Consumer medicine information

Elelyso

Taliglucerase alfa

BRAND INFORMATION

Brand name

Elelyso

Active ingredient

Taliglucerase alfa

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Elelyso.

What is in this leaflet

This leaflet answers some common questions about Elelyso.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you using Elelyso against the benefits it is expected to have for you.

Ask your doctor or pharmacist if you have any concerns about using this medicine.

Keep this leaflet as you may need to read it again.

What Elelyso is used for

Elelyso is an Enzyme Replacement Therapy which is used to treat Type 1 Gaucher disease in adults and children (2 to 17 years of age) with at least one of the following signs of the condition:

  • Spleen or liver enlargement
  • A low number of red blood cells (anaemia)
  • A tendency to bleed easily caused by a low blood platelet count. (platelets stop blood loss by forming a plug inside a blood vessel).

Elelyso has not been studied in Type 2 Gaucher disease.

How Elelyso works

Gaucher disease is a genetic disorder caused by a missing or defective enzyme named glucocerebrosidase. When this enzyme is missing or does not work properly, a substance called glucocerebroside builds up inside cells in the body. The build-up of this material causes the signs and symptoms found in Gaucher disease. Elelyso is designed to replace the missing or defective enzyme, glucocerebrosidase, in patients with Type 1 Gaucher disease.

Ask your doctor if you have any questions about why this medicine has been prescribed for you.

Before you are given Elelyso

When you must not use it

Do not use Elelyso if you have an allergy to:

  • Any medicine containing taliglucerase alfa rpc
  • Any of the ingredients listed at the end of this leaflet
  • Other Enzyme Replacement Therapies such as Cerezyme® or Vpriv®.

Talk to your doctor if you are not sure whether you should start using this medicine.

Before you start to use it

Tell your doctor if you have previously experienced an infusion-related reaction or allergic reaction to other Enzyme Replacement Therapy for Gaucher disease. If you have an infusion-related reaction you may be given additional medicines to treat or help prevent future reactions. These medicines may include antihistamines, antipyretics (medicine used to lower high temperature/fever), and corticosteroids.

Tell your doctor if you have an allergy to carrots. Taliglucerase alfa rpc is manufactured using carrot cells.

Tell your doctor if you are on a low salt diet. Patients on a controlled salt (sodium) diet should consider that Elelyso is given in a solution containing sodium chloride.

Tell your doctor if you are pregnant or plan to become pregnant or are breast-feeding. Your doctor can discuss with you the risks and benefits involved.

Tell your doctor if you have experienced difficulty breathing.

Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.

If you have not told your doctor about any of the above, tell him/her before you start taking Elelyso.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including:

  • All prescription medicines
  • All medicines, vitamins, herbal supplements or natural therapies you buy without a prescription from a pharmacy, supermarket, naturopath or health food shop.

Some medicines may be affected by Elelyso or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines. Your doctor will advise you.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while using this medicine.

How Elelyso is given

Elelyso is given through a drip into a vein (by intravenous infusion). The drip should be given over at least 60 minutes. It may be given to you at a hospital, a clinic or, at your home, if your doctor considers this appropriate.

Elelyso should only be administered under the supervision of a doctor (or healthcare professional) who is knowledgeable in the treatment of Gaucher disease.

Home administration may be considered for patients who tolerate their infusion well. For home administration, Elelyso should be administered by a healthcare professional trained in managing infusion-related reactions, under the direction of a doctor.

How much to use

Your doctor will decide the dosage and the frequency of the dose suitable for you.

If you forget to use it

If you miss a dose of Elelyso, tell your doctor.

If you receive too much (overdose)

Your doctor will supervise how much Elelyso you are given. If you think that you have been given too much Elelyso tell your doctor or nurse immediately.

If you need further advice, contact the Poisons Information Centre (telephone 13 11 26).

If you stop using Elelyso

Tell your doctor if you intend to stop the treatment. Patients should be aware that there are potential serious consequences in stopping the treatment and you are advised to discuss this with your doctor before doing so.

If you have any further questions on the use of this medicine, ask your doctor.

While you are using Elelyso

Things you must do

If you are about to be started on any new medicine, remind your doctor and pharmacist that you are being given Elelyso.

Tell any other doctors, dentists, and pharmacists who treat you that you are using this medicine.

If you are going to have surgery, tell the surgeon or anaesthetist that you are using this medicine. It may affect other medicines used during, or after surgery.

If you become pregnant while being given this medicine, tell your doctor immediately.

If you are about to have any blood tests, tell your doctor that you are using this medicine. It may interfere with the results of certain tests.

Keep all of your doctor or clinic appointments so that your progress can be checked. Your doctor may do certain tests, including blood tests, from time to time to make sure the medicine is working and to prevent unwanted side effects.

Things you must not do

Do not stop using your medicine or lower the dosage without checking with your doctor. If you stop using it suddenly, your condition may worsen or you may have unwanted side effects.

It is important to have your infusion at the appropriate time to make sure the medicine is effective in treating your condition.

Things to be careful of

Be careful driving or operating machinery until you know how Elelyso may affect you.

Be careful when drinking alcohol while you are using this medicine.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are being given Elelyso.

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

It can be difficult to tell whether side effects are the result of using Elelyso, effects of your condition or side effects of other medicines you may be taking. For this reason it is important to tell your doctor of any change in your condition.

Do not be alarmed by the list of side effects. You may not experience any of them.

Ask your doctor or pharmacist to answer any questions you may have.

