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Onasemnogene Abeparvovec-Xioi

FDA Drug Information • Also known as: Zolgensma

Brand Names
Zolgensma
Dosage Form
KIT
Product Type
HUMAN PRESCRIPTION DRUG

⚠ Boxed Warning (Black Box)

WARNING: SERIOUS LIVER INJURY and ACUTE LIVER FAILURE Cases of acute liver failure with fatal outcomes have been reported. Acute serious liver injury and elevated aminotransferases can also occur with ZOLGENSMA [see Warnings and Precautions ( 5.1 )]. Patients with preexisting liver impairment may be at higher risk [see Warnings and Precautions ( 5.1 )]. Prior to infusion, assess liver function of all patients by clinical examination and laboratory testing. Administer systemic corticosteroid to all patients before and after ZOLGENSMA infusion. Continue to monitor liver function for at least 3 months after infusion, and at other times as clinically indicated [see Dosage and Administration ( 2.1 , 2.3 )]. WARNING: SERIOUS LIVER INJURY and ACUTE LIVER FAILURE See full prescribing information for complete boxed warning. Cases of acute liver failure with fatal outcomes have been reported. Acute serious liver injury and elevated aminotransferases can also occur with ZOLGENSMA. ( 5.1 ) Patients with preexisting liver impairment may be at higher risk. ( 5.1 ) Prior to infusion, assess liver function of all patients by clinical examination and laboratory testing. Administer systemic corticosteroid to all patients before and after ZOLGENSMA infusion. Continue to monitor liver function for at least 3 months after infusion, and at other times as clinically indicated. ( 2.1 , 2.3 )

Description

11 DESCRIPTION ZOLGENSMA is a suspension of an adeno-associated viral vector-based gene therapy for intravenous infusion. It is a recombinant self-complementary AAV9 containing a transgene encoding the human survival motor neuron (SMN) protein, under the control of a cytomegalovirus enhancer/chicken-β-actin hybrid promoter. ZOLGENSMA has a nominal concentration of 2.0 × 10 13 vg/mL. Each vial contains an extractable volume of not less than either 5.5 mL or 8.3 mL and the excipients 20 mM Tris (pH 8.0), 1 mM magnesium chloride (MgCl 2 ), 200 mM sodium chloride (NaCl) and 0.005% poloxamer 188. ZOLGENSMA is packaged as a sterile suspension and contains no preservative.

What Is Onasemnogene Abeparvovec-Xioi Used For?

1 INDICATIONS AND USAGE ZOLGENSMA is an adeno-associated virus (AAV) vector-based gene therapy indicated for the treatment of pediatric patients less than 2 years of age with spinal muscular atrophy (SMA) with bi-allelic mutations in the survival motor neuron 1 (SMN1) gene. Limitations of Use The safety and effectiveness of repeat administration of ZOLGENSMA have not been evaluated [see Adverse Reactions ( 6.2 )] . The use of ZOLGENSMA in patients with advanced SMA (e.g., complete paralysis of limbs, permanent ventilator-dependence) has not been evaluated [see Clinical Studies ( 14 )] . ZOLGENSMA is an adeno-associated virus (AAV) vector-based gene therapy indicated for the treatment of pediatric patients less than 2 years of age with spinal muscular atrophy (SMA) with bi-allelic mutations in the survival motor neuron 1 ( SMN1) gene. ( 1 ) Limitations of Use The safety and effectiveness of repeat administration of ZOLGENSMA have not been evaluated. ( 1 , 6.2 ) The use of ZOLGENSMA in patients with advanced SMA (e.g., complete paralysis of limbs, permanent ventilator dependence) has not been evaluated. ( 1 , 14 )

