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FIRAZYR(ICATIBANT ACETATE)injection

2014-06-14 09:29:20  作者:新特药房  来源:互联网  浏览次数:355  文字大小:【】【】【
简介: 欧盟批准德国Jerini公司的主导药物缓激肽拮抗药艾替班特预填充注射剂(Icatibant,Firazyr)上市,用于治疗遗传性血管水肿(HAE)急性发作。HAE是退行性病变有可能威胁生命的遗传性疾病,特征是自发和复 ...

欧盟批准德国Jerini公司的主导药物缓激肽拮抗药艾替班特预填充注射剂(Icatibant,Firazyr)上市,用于治疗遗传性血管水肿(HAE)急性发作。HAE是退行性病变有可能威胁生命的遗传性疾病,特征是自发和复发性水肿。
2001年开始研发的本品是该类新化合物中的第1个,作为肽类激素缓激肽的拮抗剂通过阻断B2受体发挥作用。HAE患者体内的缓激肽浓度升高,HAE发作时形成水肿。欧洲药品管理局(EMEA)和美国FDA已批准艾替班特作为罕用药物对症治疗血管水肿的急性发作,并分别给予10年和7年的市场专卖权。本品迄今在临床研究中显示对患者治疗安全有效。本品皮下注射,以预填充注射器包装,室温稳定。
本品对皮肤和腹部血管水肿患者进行了2项重要的临床研究。第1项研究纳入74例患者,比较本品与另1种治疗此种疾病的氨甲环酸的作用;第2项研究56例患者,比较本品与安慰剂的作用。结果表明,本品控制症状较氨甲环酸和安慰剂有效。在这2项研究中,本品组改善患者症状的时间较氨甲环酸组和安慰剂组缩短,分别为2.0~2.5小时、12.0小时和4.6小时。
本品最常见的不良反应是红肿,温热感,灼热,瘙痒,疼痛。
本品推荐剂量为一次性注射,若症状持续或复发,可在用药后6小时第2次注射。按需,可再过6小时第3次注射,但24小时内不可多于3剂。
Firazyr(艾替班特[icatibant])产品特点总结和使用
产品特征总结
药品名称
在预装注射器内Firazyr 30 mg注射用溶液。
定性和定量组成
每支3 ml预装注射器含艾替班特醋酸盐等同于30 mg艾替班特[icatibant]。
每ml溶液含10 mg艾替班特。
对完全辅料清单见6.1。
活性物质
(以下摘自欧盟CHMP ASSESSMENT REPORT FOR Firazyr,见http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/000899/WC500022970.pdf)
艾替班特,是在缓激肽2型(B2)受体的选择性竞争性拮抗剂,是一种有相似于缓激肽的结构d 合成十肽,但是,其中有5个非蛋白源的氨基酸。十个氨基酸顺序组成如下:H-D-Arg-Arg-Pro-Hyp-Gly-Thi-Ser-D-Tic-Oic-Arg-OH。艾替班特的所有手性氨基酸是L-构型除了精氨酸(位1)和1, 2, 3, 4-四氢异喹啉-3-羧酸(位8)。
活性物质化学上被设计为D-Arginyl-L-arginyl-L-prolyl-L[(4R)-4-hydroxyprolyl]-glycyl-L[3-(2-thienyl) alanyl]-L-seryl-D-(1,2,3,4-tetrahydroisoquinolin-3-ylcarbonyl)-L[(3aS,7aS)-octahydroindol-2-ylcarbonyl]-L-arginine,醋酸盐(CAS)或H-D-Arg-Arg-Pro-Hyp-Gly-Thi-Ser-D-Tic-Oic-Arg-OH,醋酸盐(IUPAC三字符编码)和有下列结构:

药物剂型
注射用溶液。
溶液是一种澄明和无色液体。
临床细节
1 治疗适应证
Firazyr是适用于对症治疗成年中遗传性血管水肿(HAE)的急性发作(有C1-酯酶-抑制剂缺乏)。
2 剂量学和给药方法
Firazyr的推荐剂量是1次皮下注射30 mg由卫生保健人员给药,最好在腹部,为治疗遗传性血管水肿发作。
Firazyr不是为自身给药。
Firazyr是意向皮下使用。只为单次使用。
有喉部发作患者需在适宜医疗机构小心处理,直至医生认为可安全离开为止。
由于给药体积大(3 ml)应缓慢给药。
大多数情况中单次注射Firazyr足以治疗1次发作。在不足以缓解或症状复发情况下,在6小时后可第二次注射Firazyr。如果观察到第二次注射产生不足以缓解或症状复发,在6小时后可给予第三次注射Firazyr。在24小时阶段内不应给予3次以上Firazyr注射。
在临床试验中,每个月未曾给予超过8次以上的Firazyr注射。
儿童和青少年
在儿童中无经验。
老年患者
对老于65岁患者可得到资料有限。
老年患者曾显示全身暴露于艾替班特增加。不知道这与Firazyr的关联(见节5.2).
肝脏损伤
肝损伤患者中不需要剂量调整。
肾脏损伤
肾损伤患者中不需要剂量调整.
禁忌证
对活性物质或对任何辅料超敏性。


Firazyr 30 mg solution for injection in pre-filled syringe
1. Name of the medicinal product
Firazyr 30 mg solution for injection in pre-filled syringe
2. Qualitative and quantitative composition
Each pre-filled syringe of 3 ml contains icatibant acetate equivalent to 30 mg icatibant.
Each ml of the solution contains 10 mg of icatibant.
For the full list of excipients, see section 6.1.
3. Pharmaceutical form
Solution for injection.
The solution is a clear and colourless liquid.
4. Clinical particulars
4.1 Therapeutic indications
Firazyr is indicated for symptomatic treatment of acute attacks of hereditary angioedema (HAE) in adults (with C1-esterase-inhibitor deficiency).
4.2 Posology and method of administration
Firazyr is intended for use under the guidance of a healthcare professional.
Posology
The recommended dose is a single subcutaneous injection of Firazyr 30 mg.
In the majority of cases a single injection of Firazyr is sufficient to treat an attack. In case of insufficient relief or recurrence of symptoms, a second injection of Firazyr can be administered after 6 hours. If the second injection produces insufficient relief or a recurrence of symptoms is observed, a third injection of Firazyr can be administered after a further 6 hours. No more than 3 injections of Firazyr should be administered in a 24 hour period.
In the clinical trials, not more than 8 injections of Firazyr per month have been administered.
Special populations
Older people
Limited information is available on patients older than 65 years of age.
Older people have been shown to have increased systemic exposure to icatibant. The relevance of this to the safety of Firazyr is unknown (see section 5.2).
Hepatic impairment
No dose adjustment is required in patients with hepatic impairment.
Renal impairment
No dose adjustment is required in patients with renal impairment.
Paediatric population
The safety and efficacy of Firazyr in children aged 0-18 years has not been established.
No data are available.
Method of administration
Firazyr is intended for subcutaneous administration preferably in the abdominal area.
Firazyr may be self-administered or administered by a caregiver only after training in subcutaneous injection technique by a healthcare professional.
The decision on initiating self-administration of Firazyr should only be taken by a physician experienced in the diagnosis and treatment of hereditary angioedema (see section 4.4).
Each Firazyr syringe is intended for single use only.
Firazyr solution for injection should be injected slowly due to the volume to be administered (3 ml).
4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
4.4 Special warnings and precautions for use
Laryngeal attacks
Patients with laryngeal attacks should be managed in an appropriate medical institution after injection until the physician considers discharge to be safe.
Ischemic heart disease
Under ischemic conditions, a deterioration of cardiac function and a decrease in coronary blood flow could theoretically arise from antagonism of bradykinin receptor type 2. Caution should therefore be observed in the administration of Firazyr to patients with acute ischemic heart disease or unstable angina pectoris (see section 5.3).
Stroke
Although there is evidence to support a beneficial effect of B2 receptor blockade immediately following a stroke, there is a theoretical possibility that icatibant may attenuate the positive late phase neuroprotective effects of bradykinin. Accordingly, caution should be observed in the administration of icatibant to patients in the weeks following a stroke.
