英文药名：Fasenra(Benralizumab for Subcutaneous Injection)

中文药名：贝那利珠单抗预充式注射器

生产厂家：阿斯利康
药品介绍
近日，阿斯利康新型抗炎药白介素 -5（IL-5）抑制剂Fasenra已获欧美批准用于治疗严重哮喘，该药物去年11月份已在美国获得批准。Fasenra（benralizumab）是继葛兰素史克美泊利单抗（mepolizumab）及梯瓦Cinqaero（reslizumab）之后第三个获批上市的 IL-5靶向药物，据阿斯利康称，Fasenra是首个给药方案为8周的呼吸类生物药物。
这款新药作为一种辅助维持疗法已被欧洲药品管理局批准用于严重嗜酸性哮喘，适用于用高剂量吸入性糖皮质激素加长效β受体激动剂药物不能控制症状的患者。
适应症
FASENRA适用于12岁及以上严重哮喘患者的附加维持治疗，并具有嗜酸性表型[见临床研究]。
使用限制
•FASENRA不适用于治疗其他嗜酸性粒细胞疾病。
•FASENRA不适用于缓解急性支气管痉挛或哮喘状态。
剂量和给药
推荐剂量
FASENRA仅用于皮下使用。
FASENRA的推荐剂量为30mg，前3次给药每4周给药一次，然后每8周给予一次皮下注射到上臂，大腿或腹部。
准备和管理
FASENRA应由医疗保健专业人员管理。根据临床实践，建议在给予生物制剂后监测患者[见警告和注意事项]。在施用之前，通过在室温下放置纸箱约30分钟来温暖FASENRA。在24小时内使用FASENRA或丢弃到锐器容器中。
带针安全警卫的预充式注射器说明
请勿触碰针头护罩启动夹，以防止针头安全护罩过早启动。
1.抓住注射器主体，而不是柱塞，从托盘中取出预充式注射器。检查注射器上的失效日期。在给药之前目视检查FASENRA是否有颗粒物质和变色。 FASENRA对乳白色透明，无色至微黄色，可能含有少量半透明或白色至灰白色颗粒。如果液体浑浊，变色或含有大颗粒或异物，请勿使用FASENRA。注射器可能含有小气泡;这个是正常的。给药前不要排出气泡。
2.在准备好注射之前不要取下针头盖。握住注射器主体，并直接拉下来取下针头盖。取下针盖时，请勿握住柱塞或柱塞头，否则柱塞可能会移动。如果预充式注射器受损或受污染（例如，没有使用针头盖而落下），请丢弃并使用新的预充式注射器。
3.轻轻捏紧皮肤，并将针头插入推荐的注射部位（即上臂，大腿或腹部）。
4.推入柱塞直至柱塞头完全位于针头护罩启动夹之间，从而注入所有药物。这是启动护针器所必需的。
5.注射后，保持柱塞头上的压力，并将针头从皮肤上取下。释放柱塞头上的压力，使针护套盖住针。不要重新盖上预充式注射器。
6.将用过的注射器丢弃到锐器容器中。
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注：以下产品不同的国家包装不同价格，采购者以咨询为准
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产地国家：德国
原产地英文商品名:
Fasenra 30mg Injektionslösung i.e. Fertigspritze  1Stk
原产地英文药品名:
benralizumab
中文参考商品译名:
Fasenra预充式注射器 30毫克/毫升/支
中文参考药品译名:
贝那利珠单抗
生产厂家中文参考译名:
阿斯利康
生产厂家英文名:
AstraZeneca GmbH
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产地国家：瑞典
原产地英文商品名:
Fasenra 30mg solution injection pre
原产地英文药品名:
benralizumab
中文参考商品译名:
Fasenra预充式注射器 30毫克/毫升/支
中文参考药品译名:
贝那利珠单抗
生产厂家中文参考译名:
阿斯利康
生产厂家英文名:
AstraZeneca UK Limited