Dosage and Administration

2 DOSAGE AND ADMINISTRATION For single-dose intravenous infusion only. For single-dose intravenous infusion only ( 2 ). The recommended dosage of ZOLGENSMA is 1.1 × 10 14 vector genomes (vg) per kg of body weight. ( 2.1 ) Administer ZOLGENSMA as an intravenous infusion over 60 minutes. ( 2.1 , 2.3 ) Postpone ZOLGENSMA in patients with infections until the infection has resolved and the patient is clinically stable. ( 2.1 , 5.2 ) Starting one day prior to ZOLGENSMA infusion, administer systemic corticosteroids equivalent to oral prednisolone at 1 mg/kg of body weight per day for a total of 30 days. At the end of the 30-day period, check liver function by clinical examination and by laboratory testing. For patients with unremarkable findings, taper the corticosteroid dose gradually over the next 28 days. If liver function abnormalities persist, continue systemic corticosteroids (equivalent to oral prednisolone at 1 mg/kg/day) until findings become unremarkable, and then taper the corticosteroid dose gradually over the next 28 days or longer if needed. Do not stop systemic corticosteroids abruptly. ( 2.1 ) If liver function abnormalities continue to persist ≥ 2 × ULN after the 30-day period of systemic corticosteroids, promptly consult a pediatric gastroenterologist or hepatologist. ( 2.1 ) 2.1 Dose and Administration The recommended dose of ZOLGENSMA is 1.1 × 10 14 vector genomes per kilogram (vg/kg) of body weight. Table 1: Dosing Patient weight range (kg) Dose volume a (mL) a Dose volume is calculated using the upper limit of the patient weight range for pediatric patients less than 2 years of age between 2.6 kg and 21.0 kg. 2.6 – 3.0 16.5 3.1 – 3.5 19.3 3.6 – 4.0 22.0 4.1 – 4.5 24.8 4.6 – 5.0 27.5 5.1 – 5.5 30.3 5.6 – 6.0 33.0 6.1 – 6.5 35.8 6.6 – 7.0 38.5 7.1 – 7.5 41.3 7.6 – 8.0 44.0 8.1 – 8.5 46.8 8.6 – 9.0 49.5 9.1 – 9.5 52.3 9.6 – 10.0 55.0 10.1 – 10.5 57.8 10.6 – 11.0 60.5 11.1 – 11.5 63.3 11.6 – 12.0 66.0 12.1 – 12.5 68.8 12.6 – 13.0 71.5 13.1 – 13.5 74.3 13.6 – 14.0 77.0 14.1 – 14.5 79.8 14.6 – 15.0 82.5 15.1 – 15.5 85.3 15.6 – 16.0 88.0 16.1 – 16.5 90.8 16.6 – 17.0 93.5 17.1 – 17.5 96.3 17.6 – 18.0 99.0 18.1 – 18.5 101.8 18.6 – 19.0 104.5 19.1 – 19.5 107.3 19.6 – 20.0 110.0 20.1 – 20.5 112.8 20.6 – 21.0 115.5 Prior to ZOLGENSMA infusion: Due to the increased risk of serious systemic immune response, administer ZOLGENSMA to patients who are clinically stable in their overall baseline health status (e.g., hydration and nutritional status, absence of infection) prior to infusion. Postpone ZOLGENSMA in patients with infections until the infection has resolved and the patient is clinically stable. Clinical signs or symptoms of infection should not be evident at the time of ZOLGENSMA infusion [see Warnings and Precautions ( 5.2 , 5.4 ), Patient Counseling Information ( 17 )]. Assess liver function [see Boxed Warning, Dosage and Administration ( 2.3 ), Warnings and Precautions ( 5.1 ), Use in Specific Populations ( 8.6 )]. Obtain creatinine...

Side Effects (Adverse Reactions)

