2014年9月10日,新型磷酸盐结合剂Velphoro(sucroferric oxyhydroxide)已获FDA批准,用于治疗慢性肾脏病(CKD)透析患者的高磷血症(hyperphosphatemia),以控制其血清磷水平。
*Diarrhoea Diarrhoea occurred in 11.6% of patients in clinical trials. In the 55 weeks long term studies, the majority of these treatment-related diarrhoea adverse events were transient, occurred early during treatment initiation and led to treatment discontinuation in 3.1% of the patients. 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 United Kingdom Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard 4.9 Overdose Any instances of overdose of Velphoro should be treated by standard clinical practice. 5. Pharmacological properties 5.1 Pharmacodynamic properties Pharmacotherapeutic group: Drugs for treatment of hyperkalaemia and hyperphosphataemia; ATC code: V03AE05 Mechanism of action Velphoro contains a mixture of polynuclear iron(III)-oxyhydroxide (pn-FeOOH), sucrose and starches. Phosphate binding takes place by ligand exchange between hydroxyl groups and/or water and the phosphate ions throughout the physiological pH range of the gastrointestinal tract. Serum phosphorus levels are reduced as a consequence of the reduced dietary phosphate absorption. Clinical efficacy One phase 3 clinical study has been performed in patients with CKD on dialysis to investigate the efficacy and safety of Velphoro in this population. This study was an open-label, randomised, active-controlled (sevelamer carbonate), parallel group study for up to 55 weeks. Adult patients with hyperphosphataemia (serum phosphorus levels ≥1.94 mmol/L) were treated with Velphoro at a starting dose of 1,000 mg iron/day followed by an 8-week dose titration period. Non-inferiority to sevelamer carbonate was determined at week 12. Subjects were continued on their study medication from week 12 to week 55. From week 12 to 24, dose titrations were allowed for both tolerability and efficacy reasons. Treatment of patient sub-populations from week 24 to week 27 with maintenance dose of Velphoro (1,000 to 3,000 mg iron/day) or low dose (250 mg iron/day) of Velphoro demonstrated superiority of the maintenance dose. In Study-05A, 1,055 patients on hemodialysis (N=968) or peritoneal dialysis (N=87) with serum phosphorus ≥1.94 mmol/L following a 2-4 week phosphate binder washout period, were randomized and treated with either Velphoro, at a starting dose of 1,000 mg/day (N=707), or active-control (sevelamer carbonate, N=348) for 24 weeks. At the end of week 24, 93 patients on hemodialysis whose serum phosphorus levels were controlled (<1.78 mmol/L) with Velphoro in the first part of the study, were re-randomized to continue treatment with either their week 24 maintenance dose (N=44 or a non-effective low dose control 250 mg/day, N=49) of Velphoro for a further 3 weeks. Following completion of Study-05A, 658 patients (597 on hemodialysis and 61 on peritoneal dialysis) were treated in the 28-week extension study (Study-05B) with either Velphoro (N=391) or sevelamer carbonate (N=267) according to their original randomization. Mean serum phosphorus levels were 2.5 mmol/L at baseline and 1.8 mmol/L at week 12 for Velphoro (reduction by 0.7 mmol/L). Corresponding levels for sevelamer carbonate at baseline were 2.4 mmol/L and 1.7 mmol/L at week 12 (reduction by 0.7 mmol/L), respectively. The serum phosphorus reduction was maintained over 55 weeks. Serum phosphorus levels and calcium-phosphorus product levels were reduced as a consequence of the reduced dietary phosphate absorption. The response rates, defined as the proportion of subjects achieving serum phosphorus levels within the KDOQI (Kidney Disease Outcomes Quality Initiative) recommended range were 45.3% and 59.1% at week 12 and 51.9% and 55.2% at week 52, for Velphoro and sevelamer carbonate, respectively. The mean daily dose of Velphoro over 55 weeks of treatment was 1,650 mg iron and the mean daily dose of sevelamer carbonate was 6,960 mg. Paediatric population The European Medicines Agency has deferred the obligation to submit the results of studies with Velphoro in one or more subsets of the paediatric population in the treatment of hyperphosphataemia (see section 4.2 for information on paediatric use). 5.2 Pharmacokinetic properties Velphoro works by binding phosphate in the gastrointestinal tract and thus the serum concentration is not relevant for its efficacy. Due to the insolubility and degradation characteristics of Velphoro, no classical pharmacokinetic studies can be carried out, e.g., determination of the distribution volume, area under the curve, mean residence time, etc. In 2 Phase 1 studies, it was concluded that the potential for iron overload is minimal and no dose-dependent effects were observed in healthy volunteers. Absorption The active moiety of Velphoro, pn-FeOOH, is practically insoluble and therefore not absorbed. Its degradation product, mononuclear iron species, can however be released from the surface of pn-FeOOH and be absorbed. The absolute absorption studies in humans were not performed. Non-clinical studies in several species (rats and dogs) showed that systemic absorption was very low (≤1% of the administered dose). The iron uptake from radiolabelled Velphoro drug substance, 2,000 mg in 1 day was investigated in 