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Fasenra 30 mg solution for injection in pre filled syringe
AstraZeneca UK Limited
contact details
Active ingredient
benralizumab
Legal Category
POM: Prescription only medicine
1. Name of the medicinal product
Fasenra 30 mg solution for injection in pre-filled syringe
2. Qualitative and quantitative composition
Each pre-filled syringe contains 30 mg benralizumab* in 1 ml.
Benralizumab is a humanised monoclonal antibody produced in Chinese hamster ovary (CHO) cells by recombinant DNA technology.
For the full list of excipients, see section 6.1.
3. Pharmaceutical form
Solution for injection. (injection)
Clear to opalescent, colourless to yellow solution and may contain translucent or white to off-white particles.
4. Clinical particulars
4.1 Therapeutic indications
Fasenra is indicated as an add-on maintenance treatment in adult patients with severe eosinophilic asthma inadequately controlled despite high-dose inhaled corticosteroids plus long-acting β-agonists (see section 5.1).
4.2 Posology and method of administration
Fasenra should be prescribed by physicians experienced in the diagnosis and treatment of severe asthma.
Posology
The recommended dose of benralizumab is 30 mg by subcutaneous injection every 4 weeks for the first 3 doses, and then every 8 weeks thereafter. If an injection is missed on the planned date, dosing should resume as soon as possible on the indicated regimen; a double dose must not be administered.
Fasenra is intended for long-term treatment. A decision to continue the therapy should be made at least annually based on disease severity, level of exacerbation control and blood eosinophil counts.
Elderly
No dose adjustment is required for elderly patients (see section 5.2).
Renal and hepatic impairment
No dose adjustment is required for patients with renal or hepatic impairment (see section 5.2).
Paediatric population
The safety and efficacy of Fasenra in children aged 5 to 18 years have not been established.
No data are available for children aged 5 to 11 years old. Currently available data in children 12 to less than 18 years old are described in sections 4.8, 5.1 and 5.2 but no recommendation on a posology can be made.
Method of administration
Fasenra is administered as a subcutaneous injection by a healthcare professional.
It should be injected into the upper arm, thighs, or the abdomen. It should not be injected into areas where the skin is tender, bruised, erythematous, or hardened (see section 6.6).
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
Fasenra should not be used to treat acute asthma exacerbations.
Patients should be instructed to seek medical advice if their asthma remains uncontrolled or worsens after initiation of treatment.
Abrupt discontinuation of corticosteroids after initiation of Fasenra therapy is not recommended. Reduction in corticosteroid doses, if appropriate, should be gradual and performed under the supervision of a physician.
Hypersensitivity reactions
Hypersensitivity reactions (e.g. urticaria, papular urticaria, rash) have occurred following administration of Fasenra. These reactions generally occur within hours of administration, but in some instances have a delayed onset (i.e. days).
In the event of a hypersensitivity reaction, Fasenra should be discontinued.
Parasitic (Helminth) Infection
Eosinophils may be involved in the immunological response to some helminth infections. Patients with known helminth infections were excluded from participation in clinical trials. It is unknown if Fasenra may influence a patient's response against helminth infections.
Patients with pre-existing helminth infections should be treated before initiating therapy with Fasenra. If patients become infected, while receiving treatment with Fasenra and do not respond to anti-helminth treatment, treatment with Fasenra should be discontinued until infection resolves.
4.5 Interaction with other medicinal products and other forms of interaction
No formal drug interaction studies have been conducted. An effect of benralizumab on the pharmacokinetics of co-administered medicinal products is not expected (see section 5.2).
Cytochrome P450 enzymes, efflux pumps and protein-binding mechanisms are not involved in the clearance of benralizumab. There is no evidence of IL-5Rα expression on hepatocytes. Eosinophil depletion does not produce chronic systemic alterations of proinflammatory cytokines.
4.6 Fertility, pregnancy and lactation
Pregnancy
There is a limited amount of data (less than 300 pregnancy outcomes) from the use of benralizumab in pregnant women.
Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity (see section 5.3).
Monoclonal antibodies, such as benralizumab, are transported across the placenta linearly as pregnancy progresses; therefore, potential exposure to a fetus is likely to be greater during the second and third trimester of pregnancy.
It is preferable to avoid the use of Fasenra during pregnancy. Its administration to pregnant women should only be considered if the expected benefit to the mother is greater than any possible risk to the fetus.
Breast-feeding
It is unknown whether benralizumab or its metabolites are excreted in human or animal milk. Risk to the breast-fed child cannot be excluded.
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from using Fasenra taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Fertility
There are no fertility data in humans. Animal studies showed no adverse effects of benralizumab treatment on fertility (see section 5.3).
4.7 Effects on ability to drive and use machines
Fasenra has no or negligible influence on the ability to drive and use machines.
4.8 Undesirable effects
Summary of the safety profile
The most commonly reported adverse reactions during treatment are headache (8%) and pharyngitis (3%).
Tabulated list of adverse reactions
A total of 2,514 patients, out of whom 1,663 patients had severe uncontrolled eosinophilic asthma, received benralizumab during clinical studies of 48 to 56 weeks duration.
The frequency of adverse reactions 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); and not known (cannot be estimated from available data). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
Table 1. Tabulated list of adverse reactions