Infusion-related reactions

Common side effects occurring during infusion or within 24 hours of receiving Elelyso include:

  • Muscle pain, joint pain or spasm
  • Headache
  • Vomiting
  • Stomach pains
  • Pain in hands or feet
  • Itching
  • Allergic reaction
  • Nausea
  • Limb swelling
  • Throat irritation
  • Redness of skin
  • Urticaria (slightly elevated patches on the skin) or hives
  • Swelling of the eyes
  • Feeling hot (flushing)
  • Feeling uncomfortable in your chest
  • Diarrhoea
  • Shaking
  • Rash.

Other common side effects

  • Dizziness
  • Bone pain
  • Back pain
  • Infusion site pain
  • Tiredness
  • Weight increase.

Tell your doctor if...

Severe allergic reactions are less common side effects of Elelyso but may be serious.

Tell your doctor immediately if you experience any of the allergic reactions listed below:

  • Difficulty breathing or shortness of breath
  • Swelling of the face, lips, tongue or throat.

If you experience any of the allergic reactions listed above go to hospital immediately as you may require urgent medical attention.

Tell your doctor or pharmacist if you notice anything else that is making you feel unwell. Other side effects not listed above may also occur in some people.

Some of these side effects can only be found when your doctor does tests from time to time to check your progress.

After using Elelyso

Storage

Keep out of the reach and sight of children.

Unopened vials
Store in a refrigerator (2°C to 8°C). Do not freeze. Protect from light. Keep the vial in the outer carton until use.

Do not use Elelyso after the expiry date printed on the label. The expiry date refers to the last date of that month.

Reconstituted and diluted solutions
Elelyso should be mixed (reconstituted) and diluted just before use and used immediately. If not used immediately, in-use storage times and conditions of the reconstituted solution and the diluted solution prior to use are the responsibility of the user.

The reconstituted vial and the diluted solution that is made from the reconstituted vial can be stored for a combined time of not more than 24 hours at 2°C to 8°C under protection from light after the initial reconstitution step.

Disposal

If your doctor tells you to stop using this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.

Product description

What it looks like

Elelyso 200 units is presented as a powder for injection (a single vial in a carton).

Elelyso is supplied as a white to off-white powder that may form a cake. After reconstitution the solution is a clear, colourless liquid. The reconstituted solution must be further diluted for infusion.

Ingredients

The active ingredient in Elelyso is taliglucerase alfa rpc.

The other ingredients are:

  • Mannitol
  • Sodium citrate dihydrate
  • Polysorbate 80.

This medicine does not contain lactose, sucrose, gluten, tartrazine or any other azo dyes.

Supplier

Pfizer Australia Pty Ltd
Sydney, NSW
Toll Free Number: 1800 675 229
www.pfizer.com.au

Australian registration numbers

AUST R 207695.

Date of preparation

This leaflet was prepared in June 2019.

® = Registered Trademark

© Pfizer Australia Pty Ltd 2019.

Published by MIMS August 2019

BRAND INFORMATION

Brand name

Elelyso

Active ingredient

Taliglucerase alfa

Schedule

S4

 

1 Name of Medicine

Taliglucerase alfa recombinant plant carrot (rpc).

2 Qualitative and Quantitative Composition

Elelyso (taliglucerase alfa rpc) 200 units powder for injection.
Each vial of Elelyso contains 200 units* of taliglucerase alfa rpc**.
After reconstitution, the solution contains 40 units (approximately 1.2 mg) of taliglucerase alfa rpc per mL (200 units/5 mL).
* An enzyme unit is defined as the amount of enzyme that catalyses the hydrolysis of one micromole of the synthetic substrate para-nitrophenyl-β-D-glucopyranoside (pNP-Glc) per minute at 37°C.
** Taliglucerase alfa rpc is a recombinant form of human glucocerebrosidase expressed in genetically modified carrot plant cells in suspension that naturally bears terminal mannose structures for targeting macrophages.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Elelyso powder for injection.

4 Clinical Particulars

4.1 Therapeutic Indications

Elelyso is indicated for long-term enzyme replacement therapy for adult and paediatric patients with a confirmed diagnosis of type 1 Gaucher disease associated with at least one of the following: splenomegaly, hepatomegaly, anaemia, thrombocytopenia.

4.2 Dose and Method of Administration

Treatment with Elelyso should be supervised by a physician experienced in the management of patients with Gaucher disease. Home administration under the supervision of a healthcare professional trained in recognising and medically managing serious infusion related reactions under the direction of a practising physician may be considered only for those patients who have been tolerating their infusions.
Due to the heterogeneity and the multisystemic nature of Gaucher disease, dosage must be individualised to each patient. Dose requirements may increase or decrease, based on achievement of therapeutic goals, as assessed by regular comprehensive evaluations of the patient's clinical manifestations.

Dosage.

Initial doses of Elelyso in adult and paediatric (2 years to 17 years of age) patients range from 30 units/kg to 60 units/kg of bodyweight once every 2 weeks, depending on the clinical assessment of the treating physician.
Patients currently being treated with imiglucerase for Gaucher disease can be switched to taliglucerase alfa rpc. It is recommended that patients previously treated on a stable dose of imiglucerase begin treatment with taliglucerase alfa rpc at the same dose of imiglucerase when they switch from imiglucerase to taliglucerase alfa rpc.

Method of administration.

