Teva`s Shared Solutions ® Brochure

Transcription

Get to know Teva’s Shared Solutions®
YOUR PARTNER
EVERY STEP OF
THE WAY
Maria Z., diagnosed with
a relapsing form of MS
Please see Important Safety
Information on pages 20-21,
and full Prescribing Information
beginning on page 22.
1
Our commitment to you
Teva’s Shared Solutions® understands and cares about how
relapsing MS (RMS) can affect you. We will partner with
you to provide the resources and support you need to help
you achieve your RMS management goals.
Shauna F., diagnosed with
Please see Important Safety Information on pages 20-21, and
full Prescribing Information beginning on page 22.
2
Experience personalized support
from Teva’s Shared Solutions®
With more than a decade of experience helping thousands of
people whose lives have been touched by MS, including people
with RMS, friends, and families, Teva’s Shared Solutions®
is there for you.
As you read through this booklet, discover the full breadth
of personalized services Shared Solutions® provides for people
taking Teva’s COPAXONE® (glatiramer acetate injection).
Make the most of the support offered by Teva’s Shared Solutions®.
Visit www.copaxone.com/shared-solutions today.
Use
COPAXONE® is prescription medicine used for the treatment
of people with relapsing forms of multiple sclerosis (MS).
Important Safety Information
Do not take COPAXONE® if you are allergic to glatiramer acetate
or mannitol.
Please see additional Important
Safety Information on pages 20-21,
3
Through financial support, training and nurse support, and
educational resources, Teva’s Shared Solutions® will partner
with you throughout your COPAXONE® (glatiramer acetate
injection) therapy experience.
Financial
Support
Educational
Resources
Training
and Nurse
Support
4
Experience personalized support
option 3
option 3
FINANCIAL
SUPPORT
option 3
FINANCIAL SUPPORT
Financial Support
FINANCIAL SUPPORT
Financial assistance
Benefits investigation
TRAINING and NURSE SUPPORT
TRAINING and NURSE SUPPORT
TRAINING andTraining
NURSE SUPPORT
and Nurse
Support
MS-certified nurse phone support, 24/7
Free, in-home, 1-on-1 injection training
Tools for therapy tracking
EDUCATIONAL RESOURCES
Educational Resources
Educational programs
Peer resources
Personalized communication
Some patients report a short-term reaction right after
injecting COPAXONE® (glatiramer acetate injection).
5
Teva’s Shared Solutions® is committed to helping you find
affordable access to COPAXONE® (glatiramer acetate
injection) therapy.
We have a team of dedicated Benefits Specialists who
research and understand your coverage and benefits, so
you can be confident that someone caring is working for
you to help make your COPAXONE® affordable.
Maria Z., diagnosed with
6
FINANCIAL S
Learn about financial support
Your Benefits Specialist can help you with
•
•
•
•
•
TRAINING an
Benefits investigation to see if your plan covers Teva’s
COPAXONE® (glatiramer acetate injection)
Pharmacy benefits research to help determine the most
convenient way for you to receive Teva’s COPAXONE®
Assistance with understanding your insurance benefits and
any changes that can affect your coverage
EDUCATION
Assistance with navigating Medicare Part D
Additional support, depending on your insurance coverage or
financial need
Prepare for your conversation with your Benefits Specialist
by accessing the COPAXONE® Health Plan Tool.
Be proactive.
Visit www.copaxone.com/shared-solutions/health-plan-tool.
Some patients report a short-term reaction right after injecting
COPAXONE®. This reaction can involve flushing (feeling of warmth
and/or redness), chest tightness or pain with heart palpitations,
anxiety, and trouble breathing.
7
Teva’s Shared Solutions® is dedicated to helping you
find affordable access to COPAXONE® (glatiramer acetate
injection) therapy. We can assist you in searching for financial
solutions that may help prevent financial concerns from
getting in the way of starting and staying on COPAXONE®.
“I am grateful to Shared Solutions® for their financial
assistance program.”
—Paula, Teva survey respondent
8
FINANCIAL S
Learn about financial support
If you’re eligible for COPAXONE Co-pay Solutions®, your co-pay
for 3-times-a-week COPAXONE® (glatiramer acetate injection)
TRAINING an
40 mg could be lowered to $0 per month out of pocket.*
Terms and Conditions apply.
PER MONTH
OUT OF POCKET*
EDUCATION
Find out more about COPAXONE Co-pay Solutions®.
Call Shared Solutions® today at 1-800-887-8100.
Applies only to 3-times-a-week COPAXONE® 40 mg. Certain limits and restrictions apply.
Terms and Conditions for 3-times-a-week COPAXONE® 40 mg include: COPAXONE Co-pay Solutions® is open to both
new and existing patients who are residents of the US or Puerto Rico and who have commercial prescription insurance
coverage for COPAXONE® 40 mg. The offer is not valid for uninsured patients or patients covered in whole or in part
by Medicaid, Medicare, TRICARE, or any other federal or state government pharmaceutical assistance plan or program
(regardless of whether a specific prescription is covered), or by private health benefit programs that reimburse for
the entire cost of prescription drugs. Use of this offer must be consistent with the terms of any drug benefit provided
by a health insurer, health plan, or private third-party payor. This offer is void in Massachusetts and where otherwise
prohibited by law, taxed, or restricted. No additional purchase is required. This offer is valid only at participating
PER
pharmacies
andMONTH
may be changed or discontinued at any time without notice. This program is not health insurance.
*
OUT OF POCKET*
These symptoms generally appear within minutes of an injection,
last about 15 minutes, and do not require specific treatment.
9
Teva’s Shared Solutions® is dedicated to providing you
with the education and training to support your COPAXONE®
(glatiramer acetate injection) therapy experience.
Teva-trained nurses are caring professionals who can come
to your home and work with you to create a personalized
injection plan, help you maintain your commitment to therapy,
and help you achieve your treatment management goals.
Bill S., diagnosed with a
relapsing form of MS
10
TRAINING a
Experience training and nurse support
Teva’s Shared Solutions® provides customized, in-home,
EDUCATION
1-on-1 injection training from Teva-trained nurses whenever
you need it at any time throughout your COPAXONE®
therapy experience.
MS-certified nurse phone support 24/7
Teva’s Shared Solutions® is there for you whenever you
need support. Compassionate MS-certified nurses are
available by phone around the clock so you will always have
the one-on-one support you need. We will work with you to
help you take control of your therapy management. Teva’s
Shared Solutions® supports you in maintaining a commitment
to your treatment goals.
Call Shared Solutions® at 1-800-887-8100 to set up a
free, in-home, 1-on-1 injection training session.
COPAXONE® (glatiramer acetate injection).
11
Teva’s Shared Solutions® has carefully and thoughtfully
designed resources to help you stay on track with
3-times-a-week COPAXONE® (glatiramer acetate
injection) 40 mg.
We’ve created innovative, interactive injection-tracking tools,
such as the COPAXONE iTracker®, to provide 24/7 injection
support between your office visits.
With this customizable mobile tool, you can create and
manage an injection schedule that works for you, to help you
stay the course with your COPAXONE® therapy.
“…I especially like the online app that sends me reminders
and makes rotating my injections very simple.”
—Pamela takes 3-times-a-week COPAXONE® 40 mg.
Individual results may vary.
12 full Prescribing Information beginning on page 22.
TRAINING a
Experience injection-tracking support
Teva’s Shared Solutions® understands that everyone has different
EDUCATION
needs for therapy and therapy support. That’s why we provide
you
with on-the-go or at-home tracking and support options.
Virtual support wherever you need it
Claire, Teva’s Virtual Health
Assistant, can provide instant
information and support from
your smartphone or computer.
...on your smartphone or tablet
The award finalist COPAXONE
iTracker® provides injection
tracking support from your
smartphone or tablet.
...from your desktop
COPAXONE webTracker™ can
help you track your injections
from your computer.
Offline support
Use the Printed Planner and
Reminder Stickers* to stay on track
with your injection schedule.
Please see Important Safety
Information on pages 20-21,
Available on the iTunes® App Store®
for Apple® mobile devices and
on Google Play™ for Android™
mobile devices.
Printed Planner
sun
mon
tue
wed
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5
12
6
13
1
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14
8
15
2
thur
fri
2
3
9
10
16
sat
4
3
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17
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Reminder
Stickers*
DECEMBER ’13
s m t w t f s
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31
left arm
stomach
Checklist:
___ Plot important appointments
___ Place refill reminder
___ Note birthdays, anniversaries,
and celebrations
___
___
___
Notes:
F EBRUARY ’14
s m t w t f s
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28
right arm
*Available for 3-timesa-week COPAXONE®
(glatiramer acetate
injection) 40 mg only.
right thigh
left thigh
right hip
left hip
13
Teva’s Shared Solutions® cares about empowering you to
stay committed to your COPAXONE® (glatiramer acetate
injection) therapy.