System organ class	Adverse reaction	Frequency
Infections & infestations	Pharyngitis*	Common
Immune system disorders	Hypersensitivity reactions**	Common
Nervous system disorders	Headache	Common
General disorders and administration site conditions	Pyrexia Injection site reaction	Common

Pharyngitis was defined by the following grouped preferred terms: 'Pharyngitis', 'Pharyngitis bacterial', 'Viral pharyngitis', 'Pharyngitis streptococcal'.
Hypersensitivity reactions were defined by the following grouped preferred terms: 'Urticaria', 'Papular urticaria', and 'Rash'. For examples of the associated manifestations reported and a description of the time to onset, see section 4.4
Description of selected adverse reaction
Injection site reactions
In placebo-controlled studies, injection site reactions (e.g. pain, erythema, pruritus, papule) occurred at a rate of 2.2% in patients treated with the recommended benralizumab dose compared with 1.9% in patients treated with placebo.
Paediatric population
There are limited data in paediatric patients (see section 5.1). The frequency, type and severity of adverse reactions in the adolescent population were observed to be similar to those seen in adults.
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 or search for MHRA Yellow Card in the Google Play or Apple App Store
Ireland
HPRA Pharmacovigilance
Earlsfort Terrace
IRL - Dublin 2
Tel: +353 1 6764971
Fax: +353 1 6762517
Website: www.hpra.ie
e-mail: medsafety@hpra.ie
Malta
ADR Reporting
Website: www.medicinesauthority.gov.mt/adrportal
4.9 Overdose
Doses of up to 200 mg were administered subcutaneously in clinical trials to patients with eosinophilic asthma without evidence of dose-related toxicities.
There is no specific treatment for an overdose with benralizumab. If overdose occurs, the patient should be treated supportively with appropriate monitoring as necessary.
5. Pharmacological properties
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Drugs for obstructive airway diseases, other systemic drugs for obstructive airway diseases, ATC code: R03DX10
Mechanism of action
Benralizumab is an anti-eosinophil, humanised afucosylated, monoclonal antibody (IgG1, kappa). It binds to the alpha subunit of the human interleukin-5 receptor (IL-5Rα) with high affinity and specificity. The IL-5 receptor is specifically expressed on the surface of eosinophils and basophils. The absence of fucose in the Fc domain of benralizumab results in high affinity for FcɣRIII receptors on immune effectors cells such as natural killer (NK) cells. This leads to apoptosis of eosinophils and basophils through enhanced antibody-dependent cell-mediated cytotoxicity (ADCC), which reduces eosinophilic inflammation.
Pharmacodynamic effects
Effect on blood eosinophils
Treatment with benralizumab results in near complete depletion of blood eosinophils within 24 hours following the first dose which is maintained throughout the treatment period. The depletion of blood eosinophils is accompanied by a reduction in serum eosinophil granule proteins eosinophil derived neurotoxin (EDN) and eosinophil cationic protein (ECP) and a reduction in blood basophils.
Effect on eosinophils in the airway mucosa
The effect of benralizumab on eosinophils in the airway mucosa in asthmatic patients with elevated sputum eosinophil counts (at least 2.5%) was evaluated in a 12-week, phase 1, randomised, double-blind, placebo-controlled clinical study with benralizumab 100 or 200 mg SC. In this study there was a median reduction from baseline in airway mucosa eosinophils of 96% in the benralizumab treated group compared to a 47% reduction in the placebo group (p=0.039).
Clinical efficacy
The efficacy of Fasenra was evaluated in 3 randomised, double-blind, parallel-group, placebo-controlled clinical trials between 28 to 56 weeks duration, in patients aged 12 to 75 years.
In these studies, Fasenra was administered at a dose of 30 mg once every 4 weeks for the first 3 doses, and then every 4 or 8 weeks thereafter as add-on to background treatment and was evaluated in comparison with placebo.
The two exacerbation trials, SIROCCO (Trial 1) and CALIMA (Trial 2), enrolled a total of 2,510 patients with severe uncontrolled asthma, 64% females, with a mean age of 49 years. Patients had a history of 2 or more asthma exacerbations requiring oral or systemic corticosteroid treatment (mean of 3) in the past 12 months, ACQ-6 score of 1.5 or more at screening, and reduced lung function at baseline (mean predicted pre-bronchodilator forced expiratory volume in 1 second [FEV1] of 57.5%), despite regular treatment with high-dose inhaled corticosteroid (ICS) (Trial 1) or with medium or high-dose ICS (Trial 2) and a long-acting β-agonist (LABA); at least one additional controller was administered to 51% and 41% of these patients, respectively.
For the oral corticosteroid (OCS) reduction trial ZONDA (Trial 3), a total of 220 asthma patients (61% female; mean age of 51 years) were enrolled; they were treated with daily OCS (8 to 40 mg per day; median of 10 mg) in addition to regular use of high-dose ICS and LABA with at least one additional controller to maintain asthma control in 53% of the cases. The trial included an 8-week run-in period during which the OCS was titrated to the minimum effective dose without losing asthma control. Patients had blood eosinophil counts ≥150 cells/μL and a history of at least one exacerbation in the past 12 months.
While 2 dosing regimens were studied in Trials 1, 2, and 3, the recommended dosing regimen is Fasenra administered every 4 weeks for the first 3 doses, then every 8 weeks thereafter (see section 4.2) as no additional benefit was observed by more frequent dosing. The results summarised below are those for the recommended dosing regimen.
Exacerbation trials
The primary endpoint was the annual rate of clinically significant asthma exacerbations in patients with baseline blood eosinophil counts ≥300 cells/μL who were taking high-dose ICS and LABA. Clinically significant asthma exacerbation was defined as worsening of asthma requiring use of oral/systemic corticosteroids for at least 3 days, and/or emergency department visits requiring use of oral/systemic corticosteroids and/or hospitalisation. For patients on maintenance oral corticosteroids, this was defined as a temporary increase in stable oral/systemic corticosteroids for at least 3 days or a single depo-injectable dose of corticosteroids.
In both trials, patients receiving Fasenra experienced significant reductions in annual exacerbation rates compared to placebo in patients with blood eosinophils ≥300 cells/μL. In addition, change from baseline in mean FEV1 showed benefit as early as 4 weeks, which was maintained through to end of treatment (Table 2).
Reductions in exacerbation rates were observed irrespective of baseline eosinophil count; however, increasing baseline eosinophil counts was identified as a potential predictor of improved treatment response particularly for FEV1.
Table 2. Results of annual exacerbation rate and lung function at end of treatment of Trial 1 and 2 by eosinophil count.