6 ADVERSE REACTIONS The most common adverse reactions (incidence ≥ 5%) were elevated aminotransferases and vomiting. The most common adverse reactions (incidence ≥ 5%) were elevated aminotransferases and vomiting. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Novartis Gene Therapies at 1-833-828-3947 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials 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 product and may not reflect the rates observed in practice. The safety data described in this section reflect exposure to ZOLGENSMA in five clinical studies enrolling a total of 68 patients. This includes four prospective open-label clinical trials [NCT03306277 (Study 1), NCT02122952 (Study 2), NCT03505099, NCT04851873 (Study 3)], and one observational long-term follow-up study [NCT03421977]. The patient population in NCT03306277, NCT03505099, and NCT02122952 ranged in age from 0.3 months to 7.9 months at the time of infusion (median age, 3.3 months), with weight range from 3.0 kg to 8.4 kg (median weight, 5.5 kg) [see Clinical Studies ( 14 )] . In an open-label, post-authorization clinical study (Study 3, NCT04851873), safety of ZOLGENSMA was evaluated in 24 children, aged between 1.5 to 9.1 years (median age, 4.9 years), with weight range from ≥ 8.5 kg to ≤ 21 kg (median weight, 15.8 kg). Only one of the 24 patients was under the age of 2 years at the time of ZOLGENSMA administration. Patients in Study 3 had 2 to 4 copies of SMN2 . Before treatment with ZOLGENSMA, 21 patients discontinued their previous treatment with nusinersen or risdiplam. The types of adverse reactions observed in Study 3 were consistent with those of Studies 1 and 2. Liver enzyme increases in Study 3 occurred at a higher frequency compared with the previous 4 studies. AST or ALT elevations > 2 × ULN were observed in the majority of patients (23 out of 24 patients), including 21 patients with ALT elevations > 3 × ULN and 5 patients with ALT elevations > 20 × ULN. These patients were clinically asymptomatic and there were no elevations of bilirubin. The AST and ALT elevations were managed with the use of corticosteroids, typically with prolonged duration and/or given at a higher dose [see Warnings and Precautions ( 5.1 )] . Transient decreases in platelet counts, which met the criteria for thrombocytopenia were observed in 20 out of 24 patients. Four patients had platelet counts below 50,000 per µL [see Warnings and Precautions ( 5.3 )] . The most frequent adverse reactions (incidence ≥ 5%) and increases in alanine aminotransferase in the 4 studies (data cut-off date: September 27, 2018) are summarized in Table 2 . Table 2: Adverse Reactions and ALT Increases* Following Treatment With ZOLGENSMA Patients n = 44 (3.0-8.4 kg) Adverse reactions n (%) Abbreviations: ULN, upper limit of normal; ALT, alanine aminotransferase. *Laboratory finding. Elevated aminotransferases 12 (27%) ALT > 3 X ULN 7 (16%) ALT > 20 X ULN 4 (9%) Vomiting 3 (7%) One death occurred in a patient, who received ZOLGENSMA at the age of 5 months (6 kg), in a completed non-United States clinical trial (NCT03461289). The patient initially presented with respiratory insufficiency 12 days after ZOLGENSMA infusion and was found to have RSV and parainfluenza in respiratory secretions. The patient had episodes of serious hypotension, followed by seizures, and was found to have leukoencephalopathy (brain white matter defects) approximately 30 days after ZOLGENSMA infusion. The patient died after withdrawal of life support 52 days after ZOLGENSMA infusion. 6.2 Immunogenicity In ZOLGENSMA clinical trials, patients were required to have baseline anti-AAV9 antibody titers of ≤ 1:50, measured using an enzyme-linked immunosorbent assay (ELISA). Evidence of prior exposure to AAV9 was uncommon. The safety and efficacy...

Drug Interactions

7 DRUG INTERACTIONS Where feasible, adjust a patient’s vaccination schedule to accommodate concomitant corticosteroid administration prior to and following ZOLGENSMA infusion [see Dosage and Administration ( 2.1 )] . Certain vaccines, such as measles, mumps, and rubella (MMR) and varicella, are contraindicated for patients on a substantially immunosuppressive steroid dose (i.e., ≥ 2 weeks of daily receipt of 20 mg or 2 mg/kg body weight of prednisone or equivalent). Seasonal RSV prophylaxis is recommended (General Best Practice Guidelines for Immunization [ www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf ], eds2017). Where feasible, adjust a patient’s vaccination schedule to accommodate concomitant corticosteroid administration prior to and following ZOLGENSMA infusion. ( 7 )