We can connect you with resources, people, and programs to
help you obtain knowledge about Teva’s COPAXONE® and RMS.
We can provide ways for you to stay current on the latest
COPAXONE® management tools and developments, while
creating opportunities for you to meet and interact with others
who are also living with RMS.
Shauna F., diagnosed with
14
EDUCATION
Experience educational support
Access Peer Resources
Teva’s Shared Solutions® recognizes the importance of
making a personal connection with someone who has had
similar experiences. Shared Solutions® can match you with
an MS Peer so you can get support from someone who can
relate to your experience of living with RMS. MS Peers are
compensated by Teva.
Join Lift MS, an online Facebook community for people with RMS
Lift MS is a patient community hosted
by Teva Neuroscience, Inc. Lift MS
provides information and encouragement
by connecting you with others whose lives
are affected by RMS. Through education,
information, and empowerment, we hope
to give you the Lift you need!
Find Lift MS on Facebook today at www.facebook.com/LiftMS.
Call your doctor right away if you develop hives, skin rash with
irritation, dizziness, sweating, chest pain, trouble breathing, or
severe pain at the injection site.
15
Teva’s Shared Solutions® wants to keep you informed,
educated, and connected. That’s why we strive to provide
you with personalized services and support tools for every
stage of your therapy experience.
MORE THAN
1,700
EVENTS HOSTED BY
SHARED SOLUTIONS ®1
Number of live events hosted by Shared Solutions® in 2015.
16
EDUCATION
Experience educational support
Educational programs
Teva’s Shared Solutions® wants to keep you connected to
the MS community. That’s why we provide you with live
educational events, webcasts, and teleconferences to help
you stay informed and empowered.
Personalized communications
Teva’s Shared Solutions® is committed to staying in close
touch. You will receive personalized, ongoing contact from
the team at Shared Solutions® via email, mail, or phone, so
you can be confident knowing that you have someone with
you every step of the way.
Find a live local event or program near you.
Visit www.copaxone.com/joinevent.
Chest pain may occur either as part of the immediate postinjection
reaction or on its own.
17
Wherever you are in your therapy experience—whether
you are just starting on COPAXONE® (glatiramer acetate
injection) therapy, trying to build your support network,
or renewing your commitment to therapy—you will always
have access to support from Teva’s Shared Solutions®.
Are you making the most of the personalized support we offer?
Financial
Support
Educational
Resources
Training
and Nurse
Support
18
Experience caring, ongoing support
To find the resources and support that are relevant to your
current needs, make sure to take advantage of the Shared
Solutions® Services Tool.
Through the virtual profiles of Emily, Angela, and Mike, you
can explore the full breadth of services that are available to
people taking Teva’s COPAXONE® (glatiramer acetate injection)
—and discover the offerings that may be most relevant to your
needs at different stages of your therapy experience.
Tour the full breadth of personalized services today
Visit www.copaxone.com/shared-solutions/
shared-solutions-tool, or call Shared
Solutions® at 1-800-887-8100.
Tell your doctor if you experience chest pain that lasts for a long time
or feels very intense.
19
Use
COPAXONE® (glatiramer acetate injection) is prescription medicine
used for the treatment of people with relapsing forms of multiple
sclerosis (MS).
Do not take COPAXONE® if you are allergic to glatiramer acetate or
mannitol.
COPAXONE®. This reaction can involve flushing (feeling of warmth
and/or redness), chest tightness or pain with heart palpitations,
anxiety, and trouble breathing. These symptoms generally appear
within minutes of an injection, last about 15 minutes, and do not
require specific treatment. During the postmarketing period, there
have been reports of patients with similar symptoms who received
emergency medical care. If symptoms become severe, call the
emergency phone number in your area. Call your doctor right away if
you develop hives, skin rash with irritation, dizziness, sweating, chest
pain, trouble breathing, or severe pain at the injection site. If any of
the above occurs, do not give yourself any more injections until your
doctor tells you to begin again.
Please see additional Important Safety Information on page 21, and
20
Important Safety Information (continued)
Chest pain may occur either as part of the immediate postinjection
reaction or on its own. This pain should only last a few minutes.
You may experience more than one such episode, usually beginning
at least one month after starting treatment. Tell your doctor if you
experience chest pain that lasts for a long time or feels very intense.
A permanent indentation under the skin (lipoatrophy or, rarely,
necrosis) at the injection site may occur, due to local destruction of
fat tissue. Be sure to follow proper injection technique and inform
your doctor of any skin changes.
The most common side effects in studies of COPAXONE® (glatiramer
acetate injection) are redness, pain, swelling, itching, or a lump at the
site of injection, flushing, rash, shortness of breath, and chest pain.
These are not all of the possible side effects of COPAXONE®. For a
complete list, ask your doctor or pharmacist. Tell your doctor about
any side effects you have while taking COPAXONE®.
You are encouraged to report negative side effects of prescription drugs
to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see full Prescribing Information on pages 22-33.
21
HIGHLIGHTS OF PRESCRIBING INFORMATION
CONTRAINDICATIONS
Known hypersensitivity to glatiramer acetate or mannitol (4)
These highlights do not include all the information needed
to use COPAXONE® safely and effectively. See full prescribing information for COPAXONE.
WARNINGS AND PRECAUTIONS
• Immediate Post-Injection Reaction (flushing, chest pain,
palpitations, anxiety, dyspnea, throat constriction, and/or
urticaria), generally transient and self-limiting (5.1)
• Chestpain,usuallytransient(5.2)
• Lipoatrophyandskinnecrosismayoccur.Instructpatients
in proper injection technique and to rotate injection sites
(5.3)
• COPAXONEcanmodifyimmuneresponse(5.4)
COPAXONE (glatiramer acetate injection) for subcutaneous use
Initial U.S. Approval: 1996
RECENT MAJOR CHANGES
Dosage and Administration,
Recommend Dose (2.1)
Dosage and Administration,
Instructions for Use (2.2)
Warnings and Precautions,
Immediate Post-Injection Reaction (5.1)
Warnings and Precautions, Chest Pain (5.2)
Warnings and Precautions,
Lipoatrophy and Skin Necrosis (5.3)
01/2014
ADVERSE REACTIONS
• IncontrolledstudiesofCOPAXONE20mg/mL,mostcommon adverse reactions (≥10% and ≥1.5 times higher than
placebo)were:injectionsitereactions,vasodilatation,rash,
dyspnea, and chest pain (6.1)
• InacontrolledstudyofCOPAXONE40mg/mL,mostcommon adverse reactions (≥10% and ≥1.5 times higher than
placebo)were:injectionsitereactions(6.1)
01/2014
01/2014
01/2014
01/2014
INDICATIONS AND USAGE
COPAXONE is indicated for the treatment of patients with
relapsing-forms of multiple sclerosis (1).
To report SUSPECTED ADVERSE REACTIONS, contact TEVA
at 1-800-221-4026 or FDA at 1-800-FDA-1088 or www.fda.
gov/medwatch.
DOSAGE AND ADMINISTRATION
• For subcutaneous injection only; doses are not interchangeable(2.1)
• COPAXONE20mg/mLperday(2.1)
• COPAXONE40mg/mLthreetimesperweek(2.1)
• Beforeuse,allowthesolutiontowarmtoroomtemperature (2.2)
USE IN SPECIFIC POPULATIONS
• NursingMothers:ItisnotknownifCOPAXONEisexcreted
in human milk (8.3)
• PediatricUse:ThesafetyandeffectivenessofCOPAXONE
havenotbeenestablishedinpatientsunder18yearsof
age (8.4)
DOSAGE FORMS AND STRENGTHS
• Injection:20mg/mLinasingle-doseprefilledsyringewith
a white plunger (3)
• Injection:40mg/mLinasingle-dose,prefilledsyringewith
ablueplunger(3)
See 17 for PATIENT COUNSELING INFORMATION and
FDA-approved patient labeling.
Revised: 01/2014
FULL PRESCRIBING INFORMATION: CONTENTS*
8.3
8.4
8.5
8.6
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dose
2.2 Instructions for Use
NursingMothers
Pediatric Use
Geriatric Use
UseinPatientswithImpairedRenalFunction
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 MechanismofAction
12.3 Pharmacokinetics
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
5 WARNINGS AND PRECAUTIONS
5.1 Immediate Post-Injection Reaction
5.2 Chest Pain
5.3 Lipoatrophy and Skin Necrosis
5.4 Potential Effects on Immune Response
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis,Mutagenesis,ImpairmentofFertility
6 ADVERSE REACTIONS
6.1 ClinicalTrialsExperience
6.2 Postmarketing Experience
17 PATIENT COUNSELING INFORMATION
14 CLINICAL STUDIES
16 HOW SUPPLIED/STORAGE AND HANDLING
*Sectionsorsubsectionsomittedfromthefullprescribing
information are not listed.
