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Pharmaceuticals and Medical Devices Safety Information No Pharmaceuticals and Medical Devices Safety Information No. 320 January 2015 Table of Contents 1. Cabazitaxel Acetonate and Severe Febrile Neutropenia ............. 4 2. Use of Capsule Endoscope for Small Intestine Screening in Pediatrics and Geriatrics ................................................................... 16 3. Important Safety Information ............................................................ 19 1 Cabazitaxel acetonate ............................................................................... 19 2 Sodium-glucose co-transporter 2 inhibitors ............................................... 20 3 Freeze-dried live attenuated mumps vaccine ............................................ 27 4 Levetiracetam ............................................................................................ 30 4. Revision of Precautions (No. 262) .................................................. 33 Linagliptin (and 2 others) 5. List of Products Subject to Early Post-marketing Phase Vigilance ........................................... 35 This Pharmaceuticals and Medical Devices Safety Information (PMDSI) is issued based on safety information collected by the Ministry of Health, Labour and Welfare (MHLW). It is intended to facilitate safer use of pharmaceuticals and medical devices by healthcare providers. The PMDSI is available on the Pharmaceuticals and Medical Devices Agency (PMDA) Medical Product Information web page (http://www.pmda.go.jp/english/index.html) and on the MHLW website (http://www.mhlw.go.jp/, only available in Japanese language). Published by Translated by Ministry of Health, Labour and Welfare Pharmaceuticals and Medical Devices Agency 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 English version of PMDSI is intended to be a reference material to provide convenience for users. In the event of inconsistency between the Japanese original and this English translation, the former shall prevail. The PMDA shall not be responsible for any consequence resulting from use of this English version. Pharmaceuticals and Medical Devices Safety Information No. 320 January 2015 Ministry of Health, Labour and Welfare & Pharmaceutical and Food Safety Bureau, Japan [ Outline of Information ] No. Subject Measures Outline of Information Page A total of 28 cases of severe febrile neutropenia, including 5 fatal cases, have been reported in patients treated with cabazitaxel acetonate. In Cabazitaxel Acetonate P order to ensure further proper use of cabazitaxel 1 and Severe Febrile 4 acetonate, the MHLW instructed the marketing Neutropenia C authorization holder (MAH) of cabazitaxel acetonate to revise the Precautions on December 22, 2014. Details are provided in this section. The MHLW instructed the MAHs of capsule endoscopes to revise the Precautions to include Use of Capsule Endoscope harmonized information on cautions including for Small Intestine aspiration and retention of the capsules in 2 P 16 Screening in Pediatrics patients of all ages, instead of the previous and Geriatrics cautions in the use of these products in pediatrics and geriatrics. Details are provided in this section. Cabazitaxel acetonate (and 3 others): Regarding the revision of the Precautions section of package inserts of drugs in accordance with Important Safety P the Notification dated December 22, 2014 and 3 19 Information C January 9, 2015, the contents of important revisions and case summaries that served as the basis for these revisions are provided in this section. Revision of Precautions 4 Linagliptin (and 2 others) 33 (No. 262) List of Products Subject to List products subject to Early Post-marketing 5 Early Post-marketing 35 Phase Vigilance as of January 1, 2015. Phase Vigilance D: Distribution of Dear Healthcare Professional Letters P: Revision of Precautions C: Case Reports PMDA medi-navi (Pharmaceuticals and Medical Devices Information E-mail Alert Service) The PMDA is providing the “PMDA medi-navi” a Pharmaceuticals and Medical Devices Information E-mail