After reconstitution and dilution, the total volume of prepared solution is administered by intravenous infusion over a period of 60 minutes to 120 minutes. For paediatric patients with weights less than 30 kg, an infusion rate of no greater than 1 mL/minute should be used. For paediatric patients with weights more than 30 kg, after an initial infusion rate of 1 mL/minute and after tolerability to taliglucerase alfa is established, the infusion rate may be increased to 2 mL/minute. For adult patients, after an initial infusion rate of 1.2 mL/minute and after tolerability to taliglucerase alfa is established, the infusion rate may be increased to a maximum of 2.2 mL/minute. The duration of infusion may be adjusted as tolerated by the patient.
Each vial of Elelyso is for single use only in one patient only.

Paediatrics (2 to 17 years of age).

During clinical studies 16 patients, 2 years to 17 years of age, were treated with Elelyso. The safety and efficacy profiles were similar between adult and paediatric patients.

Elderly (≥ 65 years of age).

During clinical studies 8 patients, 65 years of age or older, were treated with Elelyso. This limited data set does not indicate the need for dose adjustment in this age group.

Instructions for reconstitution, dilution and disposal.

To allow accurate dispensing of the medicine, each vial contains an overfill of 6% (i.e. 12 units).
The powder for injection needs to be reconstituted with water for injections, diluted immediately with sodium chloride 9 mg/mL (0.9%) solution for infusion and then administered by intravenous infusion.
The number of vials to be reconstituted should be determined based on the individual patient's bodyweight and dosage regimen. Occasionally, small dosage adjustments may be made to avoid discarding partially used vials. Dosage may be rounded to the nearest whole vial, as long as the monthly administered dosage remains substantially unaltered.
Use aseptic technique.

Reconstitution.

Reconstitute each vial for injection with 5.1 mL water for injections. Water for injections should be added slowly to minimise the formation of air bubbles and to assure proper mixing of the product with water for injections. The reconstituted volume is 5.3 mL.
Mix vials gently. Do not shake. After reconstitution the solution should be a clear and colourless liquid, essentially free of visible particles. The reconstituted solution must be further diluted. Before further dilution, visually inspect the reconstituted solution in each vial for foreign particulate matter, and discolouration. Do not use vials that exhibit discolouration or contain foreign particulate matter.
The reconstituted solution contains 40 units of taliglucerase alfa rpc per mL. The reconstituted volume allows accurate withdrawal of 5.0 mL (equal to 200 units) from each vial.
After reconstitution, promptly dilute the reconstituted solution and discard the vial. Do not store unused vials for subsequent use.

Dilution.

Withdraw 5.0 mL reconstituted solution from each vial and combine the withdrawn volumes into a sterile infusion bag.
Then dilute the combined volume with sodium chloride 9 mg/mL (0.9%) solution for infusion to a total volume of 100 mL to 200 mL. Mix the infusion solution gently. Since this is a protein solution, a few translucent particles or fibers may be observed occasionally after dilution. The diluted solution should be filtered through an in-line low protein binding 0.2 micron filter during administration.
It is recommended that the diluted solution be administered as soon as possible after dilution.

Disposal.

Any unused product should be disposed of in accordance with local requirements.

4.3 Contraindications

Severe allergic reactions to taliglucerase alfa rpc, any excipient components of the product, or other similar glucocerebrosidase enzymes (see Section 4.4 Special Warnings and Precautions for Use).

4.4 Special Warnings and Precautions for Use

Infusion related reactions and hypersensitivity.

As with any intravenous protein product, infusion-related reactions and hypersensitivity reactions, including anaphylaxis are possible, therefore appropriate medical support should be readily available when Elelyso is administered. Infusion-related reactions and allergic hypersensitivity reactions have been reported with Elelyso.
Infusion related reactions usually represent symptoms occurring within 24 hours of the infusion and are not necessarily linked to anaphylaxis or hypersensitivity. They may include symptoms such as arthralgia, headache, vomiting, flushing, pruritus, pain in extremity, diarrhoea, chest discomfort, feeling hot, muscle spasms, tremor and throat irritation. They can usually be managed successfully and patients can continue on therapy by slowing the infusion rate and/or stopping and resuming treatment with a decreased infusion rate.
Hypersensitivity (which may include anaphylaxis), is characterised by hypotension, bronchospasm, laryngeal oedema, wheezing and urticaria. Patients who experience hypersensitivity can usually be treated with medicinal products such as antihistamines, antipyretics and/or corticosteroids. Hypersensitivity may contraindicate further treatment, however, pre-treatment with antihistamines and/or corticosteroids may prevent subsequent reactions. Hypersensitivity events occur more commonly within the first 3 months of starting treatment, however, they may occur at any time therefore ongoing monitoring is required.
If a severe allergic reaction occurs, current medical standards for emergency treatment should be followed and the immediate discontinuation of the Elelyso infusion is recommended.

Antibody response/ immunogenicity.