7 DRUG INTERACTIONS
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 LaborandDelivery
22
1
FULL PRESCRIBING INFORMATION
COPAXONE (glatiramer acetate injection)
relationship of this chest pain to an injection was not always
known. The pain was usually transient, often unassociated
with other symptoms, and appeared to have no clinical
sequelae. Some patients experienced more than one such
episode,andepisodesusuallybeganatleast1monthafter
theinitiationoftreatment.Thepathogenesisofthissymptom
is unknown.
5.3 Lipoatrophy and Skin Necrosis
At injection sites, localized lipoatrophy and, rarely, injection
site skin necrosis may occur. Lipoatrophy occurred in approximately 2% of patients exposed to COPAXONE 20 mg per mL in
the5placebo-controlledtrialscomparedtononeonplacebo,
and 0.5% of patients exposed to COPAXONE 40 mg per mL in
asingleplacebo-controlledtrialandnoneonplacebo.Skin
necrosishasonlybeenobservedinthepost-marketingsetting. Lipoatrophy may occur at various times after treatment
onset(sometimesafterseveralmonths)andisthoughttobe
permanent. There is no known therapy for lipoatrophy. To
assistinpossiblyminimizingtheseevents,thepatientshould
beadvisedtofollowproperinjectiontechniqueandtorotate
injection sites with each injection.
5.4 Potential Effects on Immune Response
Because COPAXONE can modify immune response, it may
interfere with immune functions. For example, treatment
with COPAXONE may interfere with the recognition of foreign
antigens in a way that would undermine the body’s tumor
surveillanceanditsdefensesagainstinfection.Thereisno
evidencethatCOPAXONEdoesthis,buttherehasnotbeena
systematicevaluationofthisrisk.BecauseCOPAXONEisan
antigenicmaterial,itispossiblethatitsusemayleadtothe
inductionofhostresponsesthatareuntoward,butsystematicsurveillancefortheseeffectshasnotbeenundertaken.
Although COPAXONE is intended to minimize the autoimmuneresponsetomyelin,thereisthepossibilitythatcontinued alteration of cellular immunity due to chronic treatment
with COPAXONE may result in untoward effects.
Glatiramer acetate-reactive antibodies are formed in most
patientsreceivingglatirameracetate.Studiesinboththerat
and monkey have suggested that immune complexes are
depositedintherenalglomeruli.Furthermore,inacontrolled
trial of 125 RRMS patients given COPAXONE 20 mg per
mL,subcutaneouslyeverydayfor2years,serumIgGlevels
reachedatleast3timesbaselinevaluesin80%ofpatients
by3monthsofinitiationoftreatment.By12monthsoftreatment, however, 30% of patients still had IgG levels at least
3timesbaselinevalues,and90%hadlevelsabovebaseline
by12months.TheantibodiesareexclusivelyoftheIgGsubtype and predominantly of the IgG-1 subtype. No IgE type
antibodies could be detected in any of the 94 sera tested;
nevertheless,anaphylaxiscanbeassociatedwiththeadministrationofmostanyforeignsubstance,andtherefore,this
riskcannotbeexcluded.
1 INDICATIONS AND USAGE
COPAXONE is indicated for the treatment of patients with
relapsing forms of multiple sclerosis.
2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dose
COPAXONEisforsubcutaneoususeonly.Donotadminister
intravenously.Thedosingscheduledependsontheproduct
strengththatisselected.Therecommendeddosesare:
• COPAXONE20mgpermL:administeronceperday
or
• COPAXONE40mgpermL:administerthreetimesperweek
and at least 48 hours apart
COPAXONE 20 mg per mL and COPAXONE 40 mg per mL
arenotinterchangeable.
2.2 Instructions for Use
Remove one blister-packaged prefilled syringe from the
refrigeratedcarton.Lettheprefilledsyringestandatroom
temperature for 20 minutes to allow the solution to warm
to room temperature. Visually inspect the syringe for particulate matter and discoloration prior to administration.
The solution in the syringe should appear clear, colorless
to slightly yellow. If particulate matter or discoloration is
observed,discardthesyringe.
Areas for subcutaneous self-injection include arms, abdomen,hips,andthighs.Theprefilledsyringeisforsingleuse
only. Discard unused portions.
3 DOSAGE FORMS AND STRENGTHS
• Injection:20mgpermLinasingle-dose,prefilledsyringe
withawhiteplunger.Forsubcutaneoususeonly.
• Injection:40mgpermLinasingle-dose,prefilledsyringe
withablueplunger.Forsubcutaneoususeonly.
4 CONTRAINDICATIONS
COPAXONE is contraindicated in patients with known hypersensitivity to glatiramer acetate or mannitol.
5 WARNINGS AND PRECAUTIONS
5.1 Immediate Post-Injection Reaction
Approximately 16% of patients exposed to COPAXONE
20mgpermLinthe5placebo-controlledtrialscomparedto
4%ofthoseonplacebo,andapproximately2%ofpatients
exposed to COPAXONE 40 mg per mL in a placebo-controlled trial compared to none on placebo, experienced a
constellation of symptoms immediately after injection that
includedatleasttwoofthefollowing:flushing,chestpain,
palpitations, anxiety, dyspnea, constriction of the throat, and
urticaria. In general, these symptoms have their onset several months after the initiation of treatment, although they
may occur earlier, and a given patient may experience one
or several episodes of these symptoms. Whether or not any
ofthesesymptomsactuallyrepresentaspecificsyndrome
is uncertain. Typically, the symptoms were transient and
self-limited and did not require treatment; however, there
have been reports of patients with similar symptoms who
received emergency medical care. Whether an immunologic
or nonimmunologic mechanism mediates these episodes,
or whether several similar episodes seen in a given patient
have identical mechanisms, is unknown.
5.2 Chest Pain
Approximately 13% of COPAXONE 20 mg per mL patients
inthe5placebo-controlledstudiescomparedto6%ofplacebo patients, and approximately 2% of patients exposed
to COPAXONE 40 mg per mL in a placebo-controlled trial
compared to 1% of placebo patients, experienced at least
one episode of transient chest pain. While some of these episodes occurred in the context of the Immediate Post-InjectionReactiondescribedabove,manydidnot.Thetemporal
6 ADVERSE REACTIONS
6.1 Clinical Trials Experience
Because clinical trials are conducted under widely varying
conditions, adverse reaction rates observed in the clinical
trialsofadrugcannotbedirectlycomparedtoratesinthe
clinicaltrialsofanotherdrugandmaynotreflecttherates
observedinclinicalpractice.
Incidence in Controlled Clinical Trials
COPAXONE 20 mg per mL per day
Among 563 patients treated with COPAXONE in blinded
placebo-controlledtrials,approximately5%ofthesubjects
discontinuedtreatmentbecauseofanadversereaction.The
adverse reactions most commonly associated with discontinuation were: injection site reactions, dyspnea, urticaria,
vasodilatation, and hypersensitivity. The most common
adversereactionswere:injectionsitereactions,vasodilatation, rash, dyspnea, and chest pain.
2
23
Table1liststreatment-emergentsignsandsymptomsthat
occurred in at least 2% of patients treated with COPAXONE
20mgpermLintheplacebo-controlledtrials.Thesesigns
and symptoms were numerically more common in patients
treated with COPAXONE than in patients treated with placebo.Adversereactionswereusuallymildinintensity.