Trial 1		Trial 2
Fasenra	Placebo	Fasenra	Placebo
	n = 267	n =267	n =239	n =248
Clinically significant exacerbations
Rate	0.74	1.52	0.73	1.01
Difference	-0.78		-0.29
Rate ratio (95% CI)	0.49 (0.37, 0.64)		0.72 (0.54, 0.95)
p-value	<0.001		0.019
Pre-bronchodilator FEV1 (L)
Mean baseline	1.660	1.654	1.758	1.815
Improvement from baseline	0.398	0.239	0.330	0.215
Difference (95% CI)	0.159 (0.068, 0.249)		0.116 (0.028, 0.204)
p-value	0.001		0.010
Blood eosinophil count <300 cells/μLb	n =131	n =140	n =125	n =122
Clinically significant exacerbations
Rate	1.11	1.34	0.83	1.38
Difference	-0.23		-0.55
Rate ratio (95% CI)	0.83 (0.59, 1.16)		0.60 (0.42, 0.86)
Pre-bronchodilator FEV1 (L)
Mean change	0.248	0.145	0.140	0.156
Difference (95% CI)	0.102 (-0.003, 0.208)		-0.015 (-0.127, 0.096)

a. Intent to treat population (patients on high-dose ICS and blood eosinophils ≥300 cells/μl).
b. Not powered to detect a treatment difference in patients with blood eosinophils <300 cells/μl.
Across Trials 1 and 2 combined, there was a numerically greater exacerbation rate reduction and greater improvements in FEV1 with increasing baseline blood eosinophils.
The rate of exacerbations requiring hospitalisation and/or emergency room visits for patients receiving Fasenra compared to placebo for Trial 1 were 0.09 versus 0.25 (rate ratio 0.37, 95% CI: 0.20, 0.67, p=<0.001) and for Trial 2 were 0.12 versus 0.10 (rate ratio 1.23, 95% CI: 0.64, 2.35, p=0.538). In Trial 2, there were too few events in the placebo treatment arm to draw conclusions for exacerbations requiring hospitalisation or emergency room visits.
In both Trials 1 and 2, patients receiving Fasenra experienced statistically significant reductions in asthma symptoms (Total Asthma Score) compared to patients receiving placebo. Similar improvement in favour of Fasenra was observed for the Asthma Control Questionnaire-6 (ACQ-6) and Standardised Asthma Quality of Life Questionnaire for 12 Years and Older (AQLQ(S)+12) (Table 3).
Table 3. Treatment difference in mean change from baseline in total asthma symptom score, ACQ-6 and AQLQ(s)+12 at end of treatment - Patients on high-dose ICS and blood eosinophils ≥300 cells/μL

Trial 1		Trial 2
Fasenra (na=267)	Placebo (na=267)	Fasenra (na=239)	Placebo (na=248)
Total asthma symptom scoreb
Mean baseline	2.68	2.74	2.76	2.71
Improvement from baseline	-1.30	-1.04	-1.40	-1.16
Difference (95% CI)	-0.25 (-0.45, -0.06)		-0.23 (-0.43, -0.04)
p-value	0.012		0.019
ACQ-6
Mean baseline	2.81	2.90	2.80	2.75
Improvement from baseline	-1.46	-1.17	-1.44	-1.19
Difference (95% CI)	-0.29 (-0.48, -0.10)		-0.25 (-0.44, -0.07)
AQLQ(S)+12
Mean baseline	3.93	3.87	3.87	3.93
Improvement from baseline	1.56	1.26	1.56	1.31
Difference (95% CI)	0.30 (0.10, 0.50)		0.24 (0.04, 0.45)

a. Number of patients (n) varies slightly due to the number of patients for whom data were available for each variable. Results shown based on last available data for each variable.
b. Asthma symptom scale: total score from 0 (least) to 6 (most); day and night time asthma symptom scores from 0 (least) to 3 (most) symptoms. Individual day and night time scores were similar.
Subgroup analyses by prior exacerbation history
Subgroup analyses from Trials 1 and 2 identified patients with higher prior exacerbation history as a potential predictor of improved treatment response. When considered alone or in combination with baseline blood eosinophils count, these factors may further identify patients who may achieve greater response from benralizumab treatment (Table 4).
Table 4. Exacerbation rate and pulmonary function (FEV1) at end of treatment by number of exacerbations in the previous year - Patients on high-dose ICS and blood eosinophils ≥300 cells/μL