As with other therapeutic proteins, the development of immunoglobulin G (IgG) antidrug antibodies (ADA) to taliglucerase alfa has been described. Hypersensitivity reactions occur in patients with and without ADA, but are more common among those with ADA some of whom experience anaphylactic reactions.
In a study in ERT naïve adult patients, seventeen of 32 patients (17 of 32, 53%) who were administered taliglucerase alfa every two weeks developed ADA post-treatment (defined as ADA positive at one or more post-treatment time points). Two additional patients were ADA positive at baseline; one patient withdrew after developing an allergic reaction with the first dose of taliglucerase alfa, and the second patient became ADA negative at 21 months treatment and remained negative thereafter with continued treatment. In ERT naïve paediatric patients, 2 of 11 (18%) patients developed ADA. One ERT naïve paediatric patient was ADA positive at baseline but became ADA negative following treatment with taliglucerase alfa. In a study in ERT experienced adult and paediatric patients, (N = 31; 26 adult patients and 5 paediatric patients) 5 adult patients (16% of all patients) who switched from imiglucerase treatment to taliglucerase alfa treatment once every two weeks developed ADA after the switch. None of the ERT experienced paediatric patients developed ADA after switching from imiglucerase treatment to taliglucerase alfa treatment. In the ERT experienced population, two adult and two paediatric patients who switched from imiglucerase were ADA positive at baseline but ADA negative following taliglucerase alfa treatment. One of these ERT experienced adults subsequently became ADA positive following continued treatment. In total, 31 adult and paediatric patients tested positive for the taliglucerase alfa ADA. The relevance of ADA to adverse events is currently unclear.
Thirty of 31 adult and paediatric patients, who previously tested positive for the anti-taliglucerase alfa ADA, were also evaluated for the presence of neutralising antibodies in the mannose receptor binding and enzyme activity assays. Nineteen (63%) of the 30 patients were positive for the neutralising antibodies capable of inhibiting mannose receptor binding of taliglucerase alfa. Eight of these 19 patients were also positive for neutralising antibodies capable of inhibiting the enzymatic activity of taliglucerase alfa.
Nine (29%) of the 31 adult and pediatric patients who developed ADA to Elelyso during treatment or tested positive for ADA at baseline also developed antibodies against plant-specific glycans in Elelyso.
The significance of these findings is unknown at this time.
There has been no demonstrated consistent association between positive neutralising antibody assay results and therapeutic response, however, in three patients with antineutralising antibodies, there was a tendency to lower haematological response. It may be useful for clinicians to measure neutralising antibodies in patients where there is a lack of therapeutic response at a reasonable dose.
Testing for anti-taliglucerase antibodies should be considered in cases of severe infusion related reactions or hypersensitivity. High or rising titres or the presence of neutralising antibodies would be of concern.
Immunogenicity assay results are highly dependent on the sensitivity and specificity of the assay and may be influenced by several factors such as assay methodology, sample handling, timing of sample collection, concomitant medication, and underlying disease. For these reasons, comparison of the incidence of antibodies to Elelyso with the incidence of antibodies to other products may be misleading.

Pulmonary hypertension.

Pulmonary hypertension is a known complication of Gaucher disease. Patients with respiratory symptoms should be evaluated for the presence of pulmonary hypertension.
Routine evaluation to detect the presence of pulmonary hypertension after diagnosis of Gaucher disease and over time is recommended. Patients diagnosed with pulmonary hypertension should receive adequate doses of Elelyso to ensure control of underlying Gaucher disease as well as be evaluated for the need of additional pulmonary hypertension specific treatments.

Allergy to carrots.

The occurrence of allergic reactions to taliglucerase alfa rpc in patients with known carrot allergies is currently unknown and has not been studied in clinical trials; therefore, caution should be exercised in treating such patients. If infusion related reactions or hypersensitivity occurs, patients should be managed as described above.

Sodium.

This medicinal product contains sodium and is administered in 9 mg/mL (0.9%) sodium chloride intravenous solution. This should be taken into consideration when administered to patients on a controlled sodium diet.

Neuronopathic Gaucher disease.

Patients with severe and complex neurological symptoms were excluded from clinical studies; paediatric patients with longstanding oculomotor gaze palsy and/or mutations suggestive of neuronopathic disease were permitted to enrol. Two out of 11 (18%) patients in the paediatric study (PB-06-005) for patients naïve to enzyme replacement therapy were diagnosed with type 3c disease and one child in the switch trial possesses the homozygote L444P genotype. There is no clinical experience with the use of Elelyso in patients with type 2 Gaucher disease.

Use in renal and hepatic impairment.

Studies of taliglucerase alfa rpc in patients with Gaucher disease with renal or hepatic impairment have not been conducted.

Use in the elderly.

Clinical studies of Elelyso did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.
In general, dose selection for an elderly patient requires caution, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy in this patient group.

Paediatric use.

The safety and efficacy profiles were similar between adult and paediatric patients.

Effects on laboratory tests.

No data available.

4.5 Interactions with Other Medicines and Other Forms of Interactions

In the absence of compatibility studies, Elelyso should not be mixed with other medicinal products, except those mentioned, see Section 4.2 Dose and Method of Administration.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

Taliglucerase alfa rpc did not affect fertility or reproductive performance in male and female rats.
(Category B1)
Reproductive toxicity studies using pregnant rats and rabbits given high doses of taliglucerase alfa rpc revealed no evidence of harm to the fetus. There are, however, no adequate and well controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, caution should be exercised when prescribing to pregnant women and this medicine should only be used during pregnancy if the potential benefit justifies the risk.
 It is unknown whether Elelyso is excreted in animal or human breast milk. Because many medicines are excreted in human milk, caution should be exercised when Elelyso is administered to a breastfeeding woman.

4.7 Effects on Ability to Drive and Use Machines

Patients should be aware of how they react to Elelyso before driving or operating machinery as dizziness has been reported in clinical trials with Elelyso.

4.8 Adverse Effects (Undesirable Effects)

Summary of the safety profile.