COPAXONE
20 mg/mL Placebo
(n=563)
(n=564)
Immune System HyperDisorders
sensitivity
Infections And
Infestations
Table 1: Adverse reactions in controlled clinical trials
with an incidence ≥2% of patients and more frequent with
COPAXONE (20 mg per mL daily) than with placebo
Lymphadenopathy
Cardiac
Disorders
Palpitations
9%
4%
Tachycardia
5%
2%
Eye Disorders
Eye Disorder
3%
1%
Diplopia
3%
2%
Nausea
15%
11%
Vomiting
7%
4%
Gastrointestinal
Disorders
General
Disorders And
Administration
Site
Conditions
30%
28%
Influenza
14%
13%
Rhinitis
7%
5%
Bronchitis
6%
5%
Gastroenteritis
6%
4%
Vaginal
Candidiasis
4%
2%
Weight
Increased
3%
1%
Musculoskeletal BackPain
And Connective
Tissue
Disorders
12%
10%
Benign
Neoplasms
Neoplasm
Benign,
of Skin
Malignant
AndUnspecified
(Incl Cysts
And Polyps)
2%
1%
Tremor
4%
2%
Migraine
4%
2%
Syncope
3%
2%
Speech
Disorder
2%
1%
Psychiatric
Disorders
Anxiety
13%
10%
Nervousness
2%
1%
Renal
And Urinary
Disorders
Micturition
Urgency
5%
4%
14%
4%
6%
5%
3%
Dysphagia
2%
1%
Injection Site
Erythema
43%
10%
Injection Site
Pain
40%
20%
Injection Site
Pruritus
27%
Injection Site
Mass
26%
6%
Asthenia
22%
21%
Pain
20%
17%
Injection Site
Edema
19%
4%
Chest Pain
13%
6%
Injection Site
Inflammation
9%
1%
Edema
8%
2%
Injection Site
Reaction
8%
1%
Pyrexia
24
7%
6%
Metabolism
And Nutrition
Disorders
Nervous
System
Disorders
4%
Dyspnea
Respiratory,
Thoracic
Cough
AndMediastinal
Laryngospasm
Disorders
Skin And
Subcutaneous
Tissue
Disorders
5%
Injection Site
Hypersensitivity
4%
0%
Local Reaction
3%
1%
Chills
3%
1%
FaceEdema
3%
1%
Edema
Peripheral
3%
2%
Injection Site
Fibrosis
2%
1%
Injection Site
Atrophy*
2%
0%
2%
Infection
COPAXONE
20 mg/mL Placebo
(n=563)
(n=564)
BloodAnd
Lymphatic
System
Disorders
3%
2%
1%
Rash
19%
11%
Hyperhidrosis
7%
5%
Pruritus
5%
4%
Urticaria
3%
1%
Skin Disorder
3%
1%
Vascular
Vasodilatation
20%
5%
Disorders
*Injection site atrophy comprises terms relating to localized
lipoatrophy at injection site
Adversereactionswhichoccurredonlyin4to5moresubjects in the COPAXONE group than in the placebo group
(less than 1% difference), but for which a relationship to
COPAXONEcouldnotbeexcluded,werearthralgiaandherpes simplex.
Laboratory analyses were performed on all patients participating in the clinical program for COPAXONE. Clinicallysignificantlaboratoryvaluesforhematology,chemistry,and
3
urinalysis were similar for both COPAXONE and placebo
groupsinblindedclinicaltrials.Incontrolledtrialsonepatient
discontinuedtreatmentduetothrombocytopenia(16x109/L),
which resolved after discontinuation of treatment.
Data on adverse reactions occurring in the controlled clinical trials of COPAXONE 20 mg per mL were analyzed to
evaluate differences based on sex. No clinically-significant
differenceswereidentified.Ninety-sixpercentofpatientsin
theseclinicaltrialswereCaucasian.Themajorityofpatients
treatedwithCOPAXONEwerebetweentheagesof18and45.
Consequently, data are inadequate to perform an analysis of
the adverse reaction incidence related to clinically-relevant
agesubgroups.
Other Adverse Reactions
In the paragraphs that follow, the frequencies of less commonly reported adverse clinical reactions are presented.
Because the reports include reactions observed in open
anduncontrolledpremarketingstudies(n=979),theroleof
COPAXONEintheircausationcannotbereliablydetermined.
Furthermore, variability associated with adverse reaction
reporting, the terminology used to describe adverse reactions, etc., limit the value of the quantitative frequency estimates provided. Reaction frequencies are calculated as the
number of patients who used COPAXONE and reported a
reactiondividedbythetotalnumberofpatientsexposedto
COPAXONE. All reported reactions are included except those
alreadylistedintheprevioustable,thosetoogeneraltobe
informative, and those not reasonably associated with the
useofthedrug.Reactionsarefurtherclassifiedwithinbody
system categories and enumerated in order of decreasing
frequencyusingthefollowingdefinitions:Frequent adverse
reactions are defined as those occurring in at least 1/100
patients and infrequent adverse reactions are those occurring in 1/100 to 1/1,000 patients.
Body as a Whole:
Frequent:Abscess.
Infrequent: Injection site hematoma, moon face, cellulitis, hernia, injection site abscess, serum sickness, suicide
attempt, injection site hypertrophy, injection site melanosis,
lipoma, and photosensitivity reaction.
Cardiovascular:
Frequent: Hypertension.
Infrequent: Hypotension, midsystolic click, systolic murmur,
atrial fibrillation, bradycardia, fourth heart sound, postural
hypotension, and varicose veins.
Digestive:
Infrequent: Dry mouth, stomatitis, burning sensation on
tongue, cholecystitis, colitis, esophageal ulcer, esophagitis,
gastrointestinal carcinoma, gum hemorrhage, hepatomegaly, increased appetite, melena, mouth ulceration, pancreas
disorder, pancreatitis, rectal hemorrhage, tenesmus, tongue
discoloration, and duodenal ulcer.
Endocrine:
Infrequent: Goiter, hyperthyroidism, and hypothyroidism.
Gastrointestinal:
Frequent: Bowel urgency, oral moniliasis, salivary gland
enlargement, tooth caries, and ulcerative stomatitis.
Hemic and Lymphatic:
Infrequent: Leukopenia, anemia, cyanosis, eosinophilia,
hematemesis, lymphedema, pancytopenia, and splenomegaly.
Metabolic and Nutritional:
Infrequent:Weightloss,alcoholintolerance,Cushing’ssyndrome,gout,abnormalhealing,andxanthoma.
Musculoskeletal:
Infrequent: Arthritis, muscle atrophy, bone pain, bursitis,
kidney pain, muscle disorder, myopathy, osteomyelitis, tendon pain, and tenosynovitis.
Nervous:
Frequent:Abnormaldreams,emotionallability,andstupor.
Infrequent: Aphasia, ataxia, convulsion, circumoral paresthesia, depersonalization, hallucinations, hostility, hypokinesia, coma, concentration disorder, facial paralysis,
decreased libido, manic reaction, memory impairment,
myoclonus, neuralgia, paranoid reaction, paraplegia, psychotic depression, and transient stupor.
Respiratory:
Frequent: Hyperventilation and hay fever.
Infrequent: Asthma, pneumonia, epistaxis, hypoventilation,
and voice alteration.
Skin and Appendages:
Frequent: Eczema, herpes zoster, pustular rash, skin atrophy, and warts.
Infrequent: Dry skin, skin hypertrophy, dermatitis, furunculosis, psoriasis, angioedema, contact dermatitis, erythema
nodosum, fungal dermatitis, maculopapular rash, pigmentation,benignskinneoplasm,skincarcinoma,skinstriae,and
vesiculobullousrash.
Special Senses:
Frequent:Visualfielddefect.
Infrequent: Dry eyes, otitis externa, ptosis, cataract, corneal
ulcer,mydriasis,opticneuritis,photophobia,andtasteloss.
Urogenital:
Frequent: Amenorrhea, hematuria, impotence, menorrhagia,
suspicious papanicolaou smear, urinary frequency, and vaginal hemorrhage.
Infrequent: Vaginitis, flank pain (kidney), abortion, breast
engorgement,breastenlargement,carcinomain situ cervix,
fibrocystic breast, kidney calculus, nocturia, ovarian cyst,
priapism, pyelonephritis, abnormal sexual function, and
urethritis.
COPAXONE 40 mg per mL three times per week
Among943patientstreatedwithCOPAXONE40mgpermL
threetimesperweekinablinded,placebo-controlledtrial,
approximately 3% of the subjects discontinued treatment
becauseofanadversereaction.Themostcommonadverse
reactions were injection site reactions, which were also the
most common cause of discontinuation.
Table2liststreatment-emergentsignsandsymptomsthat
occurred in at least 2% of patients treated with COPAXONE
40mgpermLintheblinded,placebo-controlledtrial.These
signs and symptoms were numerically more common in
patients treated with COPAXONE 40 mg per mL than in
patientstreatedwithplacebo.Adversereactionswereusually mild in intensity.
