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Australian Public Assessment Report for Progesterone

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Australian Public Assessment Report for Progesterone Australian Public Assessment Report for Progesterone Proprietary Product Name: Prometrium / Utrogestan Sponsor: Besins Healthcare Australia Pty Ltd June 2017 Therapeutic Goods Administration About the Therapeutic Goods Administration (TGA) • The Therapeutic Goods Administration (TGA) is part of the Australian Government Department of Health and is responsible for regulating medicines and medical devices. • The TGA administers the Therapeutic Goods Act 1989 (the Act), applying a risk management approach designed to ensure therapeutic goods supplied in Australia meet acceptable standards of quality, safety and efficacy (performance) when necessary. • The work of the TGA is based on applying scientific and clinical expertise to decision- making, to ensure that the benefits to consumers outweigh any risks associated with the use of medicines and medical devices. • The TGA relies on the public, healthcare professionals and industry to report problems with medicines or medical devices. TGA investigates reports received by it to determine any necessary regulatory action. • To report a problem with a medicine or medical device, please see the information on the TGA website <https://www.tga.gov.au>. About AusPARs • An Australian Public Assessment Report (AusPAR) provides information about the evaluation of a prescription medicine and the considerations that led the TGA to approve or not approve a prescription medicine submission. • AusPARs are prepared and published by the TGA. • An AusPAR is prepared for submissions that relate to new chemical entities, generic medicines, major variations and extensions of indications. • An AusPAR is a static document; it provides information that relates to a submission at a particular point in time. • A new AusPAR will be developed to reflect changes to indications and/or major variations to a prescription medicine subject to evaluation by the TGA. Copyright © Commonwealth of Australia 2017 This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the TGA Copyright Officer, Therapeutic Goods Administration, PO Box 100, Woden ACT 2606 or emailed to <[email protected]>. AusPAR Prometrium / Utrogestan Besins Healthcare Australia Pty Ltd PM-2014-03908-1-5 Page 2 of 53 Final 1 June 2017 Therapeutic Goods Administration Contents Common abbreviations _______________________________________________________ 5 I. Introduction to product submission _____________________________________ 6 Submission details ____________________________________________________________________ 6 Product background __________________________________________________________________ 7 Regulatory status _____________________________________________________________________ 9 Product information _________________________________________________________________ 10 II. Quality findings ___________________________________________________________ 10 Introduction __________________________________________________________________________ 10 Drug substance (active ingredient) ________________________________________________ 10 Drug product _________________________________________________________________________ 10 Biopharmaceutics ___________________________________________________________________ 11 Quality summary and conclusions _________________________________________________ 13 III. Nonclinical findings _____________________________________________________ 13 Introduction __________________________________________________________________________ 13 Pharmacology ________________________________________________________________________ 13 Pharmacokinetics ____________________________________________________________________ 13 Toxicology ____________________________________________________________________________ 14 Nonclinical summary and conclusions _____________________________________________ 16 IV. Clinical findings __________________________________________________________ 17 Introduction __________________________________________________________________________ 17 Pharmacokinetics ____________________________________________________________________ 19 Pharmacodynamics__________________________________________________________________ 19 Dosage selection for the pivotal studies ___________________________________________ 21 Efficacy _______________________________________________________________________________ 22 Safety _________________________________________________________________________________ 26 First round benefit-risk assessment _______________________________________________ 29 First round recommendation regarding authorisation ___________________________ 30 Clinical questions ____________________________________________________________________ 30 V. Pharmacovigilance findings ____________________________________________ 30 Risk management plan ______________________________________________________________ 30 VI. Overall conclusion and risk/benefit assessment __________________ 35 Quality ________________________________________________________________________________ 35 Nonclinical ___________________________________________________________________________ 36 Clinical ________________________________________________________________________________ 37 Risk management plan ______________________________________________________________ 42 AusPAR Prometrium / Utrogestan Besins Healthcare Australia Pty Ltd PM-2014-03908-1-5 Page 3 of 53 Final 1 June 2017 Therapeutic Goods Administration Risk-benefit analysis ________________________________________________________________ 42 Outcome ______________________________________________________________________________ 51 Attachments 1 and 2. Product Information _____________________________ 52 Attachment 3. Extract from the Clinical Evaluation Report __________ 52 AusPAR Prometrium / Utrogestan Besins Healthcare Australia Pty Ltd PM-2014-03908-1-5 Page 4 of 53 Final 1 June 2017 Therapeutic Goods Administration Common abbreviations Abbreviation Meaning AE adverse event ART assisted reproductive technology ASA Australian Specific Annex AUC area under the plasma drug concentration-time curve AUCt1-t2 area under the plasma drug concentration-time curve from t1 to t2 Cmax maximum serum concentration of drug CMI Consumer Medicine Information EMA European Medicines Agency FDA Food and Drug Administration (US) HRT hormone replacement therapy ICSI intracytoplasmic sperm injection IVF in vitro fertilisation LPS luteal phase support PD pharmacodynamic(s) PI Product Information PK pharmacokinetic(s) PO per or (oral administration) PV per vagina/vaginal RMP Risk Management Plan Tmax Time taken to reach the maximum concentration (Cmax) AusPAR Prometrium / Utrogestan Besins Healthcare Australia Pty Ltd PM-2014-03908-1-5 Page 5 of 53 Final 1 June 2017 Therapeutic Goods Administration I. Introduction to product submission Submission details Type of submission: Extension of indications Decision: Approved Date of decision: 28 April 2016 Date of entry onto ARTG 20 June 2016 Active ingredient: Progesterone Product names: Prometrium / Utrogestan Sponsor’s name and address: Besins Healthcare Australia Pty Ltd 1/495 Victoria Ave Chatswood NSW 2067 Dose form: Soft capsule Strengths: Prometrium 100 mg and 200 mg Utrogestan 200 mg Container: PVC/AL Blister Pack Pack sizes: • Prometrium (100 mg and 200 mg strengths) will be contained in packs containing 14, 15, 28, 30, 56, 84 and 90 capsules. • Utrogestan (200 mg strength) will be contained in packs containing 7, 14, 15, 21, 28, 30, 42, 45, 56, 84 and 90 capsules. Approved therapeutic use: Prometrium 100 mg and 200 mg soft capsules are indicated for: • Treatment of menstrual irregularities – In women with menstrual abnormalities or secondary amenorrhoea due to normogonadotrophic amenorrhoea (see dosage and administration) • Hormone replacement therapy – Hormone replacement therapy – adjunctive use with an oestrogen in postmenopausal women with an intact uterus Utrogestan 200 mg soft vaginal capsules are indicated for: • Luteal phase support – Luteal Support of Assisted Reproductive Technology (ART) cycles AusPAR Prometrium / Utrogestan Besins Healthcare Australia Pty Ltd PM-2014-03908-1-5 Page 6 of 53 Final 1 June 2017 Therapeutic Goods Administration Routes of administration: Prometrium 100 and 200 mg: oral (capsule) Utrogestan 200 mg: intravaginal (capsule) Dosage: Prometrium 100 and 200 mg (oral): • In women receiving oestrogen replacement therapy with intact uterus, the adjunctive use of progesterone at a dose of 200 mg daily at bedtime should be administered for twelve days in the last half of each therapeutic cycle (beginning on day 15 of the cycle and ending on day 26). Withdrawal bleeding may occur in the following week. Alternatively, 100 mg can be given at bedtime from day 1 to day 25 of each therapeutic cycle, withdrawal bleeding
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