Glybera
alipogene tiparvovec
Alipogene tiparvovec
▼ This medicine is subject to additional monitoring. This will allow quick identification of new safety information. You can help by reporting any side effects you may get. See the end of section 4 for how to report side effects
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor.
If you get any side effects, talk to your doctor. This includes any possible side effect not listed in the leaflet.
You have been given a patient card by your doctor. Read it carefully and follow the related
instructions.
You should present this card to your health care professionals (doctor, nurse) upon consultation or hospitalisation. See section 4
What Glybera is and what it is used for
What you need to know before you are given Glybera
How Glybera is given to you
Medicinal product no longer authorised
Possible side effects
How to store Glybera
Contents of the pack and other information
Glybera contains alipogene tiparvovec, a gene therapy product that works by delivering a gene into the body to correct a genetic deficiency. It belongs to a group of medicines called lipid modifying agents.
Glybera is used to treat a specific inherited condition known as “lipoprotein lipase deficiency (LPLD)”.
Lipoprotein lipase (LPL) is a naturally occurring substance in the body (known as an enzyme) that controls the level of certain fats in the blood. In lipoprotein lipase deficiency, this enzyme is missing due to a genetic defect. People who are affected by this condition have a build up of very high fat levels in their blood (hyperchylomicronemia).
Glybera is used to treat adult patients diagnosed with lipoprotein lipase deficiency (LPLD) and suffering from severe or multiple pancreatitis attacks despite dietary fat restrictions. The diagnosis of LPLD has to be confirmed by genetic testing. Glybera will only be given to you if you show detectable levels of LPL protein in your blood.
- if you are allergic to alipogene tiparvovec or to any of the other ingredients of Glybera (listed
in section 6 ‘Further information’).
if your immune system does not work properly
if you have an increased bleeding risk and or muscle disease
if you are taking oral contraceptives
If any of the above applies to you, or if you are unsure of any of the above, please talk to your doctor before you receive Glybera.
It is important that you fully understand the benefits and risks associated with the
treatment by discussing with your doctor
It is important that you tell your doctor if you have an active infection of any sort before you take the medicines you will be given to reduce your body’s defences (immunosuppressants) and before you receive Glybera. See also section 3, ‘How Glybera is used’.
Glybera is a gene therapy product. It contains genetically modified organisms. After treatment with Glybera do not donate blood, organs, tissues and cells for transplantation to avoid spreading cells that contain your medicine.
Tell your doctor if you are suffering from diabetes.
You should continue to follow a fat-restricted, alcohol-free diet. People diagnosed with lipoprotein lipase deficiency are advised to be careful with their diet, both before and after Glybera therapy; they should restrict their intake of ‘normal diet fats’ and should not drink alcohol.
Small amounts of blood will be drawn before treatment, 6 months and 12 months after treatment to measure how your body’s immune (defence) system is responding to the treatment with Glybera.
Medicinal product no longer authorised
Glybera is not recommended for use in children and adolescents under 18 years of age.
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines,
including medicines obtained without a prescription. In particular, tell your doctor if you are taking the following before you are given Glybera:
A medicine impacting blood coagulation e.g. acetylsalicylic acid (e.g.aspirin), a substance present in many medicines used to relieve pain and lower fever, as well as medicines used to prevent blood clotting eg anticoagulants such as warfarin, heparin. These medicines should not be taken for at least one week before the leg injections or one day after you have had the injections. Taking these medicines before receiving or at the same time as receiving Glybera, may cause unnecessary bruising or bleeding from the injection sites.
Oral contraceptives (see section 2 ‘Do not receive Glybera’)
People diagnosed with lipoprotein lipase deficiency are advised to be careful with their diet, both
before and after Glybera therapy; they should not drink alcohol.
If you are pregnant or breast-feeding, think you might be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before using any medicine.
Glybera is not usually recommended for use during pregnancy. There is very limited information about the safety of Glybera in pregnant women.
It is important to tell your doctor if you are pregnant, think you may be pregnant, or are planning to get pregnant. Your doctor will weigh up the benefits to you against the risks to your baby of taking Glybera whilst you are pregnant.
