FDA Updates Evusheld Dosing Recommendations

Based on recent data, the U.S. FDA has revised emergency use authorization (EUA) for

AstraZeneca’s Evuseld™ (tixagevimab co-packaged with cilgavimab).

  • According to the FDA, data suggests that Evusheld retains activity for six months, when given at a dose of 300mg tixagevimab and 300mg cilgavimab, against the current prevalent Omicron subvariants of SARS-CoV-2, the virus that causes COVID-19. Therefore, the FDA now recommends repeating this dose once every six months in eligible individuals.
  • Evusheld is authorized to prevent COVID-19 in adults and pediatric individuals (at least 12 years old and weighing at least 40kg, or 88 pounds) who are not currently infected with SARS-CoV-2, who have not had a known recent exposure to an individual infected with SARSCoV-2, and:
    • Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination, or
    • For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).
  • Evusheld first received EUA to prevent COVID-19 in 2021.

Breyanzi Wins Broader Use in Large B-Cell Lymphoma Treatment

The U.S. FDA has approved two new indications for Breyanzi® (lisocabtagene maraleucel), in the treatment of large B-cell lymphoma (LBCL).

  • Breyanzi is now approved to treat LBCL in adults who:
    • Have disease refractory to first-line chemoimmunotherapy or that has relapsed within 12 months of first-line chemoimmunotherapy; or
    • Are not eligible for hematopoietic stem cell transplant due to comorbidities or age and have disease refractory to first-line chemoimmunotherapy or that has relapsed after firstline chemoimmunotherapy.
  • First FDA approved in 2021, Breyanzi is also indicated to treat relapsed or refractory LBCL in adults who have received two or more lines of systemic therapy.
  • Recommended dosing is individualized, as Breyanzi is a CAR-T therapy made using the patient’s own immune cells.

 

 

Tafinlar and Mekinist Approved to Treat Solid Tumors

Tafinlar® (dabrafenib) and Mekinist® (trametinib), both made by Novartis, are now approved for combination use to treat unresectable or metastatic solid tumors with BRAF V600E mutation in patients who are at least six years old and have disease progression following prior treatment, with no satisfactory alternative treatment options.

  • Both medications have held FDA approval since 2013. They are indicated to treat multiple forms of cancer in patients who have a BRAF mutation.
  • The recommended dosage of Tafinlar is 150mg twice daily for adults and based on body weight in children. Recommended dosing for Mekinist is 2mg once daily for adults and based on body weight in children. Both medications are taken by mouth at least one hour before or two hours after a meal.

Merck’s Pneumococcal Vaccine Now Indicated for Children

The U.S. FDA has approved an expanded indication for Vaxneuvance™ (pneumococcal 15valent conjugate vaccine) to include pediatric patients.

  • First FDA approved in 2021 to vaccinate adults, Vaxneuvance is now indicated to provide active immunization in patients at least six weeks of age to prevent invasive disease caused by fifteen specific variants of Streptococcus pneumoniae.
  • Vaxneuvance is administered via intramuscular injection. The recommended dosing is:
    • Ages six weeks through 17 years: A series of four 0.5mL doses given at 2, 4, 6, and 12 through 15 months of age.
    • Ages 18 and up: A single 0.5mL dose.

Zulresso Indicated for Postpartum Depression in Adolescents

Zulresso (brexanolone) has obtained an expanded indication to treat postpartum depression (PPD) in patients who are at least 15 years old.

  • In 2019, the FDA approved Zulresso to treat PPD in adults. The drug is administered via intravenous infusion under the supervision of a qualified healthcare professional.
  • A full course of treatment requires 60 hours and follows a recommended dosing schedule of:
    • 0 to 4 hours: Initiate with a dosage of 30mcg/kg of the patient’s weight per hour.
    • 4 to 24 hours: Increase dosage to 60mcg/kg/hour.
    • 24 to 52 hours: Increase dosage to 90mcg/kg/hour (or consider a dosage of 60mcg/kg/hour for individuals unable to tolerate 90mcg/kg/hour).
    • 52 to 56 hours: Decrease dosage to 60mcg/kg/hour.
    • 56 to 60 hours: Decrease dosage to 30mcg/kg/hour.