The safety of Elelyso has been evaluated in over 130 patients with Gaucher disease; data from 74 patients in controlled clinical trials were used to determine the frequency of adverse drug reactions (Table 1). Elelyso was administered in median doses of 9 units/kg to 78 units/kg of body weight every 2 weeks, for treatment durations of up to 60 months.
Patients were between 2 years and 85 years of age at the time of their first treatment with Elelyso, and included both treatment naïve patients and those patients previously treated with imiglucerase.
The most serious adverse reactions in patients in clinical trials were immune mediated adverse events of type 1 hypersensitivity reactions (see Section 4.4 Special Warnings and Precautions for Use).
The most common adverse reactions were infusion related reactions occurring within 24 hours of the infusion. The most commonly observed symptoms of infusion related reactions were: arthralgia, headache, infusion related reactions, vomiting, hypersensitivity, flushing, pruritus, pain in extremity and pulmonary hypertension. Other infusion reactions included diarrhoea, chest discomfort, feeling hot, muscle spasms, tremor, throat irritation, erythema, rash and infusion site pain.
The safety of Elelyso has been established in paediatric patients from 2 to 16 years of age. One treatment related serious adverse event was reported in paediatric clinical trials; an 8 year old patient experienced a serious adverse reaction (gastroenteritis). There does not appear to be a major difference in frequency of adverse reactions in paediatric patients compared to adult patients, with the exception that vomiting and abdominal pain were seen more commonly in paediatric patients.

Tabulated list of adverse reactions.

The adverse reactions reported in patients with Gaucher disease are listed in Table 1 (all adult and paediatric patients). Information is presented by system organ class and frequency according to MedDRA convention. Frequency is defined as very common (≥ 1/10) or common (≥ 1/100 to < 1/10). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
A tabulated summary of adverse events providing percentages for each reaction observed (preferred term) with a frequency of ≥ 1% is provided in Table 2.

Post-marketing experience.

The limited post-marketing experience with this formulation of Elelyso is consistent with the above profile.
The following adverse events were reported during post-marketing surveillance.

Immune system disorders.

Anaphylactic reaction.

Skin and subcutaneous tissue disorders.

Urticaria.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

There is no experience with overdose of Elelyso. The maximum average dose of Elelyso in clinical studies was 78 units/kg body weight.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Pharmacotherapeutic group: alimentary tract and metabolism, enzymes.
Taliglucerase alfa rpc is a recombinant active form of the human lysosomal enzyme, β-glucocerebrosidase, expressed in genetically modified carrot plant root cells. β-glucocerebrosidase (β-D-glucosyl-N-acylsphingosine glucohydrolase, E.C. 3.2.1.45) is a lysosomal glycoprotein enzyme that catalyses the hydrolysis of the glycolipid glucocerebroside to glucose and ceramide.
Gaucher disease is caused by point mutations in the human glucocerebrosidase (hGCD) gene, which result in a less active endogenous enzyme resulting in the accumulation of glucocerebroside in the lysosomes of macrophages.
The characteristic glycolipid laden macrophages, called Gaucher cells, are found in liver, spleen and bone marrow. The associated clinical systemic symptoms include severe hepatosplenomegaly as well as anaemia, thrombocytopenia and skeletal deterioration in the form of osteonecrosis, pathological fractures associated with osteopaenia, remodeling failure and bone crises. The oligosaccharide chains at taliglucerase alfa rpc glycosylation sites have terminal mannose sugars that are necessary for interaction with mannose receptors present on macrophages. Taliglucerase alfa rpc uptake by macrophages was shown, in in vitro studies with both mouse and human cells, to be in large part mediated by mannose receptors.

Clinical trials.

Study in adult patients naïve to enzyme replacement therapy (PB-06-001).