Self-administration
For patients who never received Firazyr previously, the first treatment should be given in a medical institution or under the guidance of a physician.
In case of insufficient relief or recurrence of symptoms after self-treatment, it is recommended that the patient should seek medical advice and that subsequent doses are given in a medical institution (see section 4.2).
Patients experiencing a laryngeal attack should always seek medical advice and be observed in a medical institution also after having taken the injection at home.
4.5 Interaction with other medicinal products and other forms of interaction
Pharmacokinetic drug interactions involving CYP450 are not expected (see section 5.2).
Co-administration of Firazyr with angiotensin-converting-enzyme (ACE) inhibitors has not been studied. ACE inhibitors are contraindicated in HAE patients due to possible enhancement of bradykinin levels.
4.6 Fertility, pregnancy and lactation
Pregnancy
For icatibant, no clinical data on exposed pregnancies are available. Animal studies showed effects on uterine implantation and parturition (see section 5.3), but the potential risk for humans is unknown.
Firazyr should be used during pregnancy only, if the potential benefit justifies the potential risk for the foetus, (e.g for treatment of potentially life threatening laryngeal attacks).
Breast-feeding
Icatibant is excreted in the milk of lactating rats at concentrations similar to those in maternal blood. No effects were detected in the post-natal development of rat pups.
It is unknown whether icatibant is excreted in human breast milk but it is recommended that breastfeeding women, who wish to take Firazyr, should not breastfeed for 12 hours after treatment.
Fertility
In both rats and dogs, repeated use of icatibant resulted in effects on reproductive organs. Icatibant had no effect on the fertility of male mice and rats (see section 5.3). In a study of 39 healthy adult men and women treated with 30 mg every 6 hours for 3 doses every 3 days for a total of 9 doses, there were no clinically significant changes from baseline in basal and GnRH-stimulated concentration of reproductive hormones in either females or males. There were no significant effects of icatibant on the concentration of luteal phase progesterone and luteal function, or on menstrual cycle length in females and there were no significant effects of icatibant on sperm count, motility and morphology in males. The dosing regimen used for this study is unlikely to be sustained in the clinical setting.
4.7 Effects on ability to drive and use machines
Firazyr has minor influence on the ability to drive and use machines. Fatigue, lethargy, tiredness, somnolence, and dizziness have been reported following the use of Firazyr. These symptoms may occur as a result of an attack of HAE. Patients should be advised not to drive and use machines if they feel tired or dizzy.
4.8 Undesirable effects
Summary of the safety profile
In clinical studies used for registration, a total of 999 HAE attacks have been treated with 30 mg Firazyr administered subcutaneously by a healthcare professional. Firazyr 30 mg SC has been administered by a healthcare professional to 129 healthy subjects and 236 patients with HAE.
Almost all subjects who were treated with subcutaneous icatibant in clinical trials developed reactions at the site of injection (characterised by skin irritation, swelling, pain, itchiness, erythema, burning sensation). These reactions were generally mild to moderate in severity, transient, and resolved without further intervention.
Tabulated list of adverse reactions
The frequency of adverse reactions listed in Table 1 is defined using the following convention:
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); very rare (<1/10,000).
Table 1: Adverse reactions reported with icatibant