Contraindications

4 CONTRAINDICATIONS None. None. ( 4 )

Pregnancy and Breastfeeding

8.1 Pregnancy Risk Summary There are no available data regarding ZOLGENSMA use in pregnant women. No animal reproductive and developmental toxicity studies have been conducted with ZOLGENSMA. In the United States general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

How Supplied

16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied ZOLGENSMA is shipped frozen (≤ -60°C [-76°F]) in 10 mL vials with 2 fill volumes (either 5.5 mL or 8.3 mL). ZOLGENSMA is provided as a customized kit to meet dosing requirements for each patient [see Dosage and Administration ( 2.1 )] , with each kit containing: Two (2) to fourteen (14) vials of ZOLGENSMA (see below) One alcohol wipe per vial Kit sizes and National Drug Codes (NDC) are provided in Table 3 . Table 3: ZOLGENSMA Kit Sizes Patient weight (kg) 5.5 mL vial a 8.3 mL vial b Total vials per kit NDC number a Vial nominal concentration is 2.0 × 10 13 vg/mL and contains an extractable volume of not less than 5.5 mL. b Vial nominal concentration is 2.0 × 10 13 vg/mL and contains an extractable volume of not less than 8.3 mL. 2.6 – 3.0 0 2 2 71894-120-02 3.1 – 3.5 2 1 3 71894-121-03 3.6 – 4.0 1 2 3 71894-122-03 4.1 – 4.5 0 3 3 71894-123-03 4.6 – 5.0 2 2 4 71894-124-04 5.1 – 5.5 1 3 4 71894-125-04 5.6 – 6.0 0 4 4 71894-126-04 6.1 – 6.5 2 3 5 71894-127-05 6.6 – 7.0 1 4 5 71894-128-05 7.1 – 7.5 0 5 5 71894-129-05 7.6 – 8.0 2 4 6 71894-130-06 8.1 – 8.5 1 5 6 71894-131-06 8.6 – 9.0 0 6 6 71894-132-06 9.1 – 9.5 2 5 7 71894-133-07 9.6 – 10.0 1 6 7 71894-134-07 10.1 – 10.5 0 7 7 71894-135-07 10.6 – 11.0 2 6 8 71894-136-08 11.1 – 11.5 1 7 8 71894-137-08 11.6 – 12.0 0 8 8 71894-138-08 12.1 – 12.5 2 7 9 71894-139-09 12.6 – 13.0 1 8 9 71894-140-09 13.1 – 13.5 0 9 9 71894-141-09 13.6 – 14.0 2 8 10 71894-142-10 14.1 – 14.5 1 9 10 71894-143-10 14.6 – 15.0 0 10 10 71894-144-10 15.1 – 15.5 2 9 11 71894-145-11 15.6 – 16.0 1 10 11 71894-146-11 16.1 – 16.5 0 11 11 71894-147-11 16.6 – 17.0 2 10 12 71894-148-12 17.1 – 17.5 1 11 12 71894-149-12 17.6 – 18.0 0 12 12 71894-150-12 18.1 – 18.5 2 11 13 71894-151-13 18.6 – 19.0 1 12 13 71894-152-13 19.1 – 19.5 0 13 13 71894-153-13 19.6 – 20.0 2 12 14 71894-154-14 20.1 – 20.5 1 13 14 71894-155-14 20.6 – 21.0 0 14 14 71894-156-14 16.2 Storage and Handling Product is shipped and delivered...

About This Information

This drug information is sourced from FDA-approved labeling via the openFDA database. It is intended for educational and reference purposes only. This is not medical advice. Always consult your healthcare provider before making decisions about medication. Drug information may be updated by the FDA; check with your pharmacist for the most current information.

What are side effects?

Side effects are unwanted reactions that can occur when taking a medication. They range from mild (headache, nausea) to severe (allergic reactions, organ damage). Not everyone experiences side effects, and severity varies. Report any concerning side effects to your doctor.

What are drug interactions?

Drug interactions occur when a medication is affected by another drug, food, or supplement. Interactions can make medications less effective or cause dangerous side effects. Always tell your doctor about all medications and supplements you take.