16 CKD patients (8 pre-dialysis and 8 haemodialysis patients) and 8 healthy volunteers with low iron stores (serum ferritin <100 mcg/L). In healthy subjects, the median uptake of radiolabelled iron in the blood was estimated to be 0.43% (range 0.16 – 1.25%) on Day 21, in pre-dialysis patients 0.06% (range 0.008 – 0.44%) and in haemodialysis patients 0.02% (range 0 – 0.04%). Blood levels of radiolabelled iron were very low and confined to the erythrocytes. Distribution The distribution studies in humans were not performed. Non-clinical studies in several species (rats and dogs) showed that pn-FeOOH is distributed from the plasma to the liver, spleen and bone marrow, and utilized by incorporation into red blood cells. In patients, absorbed iron is expected to be also distributed to the target organs, i.e. liver, spleen and bone marrow, and utilized by incorporation into red blood cells. Biotransformation The active moiety of Velphoro, pn-FeOOH, is not metabolised. However, the degradation product of Velphoro, mononuclear iron species, can be released from the surface of polynuclear iron(III)-oxyhydroxide and be absorbed. Clinical studies have demonstrated that the systemic absorption of iron from Velphoro is low. In vitro data suggest that the sucrose and starch components of the drug substance can be digested to glucose and fructose, and maltose and glucose, respectively. These compounds can be absorbed in the blood. Elimination In animal studies with rats and dogs administered 59Fe-Velphoro drug substance orally, radiolabelled iron was recovered in the faeces but not the urine. 5.3 Preclinical safety data Nonclinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity and genotoxicity. Effects seen in the rabbit embryo-foetal development toxicity study (skeletal variations and incomplete ossificaton) are related to exaggerated pharmacology, and likely not relevant for patients. Other reproduction toxicity studies showed no adverse effects. Carcinogenicity studies were performed in mice and rats. There was no clear evidence of a carcinogenic effect in mice. Mucosal hyperplasia, with diverticulum/cyst formation was observed in the colon and caecum of mice after 2 years treatment, but this was considered a species-specific effect with no diverticula/cysts seen in long term studies in rats or dogs. In rats, there was a slightly increased incidence of benign C-cell adenoma in the thyroid of male rats given the highest dose of sucroferric oxyhydroxide. This is thought to be most likely an adaptive response to the pharmacological effect of the drug, and not clinically relevant. 6. Pharmaceutical particulars 6.1 List of excipients Woodberry flavour Neohesperidin-dihydrochalcone Magnesium stearate Colloidal anhydrous silica 6.2 Incompatibilities Not applicable. 6.3 Shelf life 30months Shelf life after first opening of the bottle: 45 days 6.4 Special precautions for storage Store in the original package in order to protect from moisture. 6.5 Nature and contents of container High density polyethylene (HDPE) bottle with child-resistant polypropylene closure and foil induction seal, containing a molecular sieve desiccant and cotton. Pack sizes of 30 or 90 chewable tablets. Child-resistant aluminium/aluminium blister, each blister containing 6 chewable tablets. Pack sizes of 30 or 90 chewable tablets (multipack containing 3 individual packs of 30 chewable tablets each). Not all pack sizes may be marketed. 6.6 Special precautions for disposal and other handling Any unused medicinal product or waste material should be disposed of in accordance with local requirements. 7. Marketing authorisation holder Vifor Fresenius Medical Care Renal Pharma France 7-13 Boulevard Paul-Emile Victor 92521 Neuilly-sur-Seine France 8. Marketing authorisation number(s) EU/1/14/943/001 EU/1/14/943/002 EU/1/14/943/003 EU/1/14/943/004 9. Date of first authorisation/renewal of the authorisation Date of first authorisation: 26 August 2014. 10. Date of revision of the text Detailed information on this medicinal product is available on the website of the European Medicines Agency http://www.ema.europa.eu. 欧盟批准高磷血症药物Velphoro,将降低患者用药负担 欧盟批准了ViforFresenius Medical Care Renal制药公司的高磷血症药物Velphoro。Velphoro(Sucroferric Oxyhydroxide)之前也叫作PA21,该药物在欧盟的获批基于其III期临床试验数据,数据显示这款药物能控制血液中磷的蓄积。与目前慢性肾病透析患者的标准治疗药物即赛诺菲旗下的Renvela(sevelamercarbonate),其用药负担更低。 透析患者平均每天要服用19片药物,磷酸盐结合剂能占这些药物中大约50%。Velphoro所推荐的起始用药剂量是每天三片(即每餐一片),所以提高了很多这款药物的依从性。 Velphoro由瑞士Vifor制药公司开发,其所有权利在2011年被转移给了Vifor Fresenius Medical Care Renal制药。于2013年11月,这款药物在美国获批并由Fresenius Medical Care North America公司于2014年3月份在美国投放市场。 ---------------------------------------------- 产地国家: 美国 原产地英文商品名: Velphoro 500mg chewable tablets 90 tabs 原产地英文药品名: SUCROFERRIC OXYHYDROXIDE 中文参考商品译名: Velphoro咀嚼片 500毫克/片 90片/盒 中文参考药品译名: 羥基氧化蔗糖鐵 生产厂家英文名: VIFOR FRESENIUS ---------------------------------------------- 产地国家: 英国 原产地英文商品名: Velphoro 500mg chewable tablets 90tabs 原产地英文药品名: SUCROFERRIC OXYHYDROXIDE 中文参考商品译名: Velphoro咀嚼片 500毫克/片 90片/盒 中文参考药品译名: 羥基氧化蔗糖鐵 生产厂家英文名: VIFOR FRESENIUS ---------------------------------------------- 产地国家: 英国 原产地英文商品名: Velphoro 500mg chewable tablets 30tabs 原产地英文药品名: SUCROFERRIC OXYHYDROXIDE 中文参考商品译名: Velphoro咀嚼片 500毫克/片 30片/盒 中文参考药品译名: 羥基氧化蔗糖鐵 生产厂家英文名: VIFOR FRESENIUS |