Table 2: Adverse reactions in a controlled clinical trial
with an incidence ≥2% of patients and more frequent with
COPAXONE (40 mg per mL three times per week) than with
placebo
COPAXONE
40 mg/mL Placebo
(n=943)
(n=461)
General
Disorders And
Administration
Site
Conditions
4
Injection Site
Erythema
22%
2%
Injection Site
Pain
10%
2%
Injection Site
Mass
6%
0%
Injection Site
Pruritus
6%
0%
25
Nervous System:myelitis;meningitis;CNSneoplasm;cerebrovascularaccident;brainedema;abnormaldreams;aphasia;convulsion;neuralgia
Respiratory System: pulmonary embolus; pleural effusion;
carcinoma of lung
Special Senses:glaucoma;blindness
Urogenital System:urogenitalneoplasm;urineabnormality;
ovarian carcinoma; nephrosis; kidney failure; breast carcinoma;bladdercarcinoma;urinaryfrequency
COPAXONE
40 mg/mL Placebo
(n=943)
(n=461)
Injection Site
Edema
6%
0%
Pyrexia
3%
2%
Influenza-like
Illness
3%
2%
Injection Site
Inflammation
2%
0%
Chills
2%
0%
Chest Pain
2%
1%
Nasopharyngitis
11%
9%
Respiratory
TractInfection
Viral
3%
2%
Respiratory,
ThoracicAnd
Mediastinal
Disorders
Dyspnea
3%
0%
Vascular
Disorders
Vasodilatation
3%
0%
2%
1%
Erythema
2%
0%
Rash
2%
1%
Infections And
Infestations
Gastrointestinal Nausea
Disorders
Skin And
Subcutaneous
Tissue
Disorders
7 DRUG INTERACTIONS
InteractionsbetweenCOPAXONEandotherdrugshavenot
beenfullyevaluated.Resultsfromexistingclinicaltrialsdo
notsuggestanysignificantinteractionsofCOPAXONEwith
therapiescommonlyusedinMSpatients,includingtheconcurrent use of corticosteroids for up to 28 days. COPAXONE
hasnotbeenformallyevaluatedincombinationwithinterferonbeta.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
PregnancyCategoryB.
Administrationofglatirameracetatebysubcutaneousinjection to pregnant rats and rabbits resulted in no adverse
effects on offspring development. There are no adequate
and well-controlled studies in pregnant women. Because
animal reproduction studies are not always predictive of
humanresponse,COPAXONEshouldbeusedduringpregnancy only if clearly needed.
Inratsorrabbitsreceivingglatirameracetatebysubcutaneous injection during the period of organogenesis, no adverse
effectsonembryo-fetaldevelopmentwereobservedatdoses
up to 37.5 mg/kg/day (18 and 36 times, respectively, the
therapeutic human dose of 20 mg/day on a mg/m2 basis).
Inratsreceivingsubcutaneousglatirameracetateatdosesof
up to 36 mg/kg from day 15 of pregnancy throughout lactation,nosignificanteffectsondeliveryoronoffspringgrowth
anddevelopmentwereobserved.
8.2 Labor and Delivery
TheeffectsofCOPAXONEonlaboranddeliveryinpregnant
women are unknown.
8.3 Nursing Mothers
It is not known if glatiramer acetate is excreted in human
milk.Becausemanydrugsareexcretedinhumanmilk,cautionshouldbeexercisedwhenCOPAXONEisadministered
to a nursing woman.
8.4 Pediatric Use
The safety and effectiveness of COPAXONE have not been
establishedinpatientsunder18yearsofage.
8.5 Geriatric Use
COPAXONEhasnotbeenstudiedinelderlypatients.
8.6 Use in Patients with Impaired Renal Function
Thepharmacokineticsofglatirameracetateinpatientswith
impairedrenalfunctionhavenotbeendetermined.
Nonewadversereactionsappearedinsubjectstreatedwith
COPAXONE 40 mg per mL three times per week as compared to subjects treated with COPAXONE 20 mg per mL
per day in clinical trials and during postmarketing experience. Data on adverse reactions occurring in the controlled
clinical trial of COPAXONE 40 mg per mL were analyzed to
evaluatedifferencesbasedonsex.Noclinicallysignificant
differenceswereidentified.Ninety-eightpercentofpatients
in this clinical trial were Caucasian and the majority were
betweentheagesof18and50.Consequently,dataareinadequate to perform an analysis of the adverse reaction incidence related to clinically-relevant age groups.
6.2 Postmarketing Experience
Thefollowingadverseeventsoccurringundertreatmentwith
COPAXONE 20 mg per mL since market introduction and not
mentionedabovehavebeenidentifiedduringpostapproval
useofCOPAXONE.Becausetheseeventsarereportedvoluntarily from a population of uncertain size, it is not always
possibletoreliablyestimatetheirfrequencyorestablisha
causal relationship to drug exposure.
Body as a Whole: sepsis; SLE syndrome; hydrocephalus;
enlargedabdomen;allergicreaction;anaphylactoidreaction
Cardiovascular System: thrombosis; peripheral vascular
disease;pericardialeffusion;myocardialinfarct;deepthrombophlebitis; coronary occlusion; congestive heart failure;
cardiomyopathy;cardiomegaly;arrhythmia;anginapectoris
Digestive System: tongue edema; stomach ulcer; hemorrhage; liver function abnormality; liver damage; hepatitis;
eructation;cirrhosisoftheliver;cholelithiasis
Hemic and Lymphatic System:thrombocytopenia;lymphomalikereaction;acuteleukemia
Metabolic and Nutritional Disorders: hypercholesterolemia
Musculoskeletal System: rheumatoid arthritis; generalized
spasm
26
11 DESCRIPTION
Glatiramer acetate, the active ingredient of COPAXONE, consists of the acetate salts of synthetic polypeptides, containing four naturally occurring amino acids: L-glutamic acid,
L-alanine, L-tyrosine, and L-lysine with an average molar
fractionof0.141,0.427,0.095,and0.338,respectively.The
average molecular weight of glatiramer acetate is 5,000 –
9,000 daltons. Glatiramer acetate is identified by specific
antibodies.
Chemically, glatiramer acetate is designated L-glutamic acid
polymer with L-alanine, L- lysine and L-tyrosine, acetate
(salt).Itsstructuralformulais:
(Glu, Ala, Lys, Tyr)x • xCH3COOH
(C5H9NO4 • C3H7NO2 • C6H14N2O2 • C9H11NO3)x • xC2H4O2
CAS - 147245-92-9
5
COPAXONE is a clear, colorless to slightly yellow, sterile, nonpyrogenicsolutionforsubcutaneousinjection.Each1mLof
COPAXONE solution contains 20 mg or 40 mg of glatiramer
acetateandthefollowinginactiveingredient:40mgofmannitol. The pH of the solutions is approximately 5.5 to 7.0.
Thebiologicalactivityofglatirameracetateisdeterminedby
itsabilitytoblocktheinductionofexperimentalautoimmune
encephalomyelitis (EAE) in mice.
14 CLINICAL STUDIES
Evidence supporting the effectiveness of COPAXONE derives
from five placebo-controlled trials, four of which used a
COPAXONE dose of 20 mg per mL per day and one of which
used a COPAXONE dose of 40 mg per mL three times per
week.
COPAXONE 20 mg per mL per day
Study 1 was performed at a single center. Fifty patients
were enrolled and randomized to receive daily doses of
either COPAXONE, 20 mg per mL subcutaneously, or placebo (COPAXONE: n=25; placebo: n=25). Patients were
diagnosedwithRRMSbystandardcriteria,andhadhadat
least 2 exacerbations during the 2 years immediately precedingenrollment.Patientswereambulatory,asevidenced
byascoreofnomorethan6ontheKurtzkeDisabilityScale
Score (DSS), a standard scale ranging from 0–Normal to
10–DeathduetoMS.Ascoreof6isdefinedasoneatwhich
a patient is still ambulatory with assistance; a score of 7
means the patient must use a wheelchair.
Patients were examined every 3 months for 2 years, as well
aswithinseveraldaysofapresumedexacerbation.Toconfirmanexacerbation,ablindedneurologisthadtodocument
objective neurologic signs, as well as document the existence of other criteria (e.g., the persistence of the neurological signs for at least 48 hours).
The protocol-specified primary outcome measure was
the proportion of patients in each treatment group who
remainedexacerbationfreeforthe2yearsofthetrial,but
twootherimportantoutcomeswerealsospecifiedasendpoints: the frequency of attacks during the trial, and the
changeinthenumberofattackscomparedwiththenumber
which occurred during the previous 2 years.
Table3presentsthevaluesofthethreeoutcomesdescribed
above, as well as several protocol-specified secondary
measures. These values are based on the intent-to-treat
population (i.e., all patients who received at least 1 dose of
treatmentandwhohadatleast1on-treatmentassessment):
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
The mechanism(s) by which glatiramer acetate exerts its
effects in patients with MS are not fully understood. However, glatiramer acetate is thought to act by modifying
immune processes that are believed to be responsible for
the pathogenesis of MS. This hypothesis is supported by
findingsofstudiesthathavebeencarriedouttoexplorethe
pathogenesis of experimental autoimmune encephalomyelitis, a condition induced in animals through immunization
against central nervous system derived material containing
myelin and often used as an experimental animal model of
MS. Studies in animals and in vitro systems suggest that
uponitsadministration,glatirameracetate-specificsuppressorT-cellsareinducedandactivatedintheperiphery.
Because glatiramer acetate can modify immune functions,
concernsexistaboutitspotentialtoalternaturally-occurring
immune responses. There is no evidence that glatiramer
acetatedoesthis,butthishasnotbeensystematicallyevaluated [see Warnings and Precautions (5.4)].