Use appropriate barrier contraception such as condoms to avoid becoming pregnant during treatment and for at least 12 months after treatment. Do not take oral contraceptives as they have the potential to worsen your disease; Use condoms so that as little Glybera as possible may be passed to/from your partner.
If you do become pregnant during treatment with Glybera, tell your doctor.
It is not known whether Glybera passes into breast milk. Breast-feeding is not recommended during treatment with Glybera.
Dizziness was commonly observed after Glybera administration. You should consider this when
driving or using machines. Talk to your doctor about this.
Glybera contains sodium and potassium. The amount of sodium and potassium that you may receive
depends on the number of injections that you need; your doctor will work this out depending on your weight.
You need to take this into consideration if you are on a controlled sodium diet.
This medicine contains potassium, less than 1 mmol (39 mg) per administration at 27 injection sites to
60 injection sites, i.e. essentially ‘potassium-free’.
Glybera therapy will be overseen by a doctor who is specialised in the treatment of patients affected by your condition and will be administered to you by an appropriately qualified and trained doctor or nurse.
Medicinal product no longer authorised
Glybera will be given to you in a single therapy administration session in a hospital. At this time a series of injections (27 to 60 injections) into the muscles of both upper and lower legs will be given. The dose you will need is dependent on your weight and is calculated by your doctor.
Due to the large number of individual injections that you will receive during the Glybera therapy session, you will be given either a regional anaesthetic into the spine (which will numb your legs only), or a more localised anaesthetic before you are given the Glybera injections. Your doctor will talk to you about the anaesthetic and how it will be given.
After you have been given Glybera, you may notice that your legs have a yellow colour; this might occur in case iodine was used to clean (sterilise) your legs before you received the medicine. This will fade after a short time. You will need to stay in hospital for a few hours or overnight to make sure that you have not had any side effects from the medicine or the anaesthetic.
Glybera should be administered to you in one treatment session only. Re-administration of Glybera after this first treatment session is not recommended.
It is important that at the time of first Glybera administration, your body’s immune (defence) system is not activated. To avoid this, your doctor will also prescribe treatment that will suppress the immune system (known as immunosuppressants), starting 3 days before the day of injection with Glybera and for 12 weeks after. Examples of these immunosuppressants are ciclosporin, mycophenolate mofetil. In addition methylprednisolone might be administered half an hour prior to the Glybera administration. It is important that you take these medicines according to the instructions given. Do not stop taking these without talking to your doctor.
Please ask your doctor for more information about the exact immunosuppressant medicine you will be taking.
As this medicine is given to you by a doctor, it is unlikely that you will be given too much. If you
receive two doses in one injection site by mistake this might lead to more local reaction such as bruising or sensitivity. Your doctor will treat this appropriately.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
Like all medicines, Glybera can cause side effects, although not everybody gets them.
pain in leg(s) (pain in extremity)
raised body temperature
tiredness (fatigue)
headache
bruises in the upper and lower leg muscle due to the injections. They only last a short time.
Increased blood level of the muscle enzyme creatine kinase
abdominal pain
nausea
constipation
chills
fever
muscle pain and joint aches, pains and stiffness
difficulty breathing, chest pain on breathing in and palpitations which may be caused by blockage of the main blood vessel of the lung
Medicinal product no longer authorised
burning sensation
high blood pressure
sensation like that of insects crawling on (or under) the skin
water retention
decreased appetite
dizziness
skin rash
muscle spasms
hair growth
injection site discomfort, swelling, rash and pain
In addition to being given Glybera, you will be given other medicines called immunosuppressants (see
section 3 ‘How Glybera is used’). It is important that you ask your doctor about the side effects of
these other medicines. Your doctor should give you a copy of the patient information leaflet (like this one) for the immunosuppressants you will need to take. Do not stop taking these without talking to your doctor.
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects
not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of
this medicine.
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the label after ‘EXP’. The expiry date refers to the last day of that month.
Vials must be stored and transported frozen at -25ºC to -15ºC. Store in the original package in order to protect from light.
Once thawed, the medicinal product must be used immediately; if not used immediately, the vials
should be stored in a refrigerator at 2ºC to 8ºC, and protected from light for a maximum of 8 hours. If not stored in a refrigerator the medicinal product can be stored in syringes at not more than 25°C, and protected from light for a maximum of 8 hours.