Trial 1		Trial 2
Fasenra (N=267)	Placebo (N=267)	Fasenra (N=239)	Placebo (N=248)
Baseline of 2 exacerbations
n	164	149	144	151
Exacerbation rate	0.57	1.04	0.63	0.62
Difference	-0.47		0.01
Rate ratio (95% CI)	0.55 (0.37, 0.80)		1.01 (0.70, 1.46)
Pre-bronchodilator FEV1 mean change	0.343	0.230	0.266	0.236
Difference (95% CI)	0.113 (-0.002, 0.228)		0.029 (-0.079, 0.137)
Baseline of 3 or more exacerbations
n	103	118	95	97
Exacerbation rate	0.95	2.23	0.82	1.65
Difference	-1.28		-0.84
Rate ratio (95% CI)	0.43 (0.29, 0.63)		0.49 (0.33, 0.74)
Pre-bronchodilator FEV1 mean change	0.486	0.251	0.440	0.174
Difference (95% CI)	0.235 (0.088, 0.382)		0.265 (0.115, 0.415)

Oral corticosteroid dose reduction trial
Trial 3 evaluated the effect of Fasenra on reducing the use of maintenance oral corticosteroids. The primary endpoint was percent reduction from baseline of the final OCS dose during Weeks 24 to 28, while maintaining asthma control. Table 5 summarizes the study results for Trial 3.
Table 5. Effect of Fasenra on OCS dose reduction, Trial 3

Fasenra (N=73)	Placebo (N=75)
Wilcoxon rank sum test (primary analysis method)
Median % reduction in daily OCS dose from baseline (95% CI)	75 (60, 88)	25 (0, 33)
Wilcoxon rank sum test p-value	<0.001
Proportional odds model (sensitivity analysis)
Percent reduction in OCS from baseline at Week 28
≥90% reduction	27 (37%)	9 (12%)
≥75% reduction	37 (51%)	15 (20%)
≥50% reduction	48 (66%)	28 (37%)
>0% reduction	58 (79%)	40 (53%)
No change or no decrease in OCS	15 (21%)	35 (47%)
Odds ratio (95% CI)	4.12 (2.22, 7.63)
Reduction in the daily OCS dose to 0 mg/day*	22 (52%)	8 (19%)
Odds ratio (95% CI)	4.19 (1.58, 11.12)
Reduction in the daily OCS dose to ≤5 mg/day	43 (59%)	25 (33%)
Odds ratio (95% CI)	2.74 (1.41, 5.31)
Exacerbation rate	0.54	1.83
Rate ratio (95% CI)	0.30 (0.17, 0.53)
Exacerbation rate requiring hospitalisation/emergency room visit	0.02	0.32
Rate ratio (95% CI)	0.07 (0.01, 0.63)

