YUTIQ

YUTIQ- fluocinolone acetonide implant
EyePoint Pharmaceuticals US, Inc

1. INDICATIONS AND USAGE

YUTIQ (fluocinolone acetonide intravitreal implant) 0.18 mg is indicated for the treatment of chronic non-infectious uveitis affecting the posterior segment of the eye.

2. DOSAGE AND ADMINISTRATION

2.1. General Dosing Information

For ophthalmic intravitreal injection.

2.2. Administration

The intravitreal injection procedure should be carried out under aseptic conditions, which include use of sterile gloves, a sterile drape, a sterile caliper, and a sterile eyelid speculum (or equivalent). Adequate anesthesia and a broad-spectrum microbicide should be given prior to the injection.

The injection procedure for YUTIQ is as follows:

  1. Just prior to injection, administer topical and/or subconjunctival anesthesia at the injection site (inferotemporal quadrant recommended).
  2. Administer 2-3 drops of a broad-spectrum microbicide into the lower fornix. The lids may be scrubbed with cotton-tipped applicators soaked with a broad-spectrum microbicide. Place a sterile lid speculum. Have the patient look up and apply additional microbicide solution to the injection site. Allow 30-60 seconds for the topical antiseptic to dry prior to injection of YUTIQ.
  3. Optimal placement of YUTIQ is inferior to the optic disc and posterior to the equator of the eye. Measure 4 millimeters inferotemporal from the limbus with the aid of callipers for point of entry into the sclera.
  4. Using sterile procedure, open the sterile foil pouch containing YUTIQ.
  5. Remove the YUTIQ applicator from the sterile pouch by grasping the barrel of the applicator; do not grasp the plunger.
  6. Remove the black plunger stop from the plunger.
  7. Carefully remove the protective cap from the needle and inspect the needle tip to ensure it is not bent.
  8. Remove the trombone wire from the distal end of the needle. Prior to injection, keep the applicator tip above the horizontal plane to ensure that the YUTIQ implant does not fall out of the applicator.
  9. Gently displace the conjunctiva so that after withdrawing the needle, the conjunctival and scleral needle entry sites will not align. Care should be taken to avoid contact between the needle and the lid margin or lashes.
  10. Insert the needle through the conjunctiva and sclera up to the positive stop of the applicator.
  11. Depress the plunger at the back of the applicator fully to deliver the YUTIQ implant into the back of the eye.
  12. Remove the YUTIQ applicator from the eye and discard in biohazard sharps container.
  13. Remove the lid speculum and perform indirect ophthalmoscopy to verify adequate central retinal artery perfusion, absence of any other complications, and to verify the placement of the implant. Scleral depression may enhance visualisation of the implant. Immediate measurement of intraocular pressure (IOP) may be performed at the discretion of the ophthalmologist.

Following the injection, patients should be monitored for change in intraocular pressure and for endophthalmitis. Monitoring may consist of a check for perfusion of the optic nerve head immediately after the injection, tonometry within 30 minutes following the injection, and biomicroscopy between two and seven days following the injection. Patients should be instructed to report without delay any symptoms suggestive of endophthalmitis.

3. DOSAGE FORMS AND STRENGTHS

YUTIQ is a non-bioerodible intravitreal implant in a drug delivery system containing 0.18 mg fluocinolone acetonide, designed to release fluocinolone acetonide at an initial rate of 0.25 mcg/day, and lasting 36 months.

4. CONTRAINDICATIONS

4.1. Ocular or Periocular Infections

YUTIQ is contraindicated in patients with active or suspected ocular or periocular infections including most viral disease of the cornea and conjunctiva including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections and fungal diseases.

4.2. Hypersensitivity

YUTIQ is contraindicated in patients with known hypersensitivity to any components of this product.

5. WARNINGS AND PRECAUTIONS

5.1. Intravitreal Injection-related Effects

Intravitreal injections, including those with YUTIQ, have been associated with endophthalmitis, eye inflammation, increased or decreased intraocular pressure, and choroidal or retinal detachments. Hypotony has been observed within 24 hours of injection and has resolved within 2 weeks. Patients should be monitored following the intravitreal injection [see Patient Counseling Information (17)].

5.2. Steroid-related Effects

Use of corticosteroids including YUTIQ may produce posterior subcapsular cataracts, increased intraocular pressure and glaucoma. Use of corticosteroids may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses.

Corticosteroids are not recommended to be used in patients with a history of ocular herpes simplex because of the potential for reactivation of the viral infection.

5.3. Risk of Implant Migration

Patients in whom the posterior capsule of the lens is absent or has a tear are at risk of implant migration into the anterior chamber.