The safety and efficacy of Elelyso was evaluated in a pivotal, multi-centre, double blind, randomised phase III study investigating two dose groups, 30 units/kg and 60 units/kg. The study was conducted in 31 adult patients, aged 18 years of age and above, with Gaucher disease (PB-06-001) who were treatment naïve to enzyme replacement therapy.
Patients with a confirmed diagnosis of Gaucher disease (leukocyte GCD activity level ≤ 3 nanomol/mg*hr (≤ 30% of the mean activity of the reference range), enlarged spleens (> 8 times normal) and thrombocytopenia (< 120,000/mm3) were eligible. Patients could not have received enzyme replacement therapy (ERT) in the past or for at least 12 months prior to study entry and must have had a negative anti-glucocerebrosidase antibody test result at screening. Patients must not have received substrate reduction therapy (SRT) in the past 12 months. Bone disease was not part of the inclusion criteria. Patients with severe neurological symptoms were excluded from the study.
The primary endpoint was percent change from baseline in spleen volume measured by MRI at month 9. Major secondary endpoints included change from baseline in haemoglobin, liver volume (percent change) and platelet count. Change from baseline in Quantitative Chemical Shift Imaging (QCSI) technique, which measures bone marrow fat fraction (Ff) and Dual Energy X-ray Absorptiometry (DEXA), which measures mineral density, were evaluated as tertiary endpoints.
Intravenous infusions were administered every 2 weeks for 9 months (i.e. 38 weeks). Thirty one (31) patients treated with 30 units/kg (n = 15) and 60 units/kg (n = 16) were evaluated for efficacy. Patient age ranged from 19 to 74 years of age (mean age 36 years), of these 48% (15/31) were male. Sixteen (16) patients had enlarged livers and 10 patients had anaemia at baseline. All patients were naïve to ERT.
Both dose groups, 30 units/kg and 60 units/kg, demonstrated a statistically significant reduction in spleen volume compared with baseline at the month 6 visit (22.21% and 29.94% respectively; both p < 0.0001) and month 9 visit (26.91% and 38.01% respectively; both p < 0.0001). Similar effects were observed for haemoglobin increase, liver volume decrease and platelet count increase as noted in Table 3.
As tertiary endpoints, bone involvement was assessed pretreatment and at 9 months in a subset of 8 out of 31 (26%) treatment naïve patients using the QCSI technique and DEXA. A trend in improvement of the mean change of T and Z score for lumbar spine and femoral neck were observed after 9 months treatment in both dose groups.
Twenty six of the 31 patients in the 9 month clinical trial continued treatment with taliglucerase alfa in extension trials. Total combined study duration with taliglucerase alfa was 60 months, the first 24 months of which were conducted as a double blind trial and the remaining 36 months as open label. Twenty six patients completed 24 months, 23 completed 36 months and 17 completed 60 months. The following data are the changes in clinical parameters for the double blind portion of the extension trial (from baseline to month 24) for the 30 units/kg (n = 12) and 60 units/kg (n = 14) dose groups, respectively: median (range) spleen volume expressed as % BW decreased 1.4 (0.7, 2.7) and 1.3 (0.6, 8.0), and as multiples of normal (MN) decreased 7.1 (3.3, 13.3) and 6.6 (3.0, 39.9); haemoglobin increased 1.2 (-1.2, 5.0) g/dL and 1.6 (-1.5, 7.3) g/dL; liver volume expressed as % BW decreased 0.9 (0.4, 2.6) and 1.0 (-0.2, 2.8), and decreased 0.4 (0.2, 1.0) and 0.4 (-0.1, 1.1) MN; and platelet count increased 15,350 (-14,000, 87,000)/mm3 and 49,000 (-10,000, 202,000)/mm3. Patients in the open label portion of the extension trials demonstrated median improvements from baseline that were generally maintained across the measurement time points of the open label period for these outcomes.

Study in paediatric patients naïve to enzyme replacement therapy (PB-06-005).

A pivotal, multi-centre, double blind, randomised phase III study of 30 units/kg or 60 units/kg was conducted in paediatric patients (2 to 17 years of age) with confirmed Gaucher disease (leukocyte acid β-glucosidase activity level ≤ 30% of the mean activity of the reference range for healthy patients) and who were naïve to ERT (PB-06-005). Eligibility criteria was as per study PB-06-001 (given above), with the additional exclusion criteria of patients with complex neuronopathic features other than longstanding oculomotor gaze palsy; unresolved anaemia due to iron, folic acid or vitamin B12 deficiency, a history of allergy to carrots, HIV, HBsAg and/or hepatitis C infections.
The primary endpoint was measured by percent (%) change in haemoglobin. Secondary endpoints included chitotriosidase or CCL18, spleen and liver volume evaluated by MRI (or ultrasound), platelet count, change in growth and development (weight, height, Tanner stage, bone age), bone disease and quality of life from baseline. The safety of taliglucerase alfa was assessed by clinical laboratory, physical examination, echocardiography and adverse events. Anti-taliglucerase alfa antibodies were also assessed.
Intravenous infusions were administered every 2 weeks for 12 months. Eleven patients treated with 30 units/kg (n = 6) and 60 units/kg (n = 5) were evaluated for efficacy, of these 8 (72%) patients were male and ranged from 2 to 14 years of age.
Both dosage groups, 30 units/kg and 60 units/kg, demonstrated an increase in haemoglobin from baseline (11.3 g/dL and 10.6 g/dL, respectively) at month 12 (12.7 g/dL, increase 13.8% and 12.2 g/dL, increase 15.8%, respectively). Haemoglobin rose 19.4% (30 units/kg) and 16.9% (60 units/kg) in those patients anaemic at baseline. Similar effects were observed for spleen volume decrease, liver volume decrease and platelet count increase as noted in Table 4.
Auxological parameters for the paediatric cohort, including height, height velocity and weight, all improved on taliglucerase alfa therapy as shown in Table 5.
Ten of the 11 paediatric patients in the 12 month clinical trial continued treatment with Elelyso in an extension trial for a total treatment duration of 36 months, the first 24 months of which were conducted as a double blind trial, while the remaining 12 months were open label. All ten patients completed 24 months and 9 of these completed 36 months. The following data are the changes in clinical parameters for the double blind portion (from baseline to month 24) for the 30 units/kg (n = 5) and 60 units/kg dose groups (n = 5), respectively: median (range) spleen volume expressed as % BW decreased 3.6 (2.0, 4.0) and 3.8 (1.0, 11.2), and as MN decreased 17.9 (9.8, 20.1) and 19.0 (5.1, 56.0); haemoglobin increased 1.7 (1.1, 3.3) g/dL and 2.5 (-0.1, 3.5) g/dL; liver volume expressed as % BW decreased 1.4 (1.1, 2.2) and 2.1 (1.1, 3.2) and decreased 0.6 (0.4, 0.9) and 0.8 (0.5, 1.3) MN; and platelet count increased 16,000 (-25,000, 76,000)/mm3 and 76,000 (66,000, 157,000)/mm3. Patients in the open label portion of the extension trials demonstrated median improvements from baseline that were generally maintained across the measurement time points of the open label period for these outcomes.