Only patients with an optimised baseline OCS dose of 12.5 mg or less were eligible to achieve a 100% reduction in OCS dose during the study.
Lung function, asthma symptom score, ACQ-6 and AQLQ(S)+12 were also assessed in Trial 3 and showed results similar to those in Trials 1 and 2.
Immunogenicity
Overall, treatment-emergent anti-drug antibody response developed in 107 out of 809 (13%) patients treated with Fasenra at the recommended dosing regimen during the 48 to 56 week treatment period of the exacerbation trials. Most antibodies were neutralising and persistent. Anti-benralizumab antibodies were associated with increased clearance of benralizumab and increased blood eosinophil levels in patients with high anti-drug antibody titres compared to antibody negative patients; in rare cases, blood eosinophil levels returned to pre-treatment levels. Based on current patient follow-up, no evidence of an association of anti-drug antibodies with efficacy or safety was observed.
Paediatric population
There were 108 adolescents aged 12 to 17 with asthma enrolled in the phase 3 trials (Trial 1: n=53, Trial 2: n=55). Of these, 46 received placebo, 40 received Fasenra every 4 weeks for 3 doses, followed by every 8 weeks thereafter, and 22 received Fasenra every 4 weeks. In these trials, the asthma exacerbation rate in adolescent patients treated with Fasenra administered at the recommended dosing regimen was 0.70 (n=40, 95% CI: 0.42, 1.18) compared to 0.41 for placebo (n=46, 95% CI: 0.23, 0.73) [rate ratio 1.70, 95% CI: 0.78, 3.69]. No conclusion can be drawn regarding asthma efficacy in the paediatric population.
The European Medicines Agency has waived the obligation to submit the results of studies with Fasenra in paediatric population aged from birth to less than 5 years in asthma (see section 4.2 for information on paediatric use).
The European Medicines Agency has deferred the obligation to submit the results of studies with Fasenra in one or more subsets of the paediatric population in asthma (see section 4.2 for information on paediatric use).
5.2 Pharmacokinetic properties
The pharmacokinetics of benralizumab were dose-proportional in patients with asthma following subcutaneous administration over a dose range of 2 to 200 mg.
Absorption
Following subcutaneous administration to patients with asthma, the absorption half-life was 3.5 days. Based on population pharmacokinetic analysis, the estimated absolute bioavailability was approximately 59% and there was no clinically relevant difference in relative bioavailability in the administration to the abdomen, thigh, or upper arm.
Distribution
Based on population pharmacokinetic analysis, central and peripheral volume of distribution of benralizumab was 3.1 L and 2.5 L, respectively, for a 70 kg individual.
Biotransformation
Benralizumab is a humanised IgG1 monoclonal antibody that is degraded by proteolytic enzymes widely distributed in the body and not restricted to hepatic tissue.
Elimination
From population pharmacokinetic analysis, benralizumab exhibited linear pharmacokinetics and no evidence of target receptor-mediated clearance pathway. The estimated systemic clearance (CL) for benralizumab was at 0.29 L/d. Following subcutaneous administration, the elimination half-life was approximately 15.5 days.
Special populations
Elderly patients (≥65 years old)
Based on population pharmacokinetic analysis, age did not affect benralizumab clearance. However, no data are available in patients over 75 years of age.
Paediatric
Based on the population pharmacokinetic analysis, the pharmacokinetics of benralizumab in adolescents aged 12 to 17 years were consistent with adults. Benralizumab has not been studied in children (5 to 11 years old) (see section 4.2).
Gender, Race
A population pharmacokinetics analysis, indicated that there was no significant effect of gender and race on benralizumab clearance.