This medicine contains genetically modified organisms and must be disposed of according to local
rules for such medicines.
The active substance is alipogene tiparvovec.
Each vial of alipogene tiparvovec contains 1 ml of solution, containing 3 x 1012 genome copies (gc).
Each patient-specific pack contains a sufficient amount of vials to dose each patient with 1 x 1012 gc/kg body weight.
Medicinal product no longer authorised
The other ingredients are, disodium phosphate, potassium chloride, potassium dihydrogen phosphate, sodium chloride, sucrose, and water for injections.
Glybera is a clear to slightly opalescent, colourless solution for injection, supplied in a clear glass vial with a siliconised injection stopper and flip-off seal.
Each preformed transparent sealed plastic casing contains either 2 or 3 individual vials with a liquid absorbing sheet. The patient-specific pack contains a variable number of casings based on the patient’s
body weight.
Marketing Authorisation Holder
uniQure biopharma B.V., Meibergdreef 61, 1105 BA Amsterdam, The Netherlands.
Manufacturer
uniQure biopharma B.V., Meibergdreef 61, 1105 BA Amsterdam, The Netherlands.
For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:
Chiesi SA/NV
Tél/Tel: +32 2 788 42 00
Chiesi Pharmaceuticals GmbH
Tel: + 43 1 4073919
Chiesi Bulgaria EOOD
Тел.: +359 29201205
Chiesi SA/NV
Tél/Tel: +32 2 788 42 00
Chiesi CZ s.r.o.
Tel: + 420 261221745
Chiesi Pharma AB
Tlf: +46 8 753 35 20
Chiesi Farmaceutici S.p.A
Tel: + 39 0521 2791
Chiesi GmbH
Tel: + 49 40 89724-0
Chiesi Pharmaceuticals B.V.
Tel: +31 0 70 413 20 80
Chiesi Pharmaceuticals GmbH
Tel: + 43 1 4073919
Chiesi Pharma AB
Tlf: +46 8 753 35 20
Chiesi Hellas AEBE
Τηλ: + 30 210 6179763
Chiesi Pharmaceuticals GmbH
Tel: + 43 1 4073919
Chiesi España, S.A
Tel: + 34 93 494 8000
Chiesi Poland Sp. z.o.o. Tel.: +48 22 620 1421
Chiesi SAS
Tél: + 33 1 47688899
Chiesi Farmaceutici S.p.A.
Tel: + 39 0521 2791
Chiesi Pharmaceuticals GmbH
Medicinal product no longer authorised
Tel: + 43 1 4073919
Chiesi Romania S.R.L.
Tel: + 40 212023642
Chiesi Ltd
Tel: + 44 0161 4885555
Chiesi Slovenija d.o.o.
Tel: ++386-1-43 00 901
Chiesi Pharma AB.
Sími: +46 8 753 35 20
Chiesi Farmaceutici S.p.A.
Tel: + 39 0521 2791
Chiesi Pharma AB
Puh/Tel: : +46 8 753 35 20
Chiesi Farmaceutici S.p.A.
Tηλ: + 39 0521 2791
Chiesi Pharma AB
Tel: +46 8 753 35 20
Chiesi Pharmaceuticals GmbH
Tel: + 43 1 4073919
Chiesi Ltd
Tel: + 44 0161 4885555
This medicine has been authorised under "exceptional circumstances”. This means that because of the rarity of this disease it has been impossible to get complete information on this medicine.
The European Medicines Agency will review any new information on the medicine every year and
this leaflet will be updated as necessary.
There are also links to other websites about rare diseases and treatments.
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Glybera therapy must be prescribed by and administered under the supervision of a physician with expertise in treating LPLD patients and in gene therapy administration, in full consultation with the patient. During administration of Glybera appropriate medical treatment and supervision should always be readily available in case of an anaphylactic event following the administration.
Posology
The maximum total dose of Glybera for administration is 1 x 1012 gc/kg body weight.
Glybera is authorised for single treatment only. No data on re-administration of Glybera are available, therefore Glybera should not be re-administered.
Glybera is administered as a one-time series of intramuscular injections in the legs. The dose per injection site is 1.5 x 1012 gc, or 0.5 ml of solution for injection. For each injection site, one syringe of 1 ml with clear volume marks of 0.5 ml must be used. Volumes per injection site must not exceed 0.5ml. Syringes must not be used more than once.