Study in patients switching from imiglucerase to Elelyso (PB-06-002).

A multi-centre, open-label, single arm 9 month study in clinically stable adult and paediatric Gaucher disease patients (2 years of age or above) treated with imiglucerase and switched to Elelyso at the same dose as the previous imiglucerase dose was performed (PB-06-002).
Patients were required to be clinically stable and to have a stable biweekly dose of imiglucerase for at least 6 months prior to enrollment. Patient age ranged from 13 to 66 years of age (mean 45 years of age), 46% were male. Imiglucerase therapy was stopped, and treatment with Elelyso was administered every 2 weeks. Adjustment of dose was allowed by study criteria if needed in order to maintain clinical parameters (i.e. haemoglobin, platelet count, spleen volume, and liver volume). One patient required a dose increase (from 9.5 units/kg to 19 units/kg at week 24) for a platelet count of 92,000/mm3 at week 22, and responded with a platelet count of 170,000/mm3 at month 9.
Primary efficacy endpoints included platelet count, haemoglobin, spleen volume, liver volume and biomarkers (chitotriosidase and PARC/ CCL18). Secondary endpoints for paediatric patients included: height and weight for growth evaluation; Tanner stage for sexual development; and bone age by X-ray of left hand and wrist.
Twenty six clinically stable adult patients were enrolled and 25 completed 9 months of treatment. Doses ranged from 9 units/kg to 60 units/kg with a mean of 28.8 units/kg. The age range was 18 years to 66 years and 14 patients were male and 12 were female.
Organ volumes remained stable. Median spleen volume was 814.2 mL at baseline and 697.3 mL after 9 months, and the respective median liver volumes were 1,816.5 mL at baseline and 1,800.6 mL at 9 months. Haematological parameters were also stable. Median haemoglobin levels were 13.6 g/dL at both baseline and after 9 months, and median platelet counts were 163,167/mm3 at baseline and 159,000/mm3 after 9 months.
Five paediatric patients were enrolled and completed the trial. Median doses ranged from 26 units/kg to 60 units/kg. The age range was 6 years to 16 years; 3 patients were male and 2 were female. Organ volumes remained stable. Median spleen values were 324 mL at baseline and 256 mL at 9 months. Median liver values were 1,243 mL at baseline and 1,305 mL at 9 months. Haematological parameters were also stable. Median haemoglobin was 13.4 g/dL and 14.3 g/dL at baseline and 9 months, respectively. Median platelet count was 146,500/mm3 and 200,000/mm3 at baseline and 9 months, respectively.
All five paediatric patients in the 9 month clinical trial continued treatment with Elelyso in an extension trial for a total treatment duration of 33 months. All five patients completed 24 months and 2 patients completed 33 months. The following data are the changes from baseline in clinical parameters at month 33 (n = 2): mean (SD) spleen volume expressed as % BW was stable 0.0 (0.0), and decreased 0.1 (0.0) MN; haemoglobin increased 0.5 (0.5) g/dL; liver volume expressed as % BW decreased 0.2 (0.0), and decreased 0.1 (0.0) MN; and platelet count increased 4,700 (13,152)/mm3.
Eighteen of the 26 adult patients who completed the 9 month clinical trial continued treatment with Elelyso in an extension trial (PB-06-003). The five paediatric patients continued into a separate extension study (PB-06-006). Ten adult patients completed 36 months of treatment. At month 36, the changes in clinical parameters from baseline for adult patients were: mean (SD) spleen volume in % BW -0.3 (0.5), in MN -1.3 (2.3); liver volume in % BW 0.0 (0.4), in MN 0.0 (0.2); platelet count -3,800 (33,920)/mm3; and haemoglobin -0.2 (0.9) g/dL.

Expanded access study (PB-06-004).

A multicentre, open label, expanded access trial was designed to assess the safety of taliglucerase alfa in patients with Gaucher disease who required enzyme replacement therapy (ERT) due to a shortage of imiglucerase product. Study duration was up to 33 months, or until marketing approval was obtained and taliglucerase alfa was available. Patients previously treated with imiglucerase were to receive the same dose as the previous imiglucerase dose, before dose reduction or discontinuation. Patient age ranged from 21 to 85 years of age (mean 46 years of age), 55% were male.
The study was not comparative and no formal hypothesis testing for efficacy was planned or done. Nonetheless, the data from the efficacy population indicate that in patients previously treated with imiglucerase the mean haemoglobin concentration and platelet counts were stable during long-term treatment with Elelyso.
Two patients withdrew from the study specifically because of adverse events (AE) which involved infusion related reactions (periorbital swelling in one and chest discomfort in the other). These reactions were characterised as mild to moderate. A third patient had mild hypersensitivity reactions during many of the infusions but was able to continue receiving study drug and completed the study.
Most AEs were mild or moderate and were not related to study drug. Thirty six of the 58 treated patients completed the study and most of the 22 patients who discontinued early voluntarily withdrew because Elelyso became commercially available in their country.

An extension study in adult patients who completed studies PB-06-001 or PB-06-002 (PB-06-003).

An open label, extension trial in patients with Gaucher disease, who completed nine months of treatment in studies PB-06-001 or PB-06-002. Patients continued to receive the allocated dose from study PB-06-001, or the same dose they received at the completion of study PB 06-002. Forty four (44) patients received treatment with Elelyso for at least 15 months and for a total of no more than 30 months.
The efficacy results provided evidence that Elelyso maintained effectiveness for as long as 39 months. Continued improvement was observed in spleen and liver volumes and in haematological parameters in patients naïve to ERT.

