scontinuation of any antiplatelet agents or anticoagulants.
Renal Monitoring
TEGSEDI should generally not be initiated in patients with a urine protein to creatinine ratio (UPCR) of 1000 mg/g or higher. Monitor serum creatinine, estimated glomerular filtration rate (eGFR), urinalysis, and UPCR every 2 weeks during treatment with TEGSEDI. Hold TEGSEDI in patients who develop a UPCR of 1000 mg/g or higher, or estimated glomerular filtration rate (eGFR) below 45 mL/minute/1.73 m2, pending further eva luation of the cause.
If a dose is held, once eGFR increases to ≥45 mL/minute/1.73 m2, UPCR decreases to below 1000 mg/g, or the underlying cause of the decline in renal function is corrected, weekly dosing may be reinitiated. In the case of UPCR of 2000 mg/g or higher, perform further eva luation for acute glomerulonephritis, as clinically indicated. If acute glomerulonephritis is confirmed, TEGSEDI should be permanently discontinued.
Liver Tests
Monitor alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin every four months during treatment with TEGSEDI.
3 DOSAGE FORMS AND STRENGTHS
Injection: 284 mg/1.5 mL clear, colorless to pale yellow solution in a single-dose prefilled syringe.
4 CONTRAINDICATIONS
TEGSEDI is contraindicated in patients with:
Platelet count below 100 x 109/L [see Warnings and Precautions (5.1)]
History of acute glomerulonephritis caused by TEGSEDI [see Warnings and Precautions (5.2)]
History of a hypersensitivity reaction to TEGSEDI [see Warnings and Precautions (5.7)].
5 WARNINGS AND PRECAUTIONS
5.1 Thrombocytopenia
TEGSEDI causes reductions in platelet count that may result in sudden and unpredictable thrombocytopenia that can be life-threatening. In Study 1 [see Clinical studies (14)] , platelet counts below 100 x 109/L occurred in 25% of TEGSEDI-treated patients, compared with 2% of patients on placebo. Platelet counts below 75 x 109/L occurred in 14% of TEGSEDI-treated patients, compared to no patient on placebo. In Study 1 and its extension study, 39% of TEGSEDI-treated patients with a baseline platelet count below 200 x109/L had a nadir platelet count below 75 x 109/L, compared to 6% of patients with baseline platelet counts 200 x109/L or higher.
Three TEGSEDI-treated patients (3%) had sudden severe thrombocytopenia (platelet count below 25 x 109/L), which can have potentially fatal bleeding complications, including spontaneous intracranial or intrapulmonary hemorrhage. One patient in a clinical trial experienced a fatal intracranial hemorrhage.
In clinical trials, all 3 patients with severe thrombocytopenia had treatment-emergent antiplatelet IgG antibodies detected shortly before or at the time of the severe thrombocytopenia. In 2 patients, platelet clumping caused uninterpretable platelet measurements that delayed the diagnosis and treatment of severe thrombocytopenia. Platelet clumping can be caused by a reaction between antiplatelet antibodies and ethylenediaminetetraacetic acid (EDTA) [see Warnings and Precautions (5.8)].
Monitoring and Dosing
Patients who are not able to adhere to the recommended laboratory monitoring or to the related treatment recommendations must not receive TEGSEDI. Do not initiate TEGSEDI in patients with a platelet count below 100 x 109/L. Follow recommended monitoring and treatment recommendations for platelet count [see Dosage and Administration (2.4)]. If a patient develops signs or symptoms of thrombocytop |
