV%) systemic clearance was 0.32 L/day (38%) and the half-life was approximately 23 days (23%).
Metabolism
The metabolic pathway of tildrakizumab has not been characterized. As a humanized IgG1/k monoclonal antibody, tildrakizumab is expected to be degraded into small peptides and amino acids via catabolic pathways in a manner similar to endogenous IgG.
Specific PopulationsNo clinically significant differences in the pharmacokinetics of tildrakizumab were observed based on age (≥18 years). No specific studies have been conducted to determine the effect of renal or hepatic impairment on the pharmacokinetics of tildrakizumab.
Body WeightTildrakizumab concentrations were lower in subjects with higher body weight.
Drug Interaction StudiesCytochrome P450 SubstratesThe AUCinf of dextromethorphan (CYP2D6 substrate) increased by 20% when used concomitantly with tildrakizumab 200 mg (two times the approved recommended dose) administered subcutaneously at Weeks 0 and 4 in subjects with plaque psoriasis. No clinically significant changes in AUCinf of caffeine (CYP1A2 substrate), warfarin (CYP2C9 substrate), omeprazole (CYP2C19 substrate), and midazolam (CYP3A4 substrate) were observed.
Clinical StudiesIn two multicenter, randomized, double-blind, placebo-controlled trials (Trial 2 [NCT01722331] and Trial 3 [NCT01729754]), 926 subjects were treated with ILUMYA 100 mg (N=616) or placebo (N=310). Subjects had a Physician Global Assessment (PGA) score of ≥3 (moderate) on a 5-point scale of overall disease severity, Psoriasis Area and Severity Index (PASI) score ≥12, and a minimum body surface area (BSA) involvement of 10%. Subjects with guttate, erythrodermic, or pustular psoriasis were excluded.
In both trials, subjects were randomized to either placebo or ILUMYA (100 mg at Week 0, Week 4, and every twelve weeks thereafter [Q12W]) up to 64 weeks.
Trials 2 and 3 assessed the changes from baseline to Week 12 in the two co-primary endpoints:
· PASI 75, the proportion of subjects who achieved at least a 75% reduction in the PASI composite score.
· PGA of 0 (“cleared”) or 1 (“minimal”), the proportion of subjects with a PGA of 0 or 1 and at least a 2-point improvement.
Other evaluated outcomes in Trials 2 and 3 included the proportion of subjects who achieved a reduction from baseline in PASI score of at least 90% (PASI 90) and a reduction of 100% in PASI score (PASI 100) at Week 12 and maintenance of efficacy up to Week 64.
In both trials, subjects in the ILUMYA 100 mg and placebo treatment groups were predominantly men (69%) and White (80%), with a mean age of 46 years. At baseline, these subjects had a median affected BSA of 27%, a median PASI score of 17.8, and approximately 33% had a PGA score of 4 (“marked”) or 5 (“severe”). Approximately 34% had received prior phototherapy, 39% had received prior conventional systemic therapy, and 18% had received prior biologic therapy for the treatment of psoriasis. Approximately 16% of subjects had a history of psoriatic arthritis.
Clinical Response At Week 12The results of Trials 2 and 3 are presented in Table 2.
Table 2: Efficacy Results at Week 12 in Adults with Plaque Psoriasis in Trials 2 and 3 (NRI*)
|
Trial 2 (NCT01722331) |
Trial 3 (NCT01729754) |
||
ILUMYA 100 mg |
Placebo |
ILUMYA 100 mg |
Placebo |
|
PGA of 0 or 1†‡ |
179 (58) |
11 (7) |
168 (55) |
7 (4) |
PASI 75† |
197 (64) |
9 (6) |
188 (61) |
9 (6) |
PASI 90 |
107 (35) |
4 (3) |
119 (39) |
2 (1) |
PASI 100 |
43 (14) |
2 (1) |
38 (12) |
0 (0) |
* NRI = Non-Responder Imputation |
Examination of age, gender, race, and previous treatment with a biologic did not identify differences in response to ILUMYA among these subgroups at Week 12.
Maintenance Of Response And Durability Of ResponseIn Trial 2, subjects originally randomized to ILUMYA and who were responders at Week 28 (i.e., PASI 75) were re-randomized to an additional 36 weeks of either maintaining the same dose of ILUMYA Q12W (every twelve weeks) or placebo.