6. ADVERSE REACTIONS

6.1. Clinical Studies Experience

Because 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.

Adverse reactions associated with ophthalmic steroids including YUTIQ include cataract formation and subsequent cataract surgery, elevated intraocular pressure, which may be associated with optic nerve damage, visual acuity and field defects, secondary ocular infection from pathogens including herpes simplex, and perforation of the globe where there is thinning of the cornea or sclera.

Studies 1 and 2 were multicenter, randomized, sham injection-controlled, masked trials in which patients with non-infectious uveitis affecting the posterior segment of the eye were treated once with either YUTIQ or sham injection, and then received standard care for the duration of the study. Study 3 was a multicenter, randomized, masked trial in which patients with non-infectious uveitis affecting the posterior segment of the eye were all treated once with YUTIQ, administered by one of two different applicators, and then received standard care for the duration of the study.

Table 1 summarizes data available from studies 1, 2 and 3 through 12 months for study eyes treated with YUTIQ (n=226) or sham injection (n=94). The most common ocular (study eye) and non-ocular adverse reactions are shown in Table 1 and Table 2.

Table 1: Ocular Adverse Reactions Reported in ≥ 1% of Subject Eyes and Non-Ocular Adverse Reactions Reported in ≥ 2% of Patients
Ocular
ADVERSE REACTIONS YUTIQ(N=226 Eyes) n (%) Sham Injection(N=94 Eyes)n (%)

1. Includes cataract, cataract subcapsular and lenticular opacities in study eyes that were phakic at baseline. 113 of the 226 YUTIQ study eyes were phakic at baseline; 56 of 94 sham-controlled study eyes were phakic at baseline.

Cataract1 63/113 (56%) 13/56 (23%)
Visual Acuity Reduced 33 ( 15%) 11 (12%)
Macular Edema 25 ( 11%) 33 (35%)
Uveitis 22 ( 10%) 33 (35%)
Conjunctival Hemorrhage 17 ( 8%) 5 ( 5%)
Eye Pain 17 ( 8%) 12 (13%)
Hypotony Of Eye 16 ( 7%) 1 ( 1%)
Anterior Chamber Inflammation 12 ( 5%) 6 ( 6%)
Dry Eye 10 ( 4%) 3 ( 3%)
Vitreous Opacities 9 ( 4%) 8 ( 9%)
Conjunctivitis 9 ( 4%) 5 ( 5%)
Posterior Capsule Opacification 8 ( 4%) 3 ( 3%)
Ocular Hyperemia 8 ( 4%) 7 ( 7%)
Vitreous Haze 7 ( 3%) 4 ( 4%)
Foreign Body Sensation In Eyes 7 ( 3%) 2 ( 2%)
Vitritis 6 ( 3%) 8 ( 9%)
Vitreous Floaters 6 ( 3%) 5 ( 5%)
Eye Pruritus 6 ( 3%) 5 ( 5%)
Conjunctival Hyperemia 5 ( 2%) 2 ( 2%)
Ocular Discomfort 5 ( 2%) 1 ( 1%)
Macular Fibrosis 5 ( 2%) 2 ( 2%)
Glaucoma 4 ( 2%) 1 ( 1%)
Photopsia 4 ( 2%) 2 ( 2%)
Vitreous Hemorrhage 4 ( 2%) 0
Iridocyclitis 3 ( 1%) 7 ( 7%)
Eye Inflammation 3 ( 1%) 2 ( 2%)
Choroiditis 3 ( 1%) 1 ( 1%)
Eye Irritation 3 ( 1%) 1 ( 1%)
Visual Field Defect 3 ( 1%) 0
Lacrimation Increased 3 ( 1%) 0
Non-ocular
ADVERSE REACTIONS YUTIQ(N=214 Patients)n (%) Sham Injection(N=94 Patients)n (%)
Nasopharyngitis 10 ( 5%) 5 ( 5%)
Hypertension 6 ( 3%) 1 ( 1%)
Arthralgia 5 ( 2%) 1 ( 1%)
Table 2: Summary of Elevated IOP Related Adverse Reactions
ADVERSE REACTIONS YUTIQ (N=226 Eyes) n (%) Sham (N=94 Eyes) n (%)
IOP elevation ≥ 10 mmHg from Baseline 50 (22%) 11 (12%)
IOP elevation > 30 mmHg 28 (12%) 3 (3%)
Any IOP-lowering medication 98 (43%) 39 (41%)
Any surgical intervention for elevated IOP 5 (2%) 2 (2%)

Figure 1: Mean IOP During the Studies

Figure 1
(click image for full-size original)
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