Epysqli

Epysqli must be administered by a healthcare professional and under the supervision of a physician experienced in the management of patients with haematological or renal disorders. Home infusion may be considered for patients who have tolerated infusions well in the clinic.

The decision of a patient to receive home infusions should be made after evaluation and recommendation from the treating physician. Home infusions should be performed by a qualified healthcare professional. Posology Paroxysmal Nocturnal Haemoglobinuria (PNH) in adults The PNH dosing regimen for adult patients (≥ 18 years of age) consists of a 4-week initial phase followed by a maintenance phase: 3 • Initial phase: 600 mg of Epysqli administered via a 25 – 45 minute (35 minutes ± 10 minutes) intravenous infusion every week for the first 4 weeks.

1). atypical Haemolytic Uremic Syndrome (aHUS) in adults The aHUS dosing regimen for adult patients (≥18 years of age) consists of a 4 week initial phase followed by a maintenance phase: • Initial phase: 900 mg of Epysqli administered via a 25 – 45 minute (35 minutes ± 10 minutes) intravenous infusion every week for the first 4 weeks.

1). Paediatric patients in PNH or aHUS Paediatric PNH or aHUS patients with body weight ≥ 40 kg are treated with the adult dosing recommendations. In paediatric PNH and aHUS patients with body weight below 40 kg, Epysqli dosing regimen consists of: Patient body weight Initial phase Maintenance phase 30 to < 40 kg 600 mg weekly for the first 2 weeks 900 mg at week 3; then 900 mg every 2 weeks 20 to < 30 kg 600 mg weekly for the first 2 weeks 600 mg at week 3; then 600 mg every 2 weeks 10 to < 20 kg 600 mg single dose at week 1 300 mg at week 2; then 300 mg every 2 weeks 5 to < 10 kg 300 mg single dose at week 1 300 mg at week 2; then 300 mg every 3 weeks Epysqli has not been studied in patients with PNH who weigh less than 40kg.

The posology of Epysqli to be used in paediatric patients with PNH patients weighing less than 40 kg is identical to the weight- based dose recommendation provided for paediatric patients with aHUS. Based on the pharmacokinetic (PK)/pharmacodynamic (PD) data available in patients with aHUS and PNH treated with eculizumab, this body-weight based dose regimen for paediatric patients is expected to result in an efficacy and safety profile similar to that in adults.

4 aHUS laboratory monitoring). 4). Special populations Elderly Epysqli may be administered to patients aged 65 years and over. There is no evidence to suggest that any special precautions are needed when older people are treated – although experience with eculizumab in this patient population is still limited.

Summary of the safety profile Supportive safety data were obtained from 33 completed clinical trials that included 1,555 patients exposed to eculizumab in complement-mediated disease populations, including PNH, aHUS, gMG and Neuromyelitis Optica Spectrum Disorder (NMOSD).

The most common adverse reaction was headache, (occurred mostly in the initial phase of dosing), and the most serious adverse reaction was meningococcal infection. Tabulated list of adverse reactions Table 1 gives the adverse reactions observed from spontaneous reporting and in eculizumab completed clinical trials, including PNH, aHUS, refractory gMG and NMOSD studies.

Adverse reactions reported at a very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1 000 to < 1/100), rare (≥ 1/10 000 to < 1/1 000) or not known (cannot be estimated from the available data) frequency with eculizumab, are listed by system organ class and preferred term.

Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.

Table 1:

Adverse reactions reported in eculizumab clinical trials, including patients with PNH, aHUS, refractory gMG and NMOSD as well as from post marketing experience MedDRA system organ class Very common (≥1/10) Common (≥1/100 to <1/10) Uncommon (≥1/1 000 to <1/100) Rare (≥1/10000 to <1/1000) Not known (cannot be estimated from the available data) Infection and infestations Pneumonia, Upper respiratory tract infection, Bronchitis, Nasopharyngitis, Urinary tract infection, Oral Herpes Meningococcal infectionb, Sepsis, Septic shock, Peritonitis, Lower respiratory tract infection, Fungal infection, Viral infection, Abscessa, Cellulitis, Influenza, Gastrointestinal infection, Cystitis, Infection, Sinusitis, Gingivitis Aspergillus infectionc, Arthritis bacterialc, Genitourinary tract gonococcal infection, Haemophilus infection, Impetigo Neoplasms benign, malignant and unspecified (including cysts Malignant melanoma, Myelodysplastic syndrome 10 MedDRA system organ class Very common (≥1/10) Common (≥1/100 to <1/10) Uncommon (≥1/1 000 to <1/100) Rare (≥1/10000 to <1/1000) Not known (cannot be estimated from the available data) and polyps) Blood and lymphatic system disorders Leukopenia, Anaemia Thrombocytopenia, Lymphopenia Haemolysis*, Abnormal clotting factor, Red blood cell agglutination, Coagulopathy Immune system disorders Anaphylactic reaction, Hypersensitivity Endocrine disorders Grave’s disease Metabolism and nutrition disorders Decreased appetite Psychiatric disorders Insomnia Depression, Anxiety, Mood swings, Sleep disorder Abnormal dreams Nervous system disorders Headache Dizziness Paraesthesia, Tremor, Dysgeusia, Syncope Eye disorders Vision blurred Conjunctival irritation Ear and labyrinth disorders Tinnitus, Vertigo Cardiac disorders Palpitation Vascular disorders Hypertension Accelerated hypertension, Hypotension, Hot flush, Vein disorder Haematoma Respiratory, thoracic and mediastinal disorders Cough, Oropharyngeal pain Dyspnoea, Epistaxis, Throat irritation, Nasal congestion, Rhinorrhoea Gastrointestinal disorders Diarrhoea, Vomiting, Nausea, Abdominal pain Constipation, Dyspepsia, Abdominal distension Gastroesophageal reflux disease, Gingival pain Hepatobiliary disorders Alanine aminotransferase increased, Aspartate aminotransferase increased, Gamma- glutamyltransferase increased Jaundice Liver injuryd Skin and subcutaneous tissue disorders Rash, Pruritus, Alopecia Urticaria, Erythema, Petechiae, Hyperhidrosis, Dry skin, Dermatitis Skin depigmentation Musculoskeletal and connective tissue disorders Arthralgia, Myalgia, Pain in extremity Muscle spasms, Bone pain, Back pain, Neck pain Trismus, Joint swelling Renal and urinary disorders Renal impairment, Dysuria, Haematuria Reproductive Spontaneous penile Menstrual disorder 11 MedDRA system organ class Very common (≥1/10) Common (≥1/100 to <1/10) Uncommon (≥1/1 000 to <1/100) Rare (≥1/10000 to <1/1000) Not known (cannot be estimated from the available data) system and breast disorders erection General disorders and administration site conditions Pyrexia, Fatigue, Influenza-like illness Edema, Chest discomfort, Asthenia, Chest pain, Infusion site pain, Chills Extravasation, Infusion site paraesthesia, Feeling hot Investigations Haematocrit decreased, Haemoglobin decreased Coombs test positivec Injury, poisoning and procedural complication Infusion related reaction Included Studies: Asthma (C07-002), aHUS(C08-002, C08-003, C10-003, C10-004), Dermatomyositis (C99- 006), refractory gMG (C08-001, ECU-MG-301, ECU-MG-302, ECU-MG-303), Neuromyelitis Optica Spectrum Disorder (ECU-NMO-301, ECU-NMO-302), IMG (C99-004, E99-004), PNH (C02-001, C04-001, C04-002, C06-002, C07-001, E02-001, E05-001, E07-001, M07-005, X03-001, X03-001A), Psoriasis (C99-007), RA (C01-004, C97-001, C99-001, E01-004, E99-001), STEC-HUS (C11-001), SLE (C97-002).

Traceability In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded. Eculizumab is not expected to affect the aplastic component of anaemia in patients with PNH.

Meningococcal Infection Due to its mechanism of action, the use of eculizumab increases the patient’s susceptibility to meningococcal infection (Neisseria meningitidis). Meningococcal disease due to any serogroup may occur. To reduce the risk of infection, all patients must be vaccinated at least 2 weeks prior to receiving eculizumab unless the risk of delaying eculizumab therapy outweighs the risks of developing a meningococcal infection.

Patients who initiate eculizumab treatment less than 2 weeks after receiving a tetravalent meningococcal vaccine must receive treatment with appropriate prophylactic antibiotics until 2 weeks after vaccination. Vaccines against all available serogroups including A, C, Y, W 135, and B, are recommended in preventing the commonly pathogenic meningococcal serogroups.

Patients must be vaccinated and revaccinated according to current national guidelines for vaccination use. Vaccination may further activate complement. As a result, patients with complement-mediated diseases, including PNH and aHUS, may experience increased signs and symptoms of their underlying disease, such as haemolysis (PNH) or TMA (aHUS).

Therefore, patients should be closely monitored for disease symptoms after recommended vaccination. Vaccination may not be sufficient to prevent meningococcal infection. Consideration should be given to official guidance on the appropriate use of antibacterial agents.

Cases of serious or fatal meningococcal infections have been reported in eculizumab-treated patients. 8). All patients should be monitored for early signs of meningococcal infection, evaluated immediately if infection is suspected, and treated with appropriate antibiotics if necessary.

1. 4): - with unresolved Neisseria meningitidis infection - who are not currently vaccinated against Neisseria meningitidis unless they receive prophylactic treatment with appropriate antibiotics until 2 weeks after vaccination.