Renal impairment
No formal clinical studies have been conducted to investigate the effect of renal impairment on benralizumab. Based on population pharmacokinetic analysis, benralizumab clearance was comparable in subjects with creatinine clearance values between 30 and 80 mL/min and patients with normal renal function. There are limited data available in subjects with creatinine clearance values less than 30 mL/min; however, benralizumab is not cleared renally.
Hepatic impairment
No formal clinical studies have been conducted to investigate the effect of hepatic impairment on benralizumab. IgG monoclonal antibodies are not primarily cleared via hepatic pathway; change in hepatic function is not expected to influence benralizumab clearance. Based on population pharmacokinetic analysis, baseline hepatic function biomarkers (ALT, AST, and bilirubin) had no clinically relevant effect on benralizumab clearance.
Drug-Drug interaction
No formal drug-drug interaction studies have been conducted. An effect of benralizumab on the pharmacokinetics of co-administered medicinal products is not expected. Based on the population pharmacokinetic analysis, commonly co-administered medicinal products (montelukast, paracetamol, proton pump inhibitors, macrolides and theophylline/aminophylline) had no effect on benralizumab clearance in patients with asthma.
5.3 Preclinical safety data
As benralizumab is a monoclonal antibody, no genotoxicity or carcinogenicity studies have been conducted.
Animal toxicology and/or pharmacology
Non-clinical data reveal no special hazards for humans based on conventional studies of safety pharmacology or repeated dose toxicity studies in monkeys. Intravenous and subcutaneous administration to cynomolgus monkeys was associated with reductions in peripheral blood and bone marrow eosinophil counts, with no toxicological findings.
Pregnancy
In a prenatal and postnatal development study in pregnant cynomolgus monkeys, there were no benralizumab-related maternal, embryo-foetal, or postnatal effects observed.
Fertility
No dedicated animal studies have been conducted. No benralizumab-related impairment was observed in reproductive parameters of male and female cynomolgus monkeys. Examination of surrogate fertility parameters (including organ weights and histopathology of reproductive tissues) in animals treated with benralizumab suggested no impairment of fertility. However, in the offspring of monkeys dosed while pregnant, there was a reduction in eosinophils.
6. Pharmaceutical particulars
6.1 List of excipients
Histidine
Histidine hydrochloride monohydrate
Trehalose dihydrate
Polysorbate 20
Water for injections
6.2 Incompatibilities
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products.
6.3 Shelf life
3 years
6.4 Special precautions for storage
Store in a refrigerator (2°C to 8°C). Store the pre-filled syringe in the original package in order to protect from light. Do not freeze. Do not shake.
6.5 Nature and contents of container
One mL solution in a single-use pre-filled syringe made from type I glass with a staked 29-gauge ½-inch stainless steel needle, rigid needle shield, and Fluorotec-coated plunger stopper in a passive safety device.
Pack containing 1 single-use pre-filled syringe.
6.6 Special precautions for disposal and other handling
Fasenra solution for injection is supplied in a sterile single-use pre-filled syringe for individual use. Do not shake. Do not use if frozen.
Instructions for administration
Prior to administration, warm Fasenra by leaving carton at room temperature. This generally takes 30 minutes. Administer within 24 hours or discard into sharps container.
Instructions for Pre-filled Syringe with Needle Safety Guard
Refer to Figure 1 below to identify the pre-filled syringe components for use in the administration steps.
Figure 1