Medicinal product no longer authorised
The treatment should be monitored by measuring neutralising antibodies and T-Cell response against AAV1 and LPLS447X at baseline as well as 6 and 12 months after treatment.
Glybera should only be used when the diagnosis of LPLD has been confirmed by an adequate genetic test.
To calculate the number of vials, the patient’s weight is determined to the nearest whole kg. The patient’s weight should be divided by 3, and rounded up to the next higher whole number. This is the number of vials that must be dispensed.
To calculate the number of injection sites and the number of syringes, the patient’s weight is determined to the nearest whole kg. The patient’s weight should be divided by 3, then without rounding up this number multiplied by 2 and rounded up to the next higher whole number. This is the number of injection sites and the total number of syringes (each filled with 0.5ml) needed to administer a volume of 0.5ml per injection site for the patient’s treatment.
Examples of typical dose schedules based on the body weight of patients are shown in the table below:
Body weight (kg) | Number of vials (1 mL) | Number of 1ml syringes (each filled with 0.5ml) | Number of injection sites |
40 | 14 | 27 | 27 |
50 | 17 | 34 | 34 |
60 | 20 | 40 | 40 |
65 | 22 | 44 | 44 |
70 | 24 | 47 | 47 |
75 | 25 | 50 | 50 |
80 | 27 | 54 | 54 |
90 | 30 | 60 | 60 |
From three days prior to and for 12 weeks following Glybera administration an immunosuppressive regimen should be administered: ciclosporin (3 mg/kg/day) and mycophenolate mofetil (2 x 1 g/day) is recommended.
In addition, half an hour prior to Glybera injection an intravenous bolus of 1mg/kg of
methylprednisolone should be administered.
Paediatric population
The safety and efficacy of Glybera in children and adolescents below 18 years has not been
established. No data are available.
Elderly
There is limited experience in the use of Glybera in elderly subjects. No dose adjustment of Glybera is
necessary in the elderly population.
Dose of immunosuppressant may need to be adjusted.
Renal impairment or hepatic impairment
There is limited experience in the use of Glybera in patients with renal or hepatic impairment. No dose adjustment of Glybera is required.
Method of administration
Upon intramuscular injection, the patient will receive multiple injections of 0.5 ml (one injection per syringe), distributed over the muscles of both upper and lower legs, under aseptic conditions such as iodine.
Medicinal product no longer authorised
Spinal or regional anaesthesia is advised prior to intramuscular administration, due to the number of injections required. In case of contraindication for such procedure deep sedation is advised instead.
Glybera should under no circumstances be administered intravascularly.
To ensure intramuscular injection, ultrasound or electrophysiologic guidance of injections is advised. Instructions for use, handling and disposal
Refer to local biosafety guidelines applicable for handling and disposal of medicinal products
containing genetically-modified organisms.
Work surfaces and material which have potentially been in contact with Glybera must be decontaminated with appropriate virucidal disinfectants with activity for non-enveloped viruses (such as hypochlorite and chlorine releasers) for at least 10 minutes.
Preparation of Glybera for administration
After the amount of Glybera to be administered has been calculated (see section posology) remove the
correct number of single use vials from the freezer to thaw at room temperature (15oC to 25oC), approximately 30-45 minutes in advance of syringe filling.
After thawing, each vial should be gently inverted twice to ensure even mixing. Vials should be visually inspected for particulate matter and colour. The clear to slightly opalescent and colourless solution must be free of visible particles. Only clear and colourless solutions without visible particles should be used. If a vial is showing damage, syringes for the injection should not be prepared and the injection procedure should be postponed and rescheduled. The Marketing Authorisation Holder should be informed immediately.
Glybera is delivered in a patient-specific pack and will therefore contain the precise amount of vials per patient, calculated according to the patient’s weight.
The calculated amount of syringes should be filled from the thawed vials, and they should be labelled and placed in a container protected from light suitable for transportation to the room where the patient
will undergo the intramuscular injections.
Medicinal product no longer authorised
To avoid any injection of particles from the stopper due to two withdrawals, one needle for the withdrawal from the vial (to be left inside the stopper) and a separate needle for each syringe must be used.