12.3 Pharmacokinetics
Results obtained in pharmacokinetic studies performed in
humans(healthyvolunteers)andanimalssupportthatasubstantial fraction of the therapeutic dose delivered to patients
subcutaneously is hydrolyzed locally. Larger fragments of
glatirameracetatecanberecognizedbyglatirameracetatereactive antibodies. Some fraction of the injected material,
either intact or partially hydrolyzed, is presumed to enter
thelymphaticcirculation,enablingittoreachregionallymph
nodes, and some may enter the systemic circulation intact.
Table 3: Study 1 Efficacy Results
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
In a 2-year carcinogenicity study, mice were administered up
to60mg/kg/dayglatirameracetatebysubcutaneousinjection (up to 15 times the human therapeutic dose of 20 mg/
day on a mg/m2basis).Noincreaseinsystemicneoplasms
was observed. In males receiving the 60-mg/kg/day dose,
there was an increased incidence of fibrosarcomas at the
injection sites. These sarcomas were associated with skin
damageprecipitatedbyrepetitiveinjectionsofanirritantover
a limited skin area.
In a 2-year carcinogenicity study, rats were administered up
to30mg/kg/dayglatirameracetatebysubcutaneousinjection (up to 15 times the human therapeutic dose on a mg/m2
basis).Noincreaseinneoplasmswasobserved.
Glatiramer acetate was not mutagenic in in vitro (Ames test,
mouse lymphoma tk) assays. Glatiramer acetate was clastogenic in two separate in vitro chromosomal aberration
assaysinculturedhumanlymphocytesbutnotclastogenic
in an in vivo mousebonemarrowmicronucleusassay.
Whenglatirameracetatewasadministeredbysubcutaneous
injection prior to and during mating (males and females) and
throughout gestation and lactation (females) at doses up to
36 mg/kg/day (18 times the human therapeutic dose on a
mg/m2basis)noadverseeffectswereobservedonreproductive or developmental parameters.
%Relapse-Free
Patients
MeanRelapse
Frequency
Reduction in
Relapse Rate
Compared to
Prestudy
MedianTimeto
FirstRelapse
(days)
% of
ProgressionFree*Patients
COPAXONE
20 mg/mL
(n=25)
Placebo
(n=25)
P-Value
14/25 (56%)
7/25 (28%)
0.085
0.6/2 years
2.4/2 years
0.005
3.2
1.6
0.025
>700
150
0.03
20/25 (80%) 13/25 (52%)
0.07
*Progressionwasdefinedasanincreaseofatleast1point
on the DSS, persisting for at least 3 consecutive months.
Study 2 was a multicenter trial of similar design which was performedin11UScenters.Atotalof251patients(COPAXONE:
n=125; placebo: n=126) were enrolled. The primary outcomemeasurewastheMean2-YearRelapseRate.Table4
presents the values of this outcome for the intent-to-treat
population,aswellasseveralsecondarymeasures:
6
27
Table 4: Study 2 Efficacy Results
COPAXONE
20 mg/mL
(n=125)
Placebo
(n=126)
P-Value
1.19/2years
1.68 /2 years
0.055
42/125 (34%) 34/126 (27%)
0.25
MeanNo.of
Relapses
% RelapseFreePatients
287
MedianTimeto
FirstRelapse
(days)
% of
ProgressionFreePatients
198
-0.05
Table 5: Study 4 MRI Results
0.23
98/125(78%) 95/126(75%)
MeanChange
in DSS
similar to those in the second study with the additional criterion that patients had to have at least one Gd-enhancing
lesion on the screening MRI. The patients were treated in
adouble-blindmannerforninemonths,duringwhichthey
underwent monthly MRI scanning. The primary endpoint
forthedouble-blindphasewasthetotalcumulativenumber
ofT1Gd-enhancinglesionsovertheninemonths.Table5
summarizes the results for the primary outcome measure
monitored during the trial for the intent-to-treat cohort.
+0.21
COPAXONE Placebo P-Value
20 mg/mL (n=120)
(n=119)
0.48
0.023
Cumulative Number of Enhancing Lesions
(median)
18
Second Exacerbation (%)
Placebo
30%
25%
Copaxone
15%
10%
5%
Day 360
179
165
Day 540
166
136
Day 720
124
98
Day 900
78
55
Day 1080
22
15
Exacerbation (%)
Patients treated with COPAXONE demonstrated fewer new
T2lesionsatthelastobservation(rateratio0.41;confidence
interval 0.28 to 0.59; p < 0.0001). Additionally, baselineadjustedT2lesionvolumeatthelastobservationwaslower
for patients treated with COPAXONE (ratio of 0.89; confi55%
denceinterval0.84to0.94;p=0.0001).
50% 4 was a multinational study in which MRI parameStudy
terswereusedbothasprimaryandsecondaryendpoints.
45%
p=0.0005
Atotalof239patientswithRRMS(COPAXONE:n=119;and
Placebo
Hazard Ratio=0.55
40%
placebo:
n=120) were randomized. Inclusion criteria were
35%
28
7
30%
25%
20%
Copaxone
Placebo
12
10
8
6
4
2
1
2
3
5
4
Months
6
7
8
9
COPAXONE 40 mg per mL three times per week
Study 5 was a double-blind, placebo-controlled, multinational study with a total of 1404 patients with RRMS
randomized in a 2:1 ratio to receive either COPAXONE
40 mg per mL (n=943) or placebo (n=461) three times a
week for 12 months. Patients had a median of 2 relapses
in the 2 years prior to screening and had not received any
interferon-beta for at least 2 months prior to screening.
BaselineEDSSscoresrangedfrom0to5.5withamedian
of2.5.Neurologicalevaluationswereperformedatbaseline,
every three months, and at unscheduled visits for suspected
relapse or early termination. MRI was performed at baseline,months6and12,orearlytermination.Atotalof91%
ofthoseassignedtoCOPAXONEand93%ofthoseassigned
toplacebocompletedtreatmentat12months.
Theprimaryoutcomemeasurewasthetotalnumberofconfirmedrelapses(persistenceofneurologicalsymptomsfor
atleast24hoursconfirmedonexaminationwithobjective
signs). The effect of COPAXONE on several magnetic resonanceimaging(MRI)variables,includingnumberofnew
or enlarging T2 lesions and number of enhancing lesions
on T1-weighted images, was also measured at months 6
and 12.
Table6presentstheresultsfortheintent-to-treatpopulation.
35%
0%
Day 0
Day 180
GA 20mg n=243
197
Placebo n=238
197
COPAXONE®
14
0
50%
20%
16
0
55%
p=0.0005
Hazard Ratio=0.55
0.0030
Figure 2: Median Cumulative Number of Gd-Enhancing
Lesions
Figure 1: Time to Second Exacerbation
40%
17
Figure2displaystheresultsoftheprimaryoutcomeona
monthlybasis.
In both studies, COPAXONE exhibited a clear beneficial
effectonrelapserate,anditisbasedonthisevidencethat
COPAXONE is considered effective.
InStudy3,481patientswhohadrecently(within90days)
experienced an isolated demyelinating event and who had
lesionstypicalofmultiplesclerosisonbrainMRIwererandomized to receive either COPAXONE 20 mg per mL (n=243)
orplacebo(n=238).Theprimaryoutcomemeasurewastime
todevelopmentofasecondexacerbation.Patientswerefollowed for up to three years or until they reached the primary
endpoint.SecondaryoutcomeswerebrainMRImeasures,
includingnumberofnewT2lesionsandT2lesionvolume.
Timetodevelopmentofasecondexacerbationwassignificantly delayed in patients treated with COPAXONE compared
to placebo (Hazard Ratio = 0.55; 95% confidence interval
0.40 to 0.77; Figure 1). The Kaplan-Meier estimates of
the percentage of patients developing a relapse within 36
monthswere42.9%intheplacebogroupand24.7%inthe
COPAXONE group.
45%
11
Mediansofthe
CumulativeNumber
ofT1Gd-Enhancing
Lesions
Lipoatrophy and Skin Necrosis at Injection Site
Advise patients that localized lipoatrophy, and rarely, skin
necrosis may occur at injection sites. Instruct patients to follow proper injection technique and to rotate injection areas
and sites with each injection to minimize these risks.
Instructions for Use
Instruct patients to read the COPAXONE Patient Information
leafletcarefully.COPAXONE20mgpermLandCOPAXONE
40 mg per mL are not interchangeable. COPAXONE 20 mg
per mL is administered daily and COPAXONE 40 mg per mL
is administered three times per week. Caution patients to use
aseptic technique. The first injection should be performed
under the supervision of a health care professional. Instruct
patients to rotate injection areas and sites with each injection.
Caution patients against the reuse of needles or syringes.
Instruct patients in safe disposal procedures.
Storage Conditions
Advise patients that the recommended storage condition
forCOPAXONEisrefrigerationat36°Fto46°F(2°Cto8°C).