At Week 28, 229 (74%) subjects treated with ILUMYA 100 mg were PASI 75 responders. At Week 64, 84% of subjects who continued on ILUMYA 100 mg Q12W maintained PASI 75 compared to 22% of subjects who were re-randomized to placebo. In addition, for subjects who were re-randomized and also had a PGA score of 0 or 1 at Week 28, 69% of subjects who continued on ILUMYA 100 mg Q12W maintained this response (PGA 0 or 1) at Week 64 compared to 14% of subjects who were rerandomized to placebo.
For PASI 75 responders at Week 28 who were re-randomized to treatment withdrawal (i.e., placebo), the median time to loss of PASI 75 was approximately 20 weeks.
In addition, for subjects who were re-randomized to placebo and also had a PGA score of 0 or 1 at Week 28, the median time to loss of PGA score of 0 or 1 was approximately 16 weeks.
Medication Guide
ILUMYA™
("e-loom'-me-a")
(tildrakizumab-asmn) injection, for subcutaneous use
What is the most important information I should know about ILUMYA?
ILUMYA may cause serious side effects, including:
Serious allergic reactions. Get emergency medical help right away if you get any of the following symptoms of a serious allergic reaction:
· feel faint
· swelling of your face, eyelids, lips, mouth, tongue or throat
· skin rash
· trouble breathing or throat tightness
· chest tightness
Infections. ILUMYA is a medicine that may lower the ability of your immune system to fight infections and may increase your risk of infections. Your healthcare provider should check you for infections and
tuberculosis (TB) before starting treatment with ILUMYA and may treat you for TB before you begin treatment with ILUMYA if you have a history of TB or have active TB. Your healthcare provider should
watch you closely for signs and symptoms of TB during and after treatment with ILUMYA.
Tell your healthcare provider right away if you have an infection or have symptoms of an infection, including:
· fever, sweats, or chills
· muscle aches
· weight loss
· cough
· warm, red, or painful skin or sores on your body different from your psoriasis
· diarrhea or stomach pain
· shortness of breath or sores on your body
· burning when you urinate or urinating more often than normal
· blood in your phlegm (mucus)
See "What are the possible side effects of ILUMYA?" for more information about side effects.
What is ILUMYA?
ILUMYA is a prescription medicine used to treat adults with moderate to severe plaque psoriasis who may benefit from taking injections, pills (systemic therapy) or treatment using ultraviolet or UV light (phototherapy).
It is not known if ILUMYA is safe and effective in children under 18 years of age.
Do not use ILUMYA if you have had a severe allergic reaction to tildrakizumab or any of the other ingredients in ILUMYA. See the end of this Medication Guide for a complete list of ingredients in ILUMYA.
Before receiving ILUMYA, tell your healthcare provider about all of your medical conditions, including if you:
· have any of the conditions or symptoms listed in the section "What is the most important information I should know about ILUMYA?"
· have an infection that does not go away or that keeps coming back
· have TB or have been in close contact with someone with TB
· recently received or are scheduled to receive a vaccine (immunization). You should avoid receiving live vaccines during treatment with ILUMYA.
· are pregnant or plan to become pregnant. It is not known if ILUMYA can harm your unborn baby.
· are breastfeeding or plan to breastfeed. It is not known if ILUMYA passes into your breast milk.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
How will I receive ILUMYA?
· ILUMYA should only be given to you by a healthcare provider.
· ILUMYA is given as an injection under your skin (subcutaneous injection) in areas of your body such as your thighs, stomach area (abdomen), or upper arm.
· If you miss a follow-up appointment and do not receive your dose of ILUMYA, schedule another appointment as soon as possible.
What are the possible side effects of ILUMYA?
ILUMYA may cause serious side effects. See "What is the most important information I should know about ILUMYA?"
The most common side effects of ILUMYA include:
· upper respiratory infections
· injection site reactions
· diarrhea
These are not all of the possible side effects of ILUMYA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
General information about the safe and effective use of ILUMYA.
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your healthcare provider for information about ILUMYA that is written for health professionals.
What are the ingredients in ILUMYA?
Active ingredient: tildrakizumab-asmn
Inactive ingredients: L-histidine, L-histidine hydrochloride monohydrate, polysorbate 80, sucrose, and Water for Injection, USP.