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Pharmaceuticals and Medical Devices Safety Information No Pharmaceuticals and Medical Devices Safety Information No. 263 November 2009 Table of Contents 1. Association between use of human insulin and insulin analogues and risk of cancer ....................................................................................... 4 2. Important Safety Information .................................................................. 7 .1. Ivermectin ································································································ 7 .2. Everolimus, gusperimus hydrochloride, cyclosporine (oral dosage form, injectable dosage form), tacrolimus hydrate (oral dosage form, injectable dosage form), basiliximab (genetical recombination), mycophenolate mofetil, muromonab-CD3 ···· 9 .3. Ciprofloxacin, ciprofloxacin hydrochloride ······················································ 15 .4. Sunitinib malate ······················································································ 18 .5. Sorafenib tosilate ····················································································· 21 .6. Tegafur/gimeracil/oteracil potassium ···························································· 23 .7. Bevacizumab (genetical recombination) ······················································· 25 .8. Rosuvastatin calcium ················································································ 29 3. Revision of PRECAUTIONS (No. 210) (1) Pancuronium bromide, vecuronium bromide, rocuronium bromide (and 7 others) ··· 31 (2) Blood circuits (and 3 others) ······································································· 34 4. List of products subject to Early Post-marketing Phase Vigilance ..................................................... 37 This Pharmaceuticals and Medical Devices Safety Information (PMDSI) is issued based on safety information collected by the Ministry of Health, Labour and Welfare. It is intended to facilitate safer use of pharmaceuticals and medical devices by healthcare providers. PMDSI is available on the Pharmaceuticals and Medical Devices Agency website (http://www.pmda.go.jp/english/index.html) and on the MHLW website (http://www.mhlw.go.jp/, Japanese only). Published by Translated by Pharmaceutical and Food Safety Bureau, Pharmaceuticals and Medical Devices Agency Ministry of Health, Labour and Welfare Pharmaceutical and Food Safety Bureau, Office of Safety I, Ministry of Health, Labour and Welfare Pharmaceuticals and Medical Devices Agency 1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo 3-3-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-8916 Japan 100-0013 Japan E-mail: [email protected] This translation of the original Japanese text is for information purpose only (in the event of inconsistency, the Japanese text shall prevail). Pharmaceuticals and Medical Devices Safety Information No. 263 November 2009 Pharmaceutical and Food Safety Bureau, Ministry of Health, Labour and Welfare, Japan [Outline of Information] No. Subject Measures Outline of information Page With regard to increased risk of cancer associated with human insulin and insulin analogues (to be referred to as “insulin preparations” in the following text), it was concluded at the time of the approval review that the insulin preparations are unlikely to affect safety in humans and no specific precaution was included in the package inserts so far. However, recently a number of study reports have been Association between published on an increased risk of cancer in association with use of human insulin insulin preparations, and EMEA and FDA have announced 1 4 and insulin analogues that patients with diabetes taking insulin glargine are and risk of cancer adviced to continue their treatment and they should consult their doctor, while EMEA and FDA began to review the association insulin glargine and the risk of cancer. On the basis of the above, PMDA has conducted a review of insulin preparations, including insulin glargine, with respect to their association with increased risk of cancer and assessed whether safety measures are necessary. The results of the review are summarized in this section. This section presents revisions, and the summary of cases that served as the basis for these revisions, to important Ivermectin (and 7 P adverse reactions included under the PRECAUTIONS 2 7 others) C section of package inserts for drugs. These revisions have been made in accordance with the Notification dated September 28, 2009. (1) Pancuronium bromide, vecuronium bromide, rocuronium 3 bromide (and 7 Revision of PRECAUTIONS (No. 210) 31 others) (2) Blood circuits (and 3 others) Products subject to Lists products subject to Early Post-marketing Phase 4 Early Post-marketing Vigilance as of November 1, 2009. 