If needed, the patient may store COPAXONE at room temperature,59°Fto86°F(15°Cto30°C),foruptoonemonth,
but refrigeration is preferred. COPAXONE should not be
exposed to higher temperatures or intense light. Do not
freeze COPAXONE.
Table 6: Study 5 Efficacy and MRI Results
COPAXONE Placebo P-Value
40 mg/mL (n=461)
(n=943)
Clinical Endpoints
Number of confirmed relapses
during the 12-month placebo-controlled phase
AdjustedMean
Estimates
Relative risk reduction
0.331
0.505
<0.0001
34%
MRI Endpoints
Cumulative number of new or enlarging T2 lesions
at Months 6 and 12
AdjustedMean
Estimates
3.650
5.592
<0.0001
35%
Cumulative number of enhancing lesions
on T1-weighted images at Months 6 and 12
AdjustedMean
Estimates
0.905
1.639
<0.0001
45%
16 HOW SUPPLIED/STORAGE AND HANDLING
COPAXONE (glatiramer acetate injection) is a clear, colorless
toslightlyyellow,sterile,nonpyrogenicsolutionsuppliedas:
• 20 mg per mL in a single-dose, prefilled syringe with a
white plunger, in individual blister packages supplied in
30-count cartons (NDC 68546-317-30).
• 40 mg per mL in a single-dose, prefilled syringe with a
blue plunger, in individual blister packages supplied in
12-count cartons (NDC 68546-325-12).
StoreCOPAXONErefrigeratedat2°Cto8°C(36°Fto46°F).
If needed, the patient may store COPAXONE at room temperature,15°Cto30°C(59°Fto86°F),foruptoonemonth,
butrefrigerationispreferred.Avoidexposuretohighertemperatures or intense light. Do not freeze COPAXONE. If a
COPAXONEsyringefreezes,itshouldbediscarded.
Marketedby:TEVANeuroscience,Inc.,OverlandPark,KS66211
Distributedby:TEVAPharmaceuticalsUSA,Inc.,NorthWales,
PA19454
Product of Israel
Patient Information
COPAXONE (co-PAX-own)
(glatiramer acetate injection)
for subcutaneous use
Read this Patient Information before you start
usingCOPAXONEandeachtimeyougetarefill.
Theremaybenewinformation.Thisinformation
does not take the place of talking with your doctor
aboutyourmedicalconditionoryourtreatment.
What is COPAXONE?
COPAXONE is prescription medicine used for
the treatment of people with relapsing forms of
multiplesclerosis(MS).
It is not known if COPAXONE is safe and effective in children under 18 years of age.
Who should not use COPAXONE?
• Do not use COPAXONE if you are allergic to
glatiramer acetate, mannitol or any of the
ingredients in COPAXONE. See the end of this
leafletforacompletelistoftheingredientsin
COPAXONE.
17 PATIENT COUNSELING INFORMATION
[See Patient Information Leaflet (Patient Information and
Instructions for Use)]
Advise the patient to read the FDA-approved patient labeling
(Patient Information and Instructions for Use).
Pregnancy
Instructpatientsthatiftheyarepregnantorplantobecome
pregnant while taking COPAXONE they should inform their
physician.
Immediate Post-Injection Reaction
Advise patients that COPAXONE may cause various symptoms
after injection, including flushing, chest pain, palpitations,
anxiety, dyspnea, constriction of the throat, and urticaria.
Thesesymptomsaregenerallytransientandself-limitedand
donotrequirespecifictreatment.Informpatientsthatthese
symptoms may occur early or may have their onset several
months after the initiation of treatment. A patient may experience one or several episodes of these symptoms.
Chest Pain
Advise patients that they may experience transient chest pain
either as part of the Immediate Post-Injection Reaction or in
isolation. Inform patients that the pain should be transient.
Some patients may experience more than one such episode,
usuallybeginningatleastonemonthaftertheinitiationoftreatment.Patientsshouldbeadvisedtoseekmedicalattentionif
they experience chest pain of unusual duration or intensity.
8
29
What should I tell my doctor before using
COPAXONE?
Before you use COPAXONE, tell your doctor if you:
• are pregnant or plan to become pregnant. It
is not known if COPAXONE will harm your
unbornbaby.
• arebreastfeedingorplantobreastfeed.Itisnot
known if COPAXONE passes into your breast
milk.Talktoyourdoctoraboutthebestway
tofeedyourbabywhileusingCOPAXONE.
Tell your doctor about all the medicines you
take, including prescription and over-the-counter
medicines,vitamins,andherbalsupplements.
COPAXONE may affect the way other medicines
work, and other medicines may affect how
COPAXONE works.
Know the medicines you take. Keep a list of your
medicines with you to show your doctor and
pharmacist when you get a new medicine.
How should I use COPAXONE?
• Fordetailedinstructions,seetheInstructions
for Useattheendofthisleafletforcomplete
information on how to use COPAXONE.
• YourdoctorwilltellyouhowmuchCOPAXONE
to use and when to use it.
• COPAXONE is given by injection under your
skin(subcutaneously).
• Use COPAXONE exactly as your doctor tells
you to use it.
• Since every body type is different, talk with
yourdoctorabouttheinjectionareasthatare
bestforyou.
• YoushouldreceiveyourfirstdoseofCOPAXONE
withadoctorornursepresent.Thismightbe
atyourdoctor’sofficeorwithavisitinghome
health nurse who will teach you how to give
your COPAXONE injections.
What are the possible side effects of COPAXONE?
COPAXONE may cause serious side effects,
including:
• Post-Injection Reactions. Serious side effects
may happen right after you inject COPAXONE at
any time during your course of treatment. Call
your doctor right away if you have any of these
post-injectionreactionsymptomsincluding:
• rednesstoyourcheeksorotherpartsof
thebody(flushing)
• chestpain
• fastheartbeat
• anxiety
• breathingproblemsortightnessinyour
throat
• swelling,rash,hives,oritching
If you have symptoms of a post-injection reaction, do not give yourself more injections until a
doctor tells you to.
• Chest Pain.You can have chest pain as part
of a post-injection reaction or by itself. This
type of chest pain usually lasts a few minutes
andcanbeginaround1monthafteryoustart
using COPAXONE. Call your doctor right away
if you have chest pain while using COPAXONE.
• Damage to your skin. Damage to the fatty tissuejustunderyourskin’ssurface(lipoatrophy)
and, rarely, death of your skin tissue (necrosis)
can happen when you use COPAXONE. Damage to the fatty tissue under your skin can
cause a “dent” at the injection site that may
notgoaway.Youcanreduceyourchanceof
developingtheseproblemsby:
• following your doctor’s instructions for
how to use COPAXONE
• choosingadifferentinjectionareaeach
time you use COPAXONE. See Step 4 in
the Instructions for Use, “Choose your
injection area”.
The most common side effects of COPAXONE
include:
• skinproblemsatyourinjectionsiteincluding:
◦ redness
◦ pain
◦ swelling
◦ itching
◦ lumps
• rash
• shortnessofbreath
• flushing(vasodilation)
Tellyourdoctorifyouhaveanysideeffectthat
bothersyouorthatdoesnotgoaway.
These are not all the possible side effects of
COPAXONE.Formoreinformation,askyourdoctor or pharmacist.
Call your doctor for medical advice about side
effects. You may report side effects to FDA at
1-800-FDA-1088.
How should I store COPAXONE?
• StoreCOPAXONEintherefrigeratorbetween
36°Fto46°F(2°Cto8°C).
• WhenyouarenotabletorefrigerateCOPAXONE,
you may store it for up to 1 month at room temperaturebetween59°Fto86°F(15°Cto30°C).
• Protect COPAXONE from light or high temperature.
• DonotfreezeCOPAXONEsyringes.Ifasyringe
freezes, throw it away in a sharps disposal
container. See Step 13 in the Instructions for
Use, “Dispose of needles and syringes”.
Keep COPAXONE and all medicines out of the
reach of children.
30
9
General information about the safe and effective
use of COPAXONE.
Medicines are sometimes prescribed for purposes other than those listed in a Patient InformationLeaflet.DonotuseCOPAXONEforaconditionforwhichitwasnotprescribed.Donotgive
COPAXONE to other people, even if they have the
same symptoms as you have. It may harm them.
ThisPatientInformationLeafletsummarizesthe
mostimportantinformationaboutCOPAXONE.
If you would like more information, talk with your
doctor. You can ask your pharmacist or doctor
forinformationaboutCOPAXONEthatiswritten
for health professionals.
Formoreinformation,gotowww.copaxone.com or
call 1-800-887-8100.
What are the ingredients in COPAXONE?
Active ingredient: glatiramer acetate
Inactive ingredients: mannitol
Instructions for Using Your COPAXONE 40 mg
Prefilled Syringe:
• COPAXONE 40 mg is injected 3 times each
weekinthefattylayerunderyourskin(subcutaneously).