5.2 Pharmacokinetic Properties

Clinical pharmacokinetics.

Adult population.

In 32 adult patients with Gaucher disease, taliglucerase alfa rpc was rapidly eliminated. Patients received a single dose by intravenous infusion over 1 to 2 hours at a dose of 30 units/kg or 60 units/kg. After continued biweekly dosing there was no clear indication of accumulation. At steady state at week 38, the mean AUCt (exposure) appears to suggest a more than dose proportional increase in AUCt. There were no observed clinically relevant gender related differences in exposure (AUC).
Mean clearance was about 30 L/hr at 30 units/kg dose and 20 L/hr at 60 units/kg dose. The median volume of distribution values during the elimination phase (Vz) range from 12.6 L to 13.9 L.
The mean tmax on both day 1 and at week 38 is longer in the 60 units/kg dose group than in the 30 units/kg dose group, while the mean CL and the mean Vz are lower on day 1 and at week 38 in the 60 units/kg dose group compared with the 30 units/kg dose group. The mean t1/2 is longer at week 38 in the 60 units/kg dose group compared with the 30 units/kg dose group. There are no notable differences in the mean Tmax, t1/2, CL or Vz on day 1 or at week 38 in either the 30 units/kg or the 60 units/kg dose groups.

Paediatric population.

Pharmacokinetics of taliglucerase alfa were evaluated in 11 paediatric subjects with Gaucher disease. Following repeated dose IV infusion of 30 units/kg and 60 units/kg taliglucerase alfa in about 100 minutes in paediatric subjects, median elimination half-life of taliglucerase alfa was 31.9 minutes (range: 12.9 to 56.8) and 32.5 minutes (range: 18.0 to 42.9), respectively. Median systemic clearance (CL) were 27.4 L/hr (range: 10.9 to 37.8) for 30 units/kg, and 15.8 L/hr (range: 11.7 to 24.9) for 60 units/kg. The steady state median AUC0-t was 1,491 nanogram.hr/mL (range: 527 to 1,932) for 30 units/kg and 2,969 nanogram.hr/mL (range: 1,593 to 4,256) for 60 units/kg. Dose normalised exposure (AUC0-t) was 46.4 ± 24.6 [nanogram.hr/mL]/mg for 30 units/kg and 63.9 ± 21.1 [nanogram.hr/mL]/mg for 60 units/kg.
AUC0-t values in paediatric patients were lower than those observed in adult patients (i.e. median AUC0-t 1,989 nanogram.hr/mL with a range of 1,002 to 9,546 at week 38 for 30 units/kg and 6,751 nanogram.hr/mL range of 2,545 to 20,496 at week 38 for 60 units/kg), due to weight based dosing of taliglucerase alfa and lower body weights in paediatric patients.

5.3 Preclinical Safety Data

Genotoxicity.

Tests for genotoxic activity were not performed. Given that taliglucerase alfa rpc is degraded to peptides and amino acids and that the products of its enzymic action are glucose and ceramide, it is unlikely to pose a genotoxic risk.

Carcinogenicity.

Tests for carcinogenic activity were not performed. Given the nature and location of the enzymic activity of taliglucerase alfa rpc (i.e. lysosomal glucocerebrosidase) and the products of its enzymic action (i.e. glucose and ceramide), Elelyso is unlikely to pose a carcinogenic risk.

6 Pharmaceutical Particulars

6.1 List of Excipients

195 mg mannitol, 28.7 mg sodium citrate dihydrate, 0.53 mg polysorbate 80.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Unopened vials.

Store and transport at 2°C to 8°C. Refrigerate. Do not freeze. Keep the vial within the outer carton in order to protect from light.

Reconstituted and diluted solutions.

Elelyso should be reconstituted and diluted just before use and used immediately. If not used immediately, in-use storage times and conditions of the reconstituted solution and the diluted solution prior to use are the responsibility of the user.
The reconstituted vial and the diluted solution that is made from the reconstituted vial can be stored for a combined time of not more than 24 hours at 2°C to 8°C under protection from light after the initial reconstitution step.

6.5 Nature and Contents of Container

Elelyso powder for injection is packaged in a 13.5 mL Type 1 borosilicate glass vial. Available as single vial packs.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Chemical structure.

Taliglucerase alfa rpc is a glycosylated protein with approximately 7% of its molecular mass contributed by glycans. The glycans present in taliglucerase alfa rpc are typical of plant expressed proteins. The most abundant glycan has terminal mannose, β-(1,2)-xylose, and α-(1,3)-fucose residues. The terminal mannose residues specifically bind the endocytic mannose receptors on macrophages, resulting in uptake of the enzyme into the macrophages, the cells that accumulate lipid in Gaucher disease and are the target cells for enzyme replacement therapy. The glycan structures β-(1,2)-xylose, and α-(1,3)-fucose residues are widely present in plant but not in mammalian glycoproteins.
Taliglucerase alfa rpc sequence contains seven cysteine residues that form two disulfide bonds between the first four cysteine residues (Cys6-Cys18, Cys20-Cys25) and three free sulfhydryls (thiols).
Taliglucerase alfa rpc is a white to off white lyophilised powder that may form a cake.

CAS number.

37228-64-1.

7 Medicine Schedule (Poisons Standard)

S4 - Prescription Only Medicine.

Summary Table of Changes