37 Phase Vigilance D: Distribution of Dear Healthcare Professional Letters P: Revision of PRECAUTIONS C: Case Reports To Pharmaceuticals and Medical Devices Safety Management Supervisor —Please use our e-mail alert service— The Pharmaceuticals and Medical Devices Agency is providing a “Pharmaceuticals and Medical Devices Information E-mail Alert Service” (http://www.info.pmda.go.jp/info/idx-push.html, Japanese only), when important safety information regarding pharmaceuticals and medical devices including Dear Healthcare Professional Letters or Revision of PRECAUTIONS is issued. You are encouraged to register to and use the service. Pharmaceuticals and Medical Devices Safety Information No. 263 - 2 - November 2009 Reporting of safety information such as adverse reactions to the Minister of Health, Labour and Welfare is a duty of medical and pharmaceutical providers. If medical and pharmaceutical providers such as physicians, dentists, and pharmacists detect adverse reactions, infections associated with drugs or medical devices, or medical device adverse events, it is mandatory for such providers to report them to the Minister of Health, Labour and Welfare directly or through the marketing authorisation holder. As medical and pharmaceutical providers, drug retailers with a second-class license and household distributors are also required to report safety issues related to drugs and medical devices. Pharmaceuticals and Medical Devices Safety Information No. 263 - 3 - November 2009 1 Association between use of human insulin and insulin analogues and risk of cancer 1. Introduction With regard to an increased risk of cancer associated with human insulin and insulin analogues (see Table, to be referred to as “insulin preparations” in the following text), no specific precaution has been included in the package inserts so far. It was concluded at the time of the approval review that, considering their clinical dose, the insulin preparations are unlikely to affect safety in humans, although cell growth activity and development of breast tumors had been noticed in non-clinical studies. However, a number of study reports on an increased risk of cancer in association with insulin preparations have recently been submitted to Pharmaceuticals and Medical Devices Association (PMDA).1,2) On June 26, 2009, four epidemiological studies regarding an increased risk of cancer in association with insulin glargine were published in the Journal of the European Association for the Study of Diabetes (EASD)3-6) and, following this, European Medicines Agency (EMEA) and U.S. Food and Drug Administration (FDA) announced on June 29, 2009 and July 1, 2009, respectively, that patients with diabetes taking insulin glargine are adviced to continue their treatment and they should consult their doctor, while EMEA and FDA began to review the association insulin glargine and the risk of cancer.7,8) In Japan, the Japan Diabetes Society announced on July 1, 2009, that patients being treated with insulin glargine are recommended to continue their treatment and consult their doctor,9) and PMDA posted its announcement on PMDA InfoWeb on July 13, 2009.10) On the basis of the above, PMDA has conducted a review of insulin preparations, including insulin glargine, with respect to their association with increased risk of cancer and assessed whether safety measures are necessary. The results of the review are summarized in this section. 2. Literature on increased risk of cancer A review of the literature on the association between use of insulin preparations and increased risk of cancer was performed in the categories of 1) epidemiological studies, 2) non-clinical studies, and 3) measures taken by foreign regulatory agencies. 1) Epidemiological studies As a result of the investigation of available published epidemiological studies regarding an increased risk of cancer in association with insulin preparations, it was found that there are studies that insulin glargine showed both increased risk of cancer 2, 6, 11-20) and no risk compared with the other insulin preparations 6, 21-25) . It was mentioned that insufficient adjustment for confounding factors such as family history was present as a limitation in a number of epidemiological studies. Regarding insulin glargine, in particular, it was found that there are studies that insulin preparations 3-5) 3,4) showed both increased risk of cancer and no risk compared with the other insulin preparations . Pharmaceuticals and Medical Devices Safety Information No. 263 - 4 - November 2009 2) Non-clinical studies The non-clinical data submitted at the time of application for approval of insulin analogues demonstrated that cell proliferation induced by insulin analogues is of a similar magnitude to that induced by human insulin, and therefore, at the time of approval review, it was concluded that it was not
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