• COPAXONE 40 mg should be given on the
same3dayseachweek,ifpossibleforexample, Monday, Wednesday, and Friday. Give
your COPAXONE injections at least 48 hours
(2 days) apart.
• Each COPAXONE 40 mg prefilled syringe is
for single use (1 time use) only.
• The COPAXONE 40 mg dose is packaged in
boxes of 12 prefilled syringes with needles
attached.COPAXONE40mgprefilledsyringes
have blue plungers.
How do I inject COPAXONE?
Step 1: Gather the supplies you will need to
inject COPAXONE. See Figure A.
• 1 blister pack with a COPAXONE Prefilled
Syringe with needle attached
• Alcoholwipe(notsupplied)
• Drycottonball(notsupplied)
• Aplacetorecordyourinjections,likeanotebook(notsupplied)
• Sharpsdisposalcontainer(notsupplied).See
Step 13 below, “Dispose of needles and
syringes”.
Instructions for Use
COPAXONE (co-PAX-own)
(glatiramer acetate injection)
for subcutaneous use
For subcutaneous injection only.
Do not inject COPAXONE in your veins (intraSharps
venously).
Disposal
Container
Do notre-useyourCOPAXONEprefilledsyringes.
Do notshareyourCOPAXONEprefilledsyringes
withanotherperson.Youmaygiveanotherperson an infection or get an infection from them.
You should receive your first dose of COPAXONE
Cotton Balls
with a doctor or nurse present. This might be
at your doctor’s office or with a visiting home
health nurse who will show you how to give
Alcohol Wipes
your own injections.
COPAXONE comes in either a 20 mg Prefilled
Syringe in Blister Package
Injection Diary
Syringe with needle attached or a 40 mg Prefilled Syringe with needle attached. How often
Figure A
a dose is given depends on the product strength Step 2: Remove only 1 blister pack from the
that is prescribed. Your doctor will prescribe COPAXONEprefilledsyringecarton. See Figure B.
the correct dose for you.
Instructions for Using Your COPAXONE 20 mg
Prefilled Syringe dose:
• COPAXONE 20 mg is injected 1 time each day, in
thefattylayerunderyourskin(subcutaneously).
• EachCOPAXONE20mgprefilledsyringeisfor
single use (1 time use) only.
Figure B
• The COPAXONE 20 mg dose is packaged in • Place the supplies you will need on a clean,
boxes of 30 prefilled syringes with needles
flatsurfaceinawell-litarea.
attached.COPAXONE20mgprefilledsyringes
have white plungers.
10
31
• Afteryouremove1blisterpackfromthecarton, keep all unused syringes in the carton
and store them in the refrigerator.
• Lettheblisterpack,withthesyringeinside,warm
toroomtemperatureforabout20minutes.
• Wash your hands. Be careful not to touch
your face or hair after washing your hands.
Step 3: Look closely at your COPAXONE prefilled
syringe.
• Theremaybesmallairbubblesinthesyringe.
Do not try to push the air bubble from the
syringebeforegivingyourinjectionsoyoudo
not lose any medicine.
• Checktheliquidmedicineinthesyringebefore
yougiveyourinjection.Theliquidinthesyringe
should look clear, and colorless, and may look
slightly yellow. If the liquid is cloudy or contains
any particles, do not use the syringe and throw it
away in a sharps disposal container. See Step 13
below, “Dispose of needles and syringes.”
Step 4: Choose your injection area. See Figure C.
See the injection areas you should use on your
body.Talkwithyourdoctorabouttheinjection
areasthatarebestforyou.
• The possible injection areas on your body
include (See Figure C):
◦your stomach area (abdomen) around
thebellybutton
◦thebackofyourupperarms
◦upperhips(belowyourwaist)
◦yourthighs(aboveyourknees)
• ForeachCOPAXONEdose,chooseadifferent
injectionareafrom1oftheareasshownabove.
See Figure C.
• Do not stick the needle in the same place
(site) more than 1 time each week. Each
injection area contains multiple injection sites
for you to choose from. Avoid injecting in the
same site over and over again.
• Keep a record of the sites where you give
yourinjectioneachdaysoyouwillremember
where you already injected.
Step 5: Prepare to give your injection.
• Therearesomeinjectionareasonyourbody
that are hard to reach (like the back of your
arm).Youmayneedhelpfromsomeonewho
hasbeeninstructedonhowtogiveyourinjection if you cannot reach certain injection areas.
• Donotinjectinsiteswheretheskinhasscarring or “dents”. Using scarred or dented skin
for your injections may make your skin worse.
Step 6: Clean your injection site.
• Cleantheinjectionsiteusingthealcoholwipe
and allow your skin to air dry. See Figure D.
Abdomen
Avoid about 2 inches around the
belly button
Figure E
Step 8:Pinchabouta2inchfoldofskinbetween
yourthumbandindexfinger.See Figure F.
Back of Hips and Arms
Fleshy areas of the upper hips, always
below the waist
Fleshy areas of the upper back portion
of the arms
Arms
Fleshy areas of the upper back portion
Figure F
Step 9: Giving your injection.
• Resttheheelofyourhandholdingthesyringe
against your skin at the injection site. Insert
theneedleata90degreeanglestraightinto
your skin. See Figure G.
Thighs
About 2 inches above the knee and
2 inches below the groin
Figure C
32
Figure D
Step 7: Pick up the syringe with 1 hand and hold
it like a pencil. Remove the needle cover with
your other hand and set it aside. See Figure E.
11
• IfyoudonothaveaFDA-clearedsharpsdisposal container, you may use a household containerthatis:
◦ made of a heavy-duty plastic,
◦canbeclosedwithatight-fitting,punctureresistantlid,withoutsharpsbeingableto
come out,
Figure G
◦uprightandstableduringuse,
• Whentheneedleisallthewayintoyourskin, ◦ leak-resistant, and
release the fold of skin. See Figure H.
◦properly labeled to warn of hazardous
waste inside the container.
• Whenyoursharpsdisposalcontainerisalmost
full, you will need to follow your community
guidelines for the right way to dispose of your
sharpsdisposalcontainer.Theremaybestate
orlocallawsabouthowyoushouldthrowaway
Figure H
usedneedlesandsyringes.FormoreinformaStep 10: Give your COPAXONE injection.
tion about safe sharps disposal, and for speTo inject the medicine, hold the syringe steady
cificinformationaboutsharpsdisposalinthe
and slowly push down the plunger. See Figure I.
statethatyoulivein,gototheFDA’swebsite
at:http://www.fda.gov/safesharpsdisposal .
• Donotdisposeofyourusedsharpsdisposal
container in your household trash unless your
community guidelines permit this. Do not recycle your used sharps disposal container.
Figure I
Step 11: Remove the needle.
After you have injected all of the medicine, pull
the needle straight out. See Figure J.
Figure L
This Patient Information and Instructions for
Use has been approved by the U.S. Food and
Drug Administration.
Figure J
Step 12:Useaclean,drycottonballtogently
press on the injection site for a few seconds. Do
notrubtheinjectionsiteorre-usetheneedleor
syringe. See Figure K.
Marketedby:TEVANeuroscience,Inc.,Overland
Park, KS 66211
Distributed by: TEVA Pharmaceuticals USA, Inc.,
NorthWales,PA19454
Product of Israel
Revised:January2014
COP-41056
Figure K
Step 13: Dispose of your needles and syringes.
• PutyourusedneedlesandsyringesinaFDAcleared sharps disposal container right away
after use. Do not throw away (dispose of)
loose needles and syringes in your household trash.
12
33
NOTES
34
NOTES
35
Get to know Teva’s Shared Solutions®
YOUR PARTNER EVERY
STEP OF THE WAY
Call Shared Solutions® at 1-800-887-8100, Monday
through Friday, from 8:00 AM to 8:00 PM (CT).
Nurses are available after these hours for more
urgent needs.
Please see Important Safety Information on pages 20-21,
and full Prescribing Information beginning on page 22.
Reference: 1. Data on file. Teva Neuroscience, Inc.
COPAXONE®, COPAXONE CO-PAY SOLUTIONS®, and COPAXONE iTracker®
are registered trademarks of Teva Pharmaceutical Industries Ltd.
Shared Solutions® is a registered service mark of Teva Neuroscience, Inc.
COPAXONE webTracker™ is a trademark of Teva Pharmaceutical Industries Ltd.
Apple and iTunes are trademarks of Apple Inc.
App Store is a registered service mark of Apple Inc.
Android, Google Play and the Google Play logo are trademarks of Google Inc.
© 2016 Teva Neuroscience, Inc. COP-43682

Teva`s Shared Solutions ® Brochure

Transcription

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