Do not touch the needle guard activation clips to prevent premature activation of the needle safety guard.
1.Grasp the syringe body, not the plunger, to remove pre-filled syringe from the tray. Check the expiry date on the syringe. Visually inspect Fasenra for particulate matter and discolouration prior to administration. Fasenra is clear to opalescent, colourless to yellow, and may contain translucent or white to off-white particles. Do not use Fasenra if liquid is cloudy, discoloured, or if it contains large particles or foreign particulate matter. The syringe may contain a small air bubble; this is normal. Do not expel the air bubble prior to administration.

2.Do not remove needle cover until ready to inject. Hold the syringe body and remove the needle cover by pulling straight off. Do not hold the plunger or plunger head while removing the needle cover or the plunger may move. If pre-filled syringe is damaged or contaminated (for example, dropped without needle cover in place), discard and use a new pre-filled syringe.

3.Gently pinch the skin and insert the needle at the recommended injection site (i.e. upper arm, thighs, or abdomen).

 
4.Inject all of the solution by pushing in the plunger all the way until the plunger head is completely between the needle guard activation clips. This is necessary to activate the needle guard.

5.After injection, maintain pressure on the plunger head and remove the needle from the skin. Release pressure on the plunger head to allow the needle guard to cover the needle. Do not re-cap the pre-filled syringe.

6.Discard the used syringe into a sharps container.
7. Marketing authorisation holder
AstraZeneca AB
SE-151 85 Södertälje
Sweden
8. Marketing authorisation number(s)
EU/1/17/1252/001
9. Date of first authorisation/renewal of the authorisation
Date of first authorisation: 08 January 2018
10. Date of revision of the text
10th January 2018
Detailed information on this medicinal product is available on the website of the European Medicines Agency http://www.ema.europa.eu.