For doctors

What is it?

Arzerra is a concentrate that is made up into a solution for infusion (drip into a vein). It contains the active substance ofatumumab.

What is it used for?

Arzerra is used to treat chronic lymphocytic leukaemia (CLL), a cancer of a type of white blood cells called lymphocytes. It is used in patients whose disease has not responded to treatment with fludarabine and alemtuzumab (other anticancer medicines).

Because the number of patients with CLL is low, the disease is considered ‘rare’, and Arzerra was designated an ‘orphan medicine’ (a medicine used in rare diseases) on 7 November 2008.

The medicine can only be obtained with a prescription.

How is it used?

Arzerra should be given under the supervision of a doctor who has experience in treating cancer and in a place where facilities for resuscitating patients are readily available.

Arzerra is given using an infusion pump, once a week for eight weeks. This is followed by a gap of four to five weeks, after which the patient is given an infusion once a month for four months. The first Arzerra infusion that the patient receives should contain 300 mg of ofatumumab, and all subsequent infusions should contain 2,000 mg.

Before every infusion, the patient needs to be treated with a corticosteroid, an antihistamine and a painkiller to help to prevent infusion reactions (such as rash, allergic reactions and difficulty breathing). To reduce the risk of these reactions, the first and second infusions are given slowly, over six and a half hours, and then sped up to a four-hour infusion if no reactions occur. If reactions do occur, treatment should be interrupted and restarted at a slower rate when the patient has recovered. For more information on how to use Arzerra, see the Summary of Product Characteristics (also part of the EPAR).

How does it work?

The active substance in Arzerra, ofatumumab, is a monoclonal antibody. A monoclonal antibody is an antibody (a type of protein) that has been designed to recognise and attach to a specific structure (called an antigen) that is found in certain cells in the body. Ofatumumab has been designed to attach to a protein called CD20 that is found on the surface of lymphocytes, including the cancerous lymphocytes seen in CLL. By attaching to CD20, ofatumumab stimulates the body’s immune system to attack the cancerous cells, helping to control the disease.

How has it been studied?

The effects of Arzerra were first tested in experimental models before being studied in humans.

Arzerra is being investigated in one main study from which results are available for 154 patients with CLL. In 59 of these patients, the disease had not responded to both fludarabine and alemtuzumab, and in 79, treatment with fludarabine had failed but they had not been treated with alemtuzumab because this medicine was not suitable for them. The remaining 16 patients did not fall into either group. Arzerra was not compared with any other treatments in this study. The main measure of effectiveness was the number of patients who ‘responded’ to treatment. The response to treatment was assessed by looking at the patients’ symptoms, the number of lymphocytes in their blood, results of blood and bone marrow tests and the size of their lymph nodes, liver and spleen.

What benefits has it shown during the studies?

Results released so far show that Arzerra was effective at treating patients with CLL: 58% of the patients whose previous treatment with both fludarabine and alemtuzumab had failed (34 out of 59) responded to treatment. The response rate was slightly lower in patients whose treatment with fludarabine had failed but who were not suitable for treatment with alemtuzumab (47%; 37 out of 79).

What is the risk associated?

The most common side effects with Arzerra (seen in more than 1 patient in 10) are lower respiratory tract infection (infection of the lungs such as pneumonia, infections of the ear, nose and throat, neutropenia (low levels of neutrophils, a type of white blood cell), anaemia (low red blood cell counts) and rash. Arzerra treatment can also lead to infusion reactions, especially during the first infusion, which is why facilities for resuscitating patients should be readily available. For the full list of all side effects reported with Arzerra, see the Package Leaflet.

Arzerra should not be used in people who may be hypersensitive (allergic) to ofatumumab or any of the other ingredients.

Why has it been approved?

The CHMP noted that there were no other authorised treatments in the European Union (EU) for patients with CLL who had not responded to treatment with both fludarabine and alemtuzumab and that Arzerra had shown a high response rate in this group of patients. The Committee decided that the medicine’s benefits are greater than its risks for this group of patients and recommended that it be given marketing authorisation.

Arzerra has been given ‘Conditional Approval’. This means that there is more evidence to come about the medicine. Every year, the European Medicines Agency will review any new information that may become available and this summary will be updated as necessary.

How has it been studied?

The company that makes Arzerra will carry out a study comparing treatment with Arzerra to treatment with other anticancer medicines chosen by the doctor, in patients with CLL whose previous treatment with fludarabine has failed but are not suitable for treatment with alemtuzumab. The company will also provide additional information on the long-term effectiveness and safety of Arzerra collected once it is being used in patients.

Further information

The European Commission granted a conditional marketing authorisation valid throughout the European Union for Arzerra to Glaxo Group Ltd on 19 April 2010. The conditional marketing authorisation is valid for one year, after which it can be renewed.

For more information about treatment with Arzerra, read the Package Leaflet (also part of the EPAR).

The summary of the opinion of the Committee for Orphan Medicinal Products for Arzerra is available here.

This summary was last updated in 02-2010.

Name

Arzerra 1,000 mg concentrate for solution for infusion

Composition

One ml of concentrate contains 20 mg of ofatumumab.
Each vial contains 1,000 mg of ofatumumab in 50 ml.

Ofatumumab is a human monoclonal antibody produced in a recombinant murine cell line (NS0).

Excipients:
This medicinal product contains 34.8 mg sodium per 300 mg dose and 232 mg sodium per 2,000 mg dose.

For a full list of excipients, see section 6.1.

Pharmaceutical Form

Concentrate for solution for infusion (sterile concentrate).
Clear to slightly opalescent, colourless liquid. Visible particles may be present.