Skyrizi Granted New Indication for Crohn’s Disease

Skyrizi® (risankizumab-rzaa – AbbVie) is now the first and only specific interleukin-23 (IL23) inhibitor to receive FDA approval for treating moderately to severely active Crohn’s disease in adults.

  • First FDA approved in 2019, Skyrizi is also indicated to treat active psoriatic arthritis and moderate to severe plaque psoriasis.
  • The recommended starting dose for Crohn’s disease is 600mg administered by intravenous infusion at Weeks 0, 4, and 8 of treatment. Maintenance treatment begins at Week 12, with a recommended dose of 360mg administered by subcutaneous injection once every eight weeks.

 

Comirnaty and Spikevax Cleared for Children Six Months and Older

Comirnaty® (COVID-19 vaccine, mRNA) and Spikevax® (COVID-19 vaccine, mRNA) have been granted emergency use authorization (EAU) to prevent COVID-19 in children who are at least six months of age. This expands the age group for which both vaccines are authorized.

  • Comirnaty, made by Pfizer and BioNTech, previously held an EUA for use in children at least five years of age, and full FDA approval for adults and for adolescents ages 16 and up.
  • Moderna’s Spikevax is FDA approved for adults ages 18 and up.
  • For both vaccines, the recommended dosing for pediatric patients varies based on age and whether the patient has a compromised immune system. Patients may require a two-dose primary vaccination series, a three-dose primary vaccination series, or a two-dose primary vaccination series plus a booster shot.
  • Comirnaty and Spikevax have been used to prevent COVID-19 in the U.S. since 2020.

Imcivree Approved to Treat Extreme Hunger Caused by Rare Disorder

The U.S. FDA has approved Imcivree® (setmelanotide – Rhythm Pharmaceuticals) to treat of obesity and control hunger in patients who are at least six years old and have Bardet-Biedl syndrome.

  • Imcivree first received FDA approval in 2020. It is also indicated for chronic weight management in patients at least six years old who have obesity due to POMC, PCSK1, or LEPR deficiency confirmed by genetic testing in which variants in POMC, PCSK1, or LEPR genes are interpreted as pathogenic, likely pathogenic, or of uncertain significance.
  • Bardet-Biedl syndrome is a rare, complex genetic disorder that can cause hyperphagia, an abnormally strong feeling of hunger or desire to eat. Hyperphagia can lead to obesity and may be present as early as the patient’s first year of life.
  • Recommended dosing under the new indication is based on the patient’s age, renal health, and clinical response to treatment. Imcivree is administered by subcutaneous injection.

FDA Approves Systemic Treatment for Alopecia

Eli Lilly has obtained FDA approval for Olumiant® (baricitinib) oral tablets to treat severe alopecia areata in adults. Olumiant is now the first FDA-approved systemic treatment for the condition.

  • Alopecia occurs when the immune system attacks hair follicles, causing hair loss. Alopecia areata describes the loss of hair in patches, usually on the face and scalp.
  • Recommended Olumiant dosing for alopecia is 2mg once daily, increased to 4mg once daily if the response to treatment is not adequate. Patients who have complete or nearly complete scalp hair loss, with or without substantial eyelash or eyebrow hair loss, may start treatment at 4mg once daily. In all patients taking 4mg daily, the dose should be reduced to 2mg once daily when an adequate response has been achieved.
  • Olumiant first received FDA approval in 2018. It is also indicated to treat moderately to severely active rheumatoid arthritis in adults who have had an inadequate response to one or more tumor necrosis factor blockers.

Amvuttra Approved for Rare Genetic Disorder

Amvuttra™ (vutrisiran) has been approved to treat polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis in adults.

  • A rapidly progressing disease with a poor prognosis, hATTR causes abnormal proteins to accumulate in the body’s tissues. This can lead to neuropathy, which occurs when damage or dysfunction of the nerves leads to numbness, tingling, weakness, and pain.
  • Recommended dosing for Amvuttra is 25mg administered via subcutaneous injection by a healthcare professional once every three months.
  • Manufacturer Alnylam Pharmaceuticals has launched Amvuttra at a wholesale acquisition cost (WAC) of $115,875 per syringe.