ENSPRYNG- satralizumab injection, solution
1 INDICATIONS AND USAGE
ENSPRYNG is indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive.
2 DOSAGE AND ADMINISTRATION
2.1 Assessments Prior to the First Dose of ENSPRYNG
Hepatitis B Virus Screening
Prior to initiating ENSPRYNG, perform Hepatitis B virus (HBV) screening. ENSPRYNG is contraindicated in patients with active HBV confirmed by positive results for surface antigen [HBsAg] and anti-HBV tests. For patients who are negative for HBsAg and positive for HB core antibody [HBcAb+] or are carriers of HBV [HBsAg+], consult liver disease experts before starting and during treatment with ENSPRYNG [see Contraindications (4) and Warnings and Precautions (5.1)].
Prior to initiating ENSPRYNG, evaluate for active tuberculosis and test for latent infection. For patients with active tuberculosis or positive tuberculosis screening without a history of appropriate treatment, consult infectious disease experts before initiating treatment with ENSPRYNG [see Contraindications (4) and Warnings and Precautions (5.1)].
Liver Transaminase Screening
Liver transaminases and serum bilirubin should be assessed prior to initiation of treatment with ENSPRYNG [see Warnings and Precautions (5.2)].
Caution should be exercised when considering initiation of ENSPRYNG treatment in patients whose aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels are greater than 1.5 times the upper limit of normal (ULN).
Because vaccination with live-attenuated or live vaccines is not recommended during treatment with ENSPRYNG, administer all immunizations according to immunization guidelines at least 4 weeks prior to initiation of ENSPRYNG for live or live-attenuated vaccines and, whenever possible, at least 2 weeks prior to initiation of ENSPRYNG for non-live vaccines [see Warnings and Precautions (5.1)].
2.2 Recommended Dosage
For subcutaneous use only.
Prior to every use of ENSPRYNG, advise patients to consult with their healthcare professional (HCP) if they suspect an active infection, including localized infections. In case of active infection, delay use of ENSPRYNG until the infection is resolved [see Warnings and Precautions (5.1)].
The recommended loading dosage of ENSPRYNG for the first three administrations is 120 mg by subcutaneous injection at Weeks 0, 2, and 4, followed by a maintenance dosage of 120 mg every 4 weeks.
If a dose of ENSPRYNG is missed for any reason other than increases in liver enzymes [see Dosage and Administration (2.4)] , administer as described in Table 1.
|Last Dose Administered||Recommended Dosage for Delayed or Missed Doses|
|Less than 8 weeks during the maintenance period or missed a loading dose||Administer 120 mg by subcutaneous injection as soon as possible, and do not wait until the next planned dose.Maintenance periodAfter the delayed or missed dose is administered, reset the dose schedule to every 4 weeks.Loading periodIf the second loading dose is delayed or missed, administer as soon as possible and administer the 3rd and final loading dose 2 weeks later.If the third loading dose is delayed or missed, administer as soon as possible and administer the 1st maintenance dose 4 weeks later.|
|8 weeks to less than 12 weeks||120 mg by subcutaneous injection at 0* and 2 weeks, followed by 120 mg every 4 weeks.|
|12 weeks or longer||120 mg by subcutaneous injection at 0*, 2, and 4 weeks followed by 120 mg every 4 weeks.|
2.3 Important Administration Instructions
- ENSPRYNG is intended for patient self-administration by subcutaneous injection under the guidance of a health care professional (HCP). After proper training in subcutaneous injection technique, a patient may self-inject ENSPRYNG or the patient’s caregiver may administer ENSPRYNG, if the HCP determines that it is appropriate. See ENSPRYNG “Instructions for Use” (IFU) for more detailed instructions on the preparation and administration of ENSPRYNG.
- Patients or caregivers should seek immediate medical attention if the patient develops symptoms of a serious allergic reaction and should not administer further doses until evaluated by a HCP [see Contraindications (4) and Warning and Precautions (5.4)].
- Prior to use, remove the prefilled syringe from the refrigerator and allow to sit at room temperature outside of the carton for 30 minutes. Do not warm ENSPRYNG in any other way.
- Inspect visually for particulate matter and discoloration prior to administration. ENSPRYNG solution should be clear and colorless to slightly yellow. Do not use ENSPRYNG if the solution is cloudy, discolored, or contains particles, or if any part of the prefilled syringe appears to be damaged.
- Instruct patients to inject the full amount in the syringe (1 mL), which provides 120 mg of ENSPRYNG, according to the directions provided in the IFU.
- Administer ENSPRYNG by subcutaneous injection in the abdomen or thigh. Rotate injection sites with each administration. Do not give injection into moles, scars, or areas where the skin is tender, bruised, red, hard, or not intact.
2.4 Safety Monitoring During Treatment
Monitor ALT and AST levels every 4 weeks for the first 3 months of treatment with ENSPRYNG, followed by every 3 months for one year, and thereafter as clinically necessary [see Warnings and Precautions (5.2)].
If an ALT or AST elevation of greater than 5 times the ULN occurs, discontinue ENSPRYNG as follows:
- If associated with any bilirubin elevation, discontinue ENSPRYNG, and reinitiation is not recommended.
- If not associated with any bilirubin elevation above the ULN, when the ALT or AST level has returned to the normal range and following a benefit-risk assessment of the patient, treatment with ENSPRYNG can be restarted per the schedule in Table 2.
Table 2 Recommended Dosage for Restart of Treatment After Liver Transaminase Elevation Last Dose Administered Recommended Dosage for Restart of Treatment
- “0 weeks” refers to time of the first administration after the missed dose.
Less than 12 weeks Restart at a dosage of 120 mg by subcutaneous injection every 4 weeks. 12 weeks or longer Restart at a dose of 120 mg by subcutaneous injection at Weeks 0*, 2, and 4, followed by a dosage of 120 mg every 4 weeks.
Monitor neutrophils 4 to 8 weeks after initiation of therapy and thereafter at regular clinically determined intervals. If the neutrophil count is below 1.0 × 109 /L and confirmed by repeat testing, ENSPRYNG should be interrupted until the neutrophil count is > 1.0 × 109 /L [see Warnings and Precautions (5.3)].
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