System Organ Class

(incidence category)

Preferred Term

Nervous system disorders

 

(Common, ≥1/100 to <1/10)

Dizziness

Headache

Gastrointestinal disorders

 

(Common, ≥1/100 to <1/10)

Nausea

Skin and subcutaneous tissue disorders

 

(Common, ≥1/100 to <1/10)

Rash

Erythema

Pruritus

General disorders and administration site conditions

 

(Very Common, ≥1/10)

Injection site reactions*

(Common, ≥1/100 to <1/10)

Pyrexia

Investigations

 

(Common, ≥1/100 to <1/10)

Transaminase increased

* Injection site bruising, Injection site hematoma, Injection site burning, Injection site erythema, Injection site hypoesthesia, Injection site irritation, Injection site numbness, Injection site edema, Injection site pain, Injection site pressure sensation, Injection site pruritus, Injection site swelling, Injection site urticaria, and Injection site warmth.

Description of selected adverse reactions
Immunogenicity
Across repeated treatment in the controlled phase III trials, transient positivity to anti-icatibant antibodies was observed in rare cases. All patients maintained efficacy. One Firazyr-treated patient tested positive for anti-icatibant antibodies before and after treatment with Firazyr. This patient was followed for 5 months and further samples were negative for anti-icatibant antibodies. No hypersensitivity or anaphylactic reactions were reported with Firazyr.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation 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 via the United Kingdom Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard
4.9 Overdose
 No clinical information on overdose is available.
A dose of 3.2 mg/kg intravenously (approximately 8 times the therapeutic dose) caused transient erythema, itching or hypotension in healthy subjects. No therapeutic intervention was necessary.
5. Pharmacological properties
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Other haematological agents, drugs used to treat hereditary angioedema; ATC code: B06AC02.
Mechanism of action
HAE (an autosomal dominant disease) is caused by an absence or dysfunction of C1-esterase-inhibitor. HAE attacks are accompanied by an increased release of bradykinin, which is the key mediator in the development of the clinical symptoms.
HAE manifests as intermittent attacks of subcutaneous and/or sub mucosal oedema involving the upper respiratory tract, the skin and the gastrointestinal tract. An attack usually lasts between 2 to 5 days.
Icatibant is a selective competitive antagonist at the bradykinin type 2 (B2) receptor. It is a synthetic decapeptide with a structure similar to bradykinin, but with 5 non-proteinogenic amino acids. In HAE increased bradykinin concentrations are the key mediator in the development of the clinical symptoms.
Pharmacodynamic effects
In healthy young subjects, icatibant administered in doses of 0.8 mg/kg over 4 hours; 1.5 mg/kg/day or 0.15 mg/kg/day for 3 days, development of bradykinin-induced hypotension, vasodilatation and reflex tachycardia was prevented. Icatibant was shown to be a competitive antagonist when the bradykinin challenge dose was increased 4-fold.
Clinical efficacy and safety
Efficacy data were obtained from an initial open-label Phase II study and from three controlled Phase III studies.
Phase III clinical studies (FAST-1 and FAST-2) were randomized, double-blind, controlled trials and had identical designs except for the comparator (one with oral tranexamic acid as the comparator and one placebo controlled). A total of 130 patients were randomized to receive either a 30 mg dose of icatibant (63 patients) or comparator (either tranexamic acid, - 38 or placebo - 29 patients). Subsequent episodes of HAE were treated in an open label extension. Patients with symptoms of laryngeal angioedema received open label treatment with icatibant. The primary efficacy endpoint was the time to onset of symptom relief using a visual analogue scale (VAS). Table 2 shows the efficacy results for these studies.
FAST-3 was a randomized, placebo-controlled, parallel-group study of 98 adult patients with a median age of 36 years. Patients were randomized to receive either icatibant 30 mg or placebo by subcutaneous injection. A subset of patients in this study experienced acute HAE attacks while receiving androgens, antifibrinolytic agents or Cl inhibitors. The primary endpoint was time to onset of symptom relief assessed using a 3-item composite visual analog score (VAS-3) consisting of assessments of skin swelling, skin pain, and abdominal pain. Table 3 shows the efficacy results for FAST-3.
In these studies, patients on icatibant had a faster median time to onset of symptom relief (2.0, 2.5 and 2.0 hours, respectively) compared to tranexamic acid (12.0 hours) and placebo (4.6 and 19.8 hours). The treatment effect of icatibant was confirmed by secondary efficacy endpoints.
In an integrated analysis of these controlled Phase III studies, the time to onset of symptom relief and time to onset of primary symptom relief were similar regardless of age group, sex, race, weight or whether or not the patient used androgens or antifibrinolytic agents.
Response was also consistent across repeated attacks in the controlled Phase III trials. A total of 237 patients were treated with 1,386 doses of 30 mg icatibant for 1,278 attacks of acute HAE. In the first 15 Firazyr treated attacks (1,114 doses for 1,030 attacks), the median times to onset of symptom relief were similar across attacks (2.0 to 2.5 hours). 92.4% of these attacks of HAE were treated with a single dose of Firazyr.
Table 2. Efficacy results for FAST-1 and FAST-2

Controlled Clinical Study of FIRAZYR vs Tranexamic acid or Placebo: Efficacy Results

FAST-2

FAST-1

 

Icatibant

Tranexamic acid

 

Icatibant

Placebo

Number of subjects in ITT Population

36

38

Number of subjects in ITT Population

27

29

Baseline VAS(mm)

63.7

61.5

Baseline VAS(mm)

69.3

67.7

Change from baseline to 4 hours

-41.6

-14.6

Change from baseline to 4 hours

-44.8

-23.5

Difference between treatments (95% CI, p-value)

-27.8 (-39.4, -16.2) p < 0.001

Difference between treatments (95% CI, p-value)

-23.3 (-37.1, -9.4) p = 0.002

Change from baseline to 12 hours

-54.0

-30.3

Change from baseline to 12 hours

-54.2

-42.4

Difference between treatments (95% CI, p-value)

-24.1 (-33.6, -14.6) p < 0.001

Difference between treatments (95% CI, p-value)

-15.2 (-28.6, -1.7) p = 0.028

Median time to onset of symptom relief (hours)

 

 

Median time to onset of symptom relief (hours)

 

 

All episodes

(N = 74)

2.0

12.0

All episodes

(N = 56)

2.5

4.6

Response rate

(%, CI) at 4 hours after start of treatment

 

 

Response rate

(%, CI) at 4 hours after start of treatment

 

 

All episodes

(N = 74)

80.0

(63.1, 91.6)

30.6

(16.3, 48.1)

All episodes

(N = 56)

66.7

(46.0, 83.5)

46.4

(27.5, 66.1)

Median time to onset of symptom relief: all symptoms (hours):

 

Median time to onset of symptom relief: all symptoms (hours):

 

Abdominal pain

1.6

3.5

Abdominal pain

2.0

3.3

Skin swelling

2.6

18.1

Skin swelling

3.1

10.2

Skin pain

1.5

12.0

Skin pain

1.6

9.0

Median time to almost complete symptom relief (hours)

 

 

Median time to almost complete symptom relief (hours)

 

 

All episodes

(N = 74)

10.0

51.0

All episodes

(N = 56)

8.5

19.4

Median time to regression of symptoms, by patient (hours)

 

 

Median time to regression of symptoms, by patient (hours)

 

 

All episodes

(N = 74)

0.8

7.9

All episodes

(N = 56)

0.8

16.9

Median time to overall patient improvement, by physician (hours)

 

 

Median time to overall patient improvement, by physician (hours)

 

 

All episodes

(N = 74)

1.5

6.9

All episodes

(N = 56)

1.0

5.7

Table 3. Efficacy results for FAST-3

Controlled Clinical Study of FIRAZYR vs Tranexamic acid or Placebo: Efficacy Results

FAST-2

FAST-1

 

Icatibant

Tranexamic acid

 

Icatibant

Placebo

Number of subjects in ITT Population

36

38

Number of subjects in ITT Population

27

29

Baseline VAS(mm)

63.7

61.5

Baseline VAS(mm)

69.3

67.7

Change from baseline to 4 hours

-41.6

-14.6

Change from baseline to 4 hours

-44.8

-23.5

Difference between treatments (95% CI, p-value)

-27.8 (-39.4, -16.2) p < 0.001

Difference between treatments (95% CI, p-value)

-23.3 (-37.1, -9.4) p = 0.002

Change from baseline to 12 hours

-54.0

-30.3

Change from baseline to 12 hours

-54.2

-42.4

Difference between treatments (95% CI, p-value)

-24.1 (-33.6, -14.6) p < 0.001

Difference between treatments (95% CI, p-value)

-15.2 (-28.6, -1.7) p = 0.028

Median time to onset of symptom relief (hours)

 

 

Median time to onset of symptom relief (hours)

 

 

All episodes

(N = 74)

2.0

12.0

All episodes

(N = 56)

2.5

4.6

Response rate

(%, CI) at 4 hours after start of treatment

 

 

Response rate

(%, CI) at 4 hours after start of treatment

 

 

All episodes

(N = 74)

80.0

(63.1, 91.6)

30.6

(16.3, 48.1)

All episodes

(N = 56)

66.7

(46.0, 83.5)

46.4

(27.5, 66.1)

Median time to onset of symptom relief: all symptoms (hours):

 

Median time to onset of symptom relief: all symptoms (hours):

 

Abdominal pain

1.6

3.5

Abdominal pain

2.0

3.3

Skin swelling

2.6

18.1

Skin swelling

3.1

10.2

Skin pain

1.5

12.0

Skin pain

1.6

9.0

Median time to almost complete symptom relief (hours)

 

 

Median time to almost complete symptom relief (hours)

 

 

All episodes

(N = 74)

10.0

51.0

All episodes

(N = 56)

8.5

19.4

Median time to regression of symptoms, by patient (hours)

 

 

Median time to regression of symptoms, by patient (hours)

 

 

All episodes

(N = 74)

0.8

7.9

All episodes

(N = 56)

0.8

16.9

Median time to overall patient improvement, by physician (hours)

 

 

Median time to overall patient improvement, by physician (hours)

 

 

All episodes

(N = 74)

1.5

6.9

All episodes

(N = 56)

1.0

5.7

Efficacy Results: FAST-3; Controlled Phase -- ITT population

Endpoint

Statistic

Firazyr

Placebo

p-value

 

 

(n = 43)

(n=45)

 

Primary Endpoint

 

 

 

 

Time to Onset of Symptom Relief-- Composite VAS (hrs)

Median

2.0

19.8

<0.001

Other Endpoints

 

 

 

 

Time to Onset of Primary Symptom Relief (hrs)

Median

1.5

18.5

< 0.001

Change in Composite VAS Score at 2 hrs after treatment

Mean

-19.74

-7.49

< 0.001

Change in Composite Subject-Assessed Symptom Score at 2 hours

Mean

-0.53

-0.22

< 0.001

Change in Composite Investigator-Assessed Symptom Score at 2 hours

Mean

-0.44

-0.19

< 0.001

Time to Almost Complete Symptom Relief (hrs)

Median

8.0

36.0

0.012

Time to Subject-Assessed Initial Symptom Improvement (hrs)

Median

0.8

3.5

< 0.001

Time to Investigator-Assessed Initial Visual Symptom Improvement (hrs)

Median

0.8

3.4

< 0.001

A total of 66 patients with attacks of HAE affecting the larynx were treated in these controlled Phase III clinical trials. The results were similar to patients with non-laryngeal attacks of HAE with respect to time to onset of symptom relief.
5.2 Pharmacokinetic properties
The pharmacokinetics of icatibant has been extensively characterized by studies using both intravenous and subcutaneous administration to healthy volunteers and patients. The pharmacokinetic profile of icatibant in patients with HAE is similar to that in healthy volunteers.
Absorption
Following subcutaneous administration, the absolute bioavailability of icatibant is 97%. The time to maximum concentration is approximately 30 minutes.
Distribution
Icatibant volume of distribution (Vss) is about 20-25 L. Plasma protein binding is 44%.
Elimination
Icatibant is mainly eliminated by metabolism with less than 10% of the dose eliminated in the urine as unchanged drug. Clearance is about 15-20 l/h and independent of dose. The terminal plasma half-life is about 1-2 hours.
Biotransformation
Icatibant is extensively metabolized by proteolytic enzymes to inactive metabolites that are primarily excreted in the urine.
In vitro studies have confirmed that icatibant is not degraded by oxidative metabolic pathways and is not an inhibitor of major cytochrome P450 (CYP) isoenzymes (CYP 1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1, and 3A4) and is not an inducer of CYP 1A2 and 3A4.
Special populations
Data suggest an age-related decline in clearance resulting in about 50-60% higher exposure in older people (75-80 years) compared to patients aged 40 years. Data suggests that gender and weight do not have a significant influence on icatibant pharmacokinetics.
Limited data suggest that icatibant exposure is not influenced by hepatic or renal impairment. The influence of race on icatibant pharmacokinetics has not been evaluated. There are no pharmacokinetic data in children.
5.3 Preclinical safety data
Repeated-dose studies of up to 6-months duration in rats and 9-months duration in dogs have been conducted. In both rats and dogs, there was a dose-related reduction in circulating sex hormone levels and the repeated use of icatibant reversibly delayed sexual maturation.
Maximum daily exposures defined by area under the curve (AUC) at the No Observed Adverse Effect Levels (NOAEL) in the 9-month study in dog were 2.3 times the AUC in humans after a subcutaneous dose of 30 mg. A NOAEL was not measurable in the rat study, however, all of the findings from that study showed either completely or partially reversible effects in treated rats. Adrenal gland hypertrophy was observed at all doses tested in rats. Adrenal gland hypertrophy was seen to reverse after cessation of icatibant treatment. The clinical relevance of the adrenal gland findings is unknown.
Icatibant had no effect on the fertility of male mice (top dose 80.8 mg/kg/day) and rats (top dose 10 mg/kg/day).
In a 2 year study to evaluate the carcinogenic potential of icatibant in rats, daily doses giving exposure levels up to approximately 2-fold that achieved after a therapeutic dose in humans had no effect on the incidence or morphology of tumours. Results do not indicate a carcinogenic potential for icatibant.
In a standard battery of in vitro and in vivo tests icatibant was not genotoxic.
Icatibant was not teratogenic when administered by s.c. injection during early embryonic and fetal development in rat (top dose 25 mg/kg/day) and rabbit (top dose 10 mg/kg/day). Icatibant is a potent antagonist of bradykinin and therefore, at high dose levels, treatment can have effects on the uterine implantation process and subsequent uterine stability in early pregnancy. These uterine effects also manifest in late stage pregnancy where icatibant exhibits a tocolytic effect resulting in delayed parturition in the rat, with increased fetal distress and perinatal death at high doses (10 mg/kg/day).
In a juvenile toxicity study in which sexually immature rats were treated daily with 3 mg/kg for 7 weeks, atrophy of testes and epididymides were observed. Similar effects of icatibant on reproductive tissue were seen in sexually mature rats and dogs. These tissue findings were consistent with reported effects on gonadotrophins and during the subsequent treatment-free period appear to be reversible.
Icatibant did not elicit any cardiac conduction change in vitro (hERG channel) or in vivo in normal dogs or in various dog models (ventricular pacing, physical exertion and coronary ligation) where no associated hemodynamic changes were observed. Icatibant has been shown to aggravate induced cardiac ischemia in several non-clinical models, although a detrimental effect has not consistently been shown in acute ischemia.
6. Pharmaceutical particulars
6.1 List of excipients
 Sodium chloride
Acetic acid, glacial (for pH adjustment)
Sodium hydroxide (for pH adjustment)
Water for injections
6.2 Incompatibilities
 Not applicable.
6.3 Shelf life
 2 years.
6.4 Special precautions for storage
 Do not store above 25○C.
Do not freeze.
6.5 Nature and contents of container
 3 ml of solution in a 3 ml pre-filled syringe (type I glass) with plunger stopper (bromobutyl coated with fluorocarbon polymer). A hypodermic needle (25 G; 16 mm) is included in the pack.
Pack size of one pre-filled syringe with one needle or a multipack containing three pre-filled syringes with three needles.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal and other handling
 The solution should be clear and colourless and free from visible particles. For single use only.
Any unused product or waste material should be disposed of in accordance with local requirements.
7. Marketing authorisation holder
 Shire Orphan Therapies GmbH
Friedrichstrasse 149
D-10117 Berlin
Germany
8. Marketing authorisation number(s)
 EU/1/08/461/001
EU/1/08/461/002
9. Date of first authorisation/renewal of the authorisation
Date of first authorisation: 11 July 2008
Date of latest renewal: 13 March 2013
10. Date of revision of the text
02/2014
Detailed information on this product is available on the website of the European Medicines Agency http://www.ema.europa.eu.
--------------------------------------------------
产地国家: 德国
原产地英文商品名:
Firazyr 30mg 1 Injectable Solution
原产地英文药品名:
Icatibant
中文参考商品译名:
FIRAZYR 30克/支 1支
中文参考药品译名:
艾替班特
生产厂家中文参考译名:
希尔医药
生产厂家英文名:
Shire Deutschland GmbH.
--------------------------------------------------
产地国家: 意大利
原产地英文商品名:
Firazyr 30mg 1 Injectable Solution
原产地英文药品名:
Icatibant
中文参考商品译名:
FIRAZYR 30克/支 1支
中文参考药品译名:
艾替班特
生产厂家中文参考译名:
希尔医药
生产厂家英文名:
Shire Deutschland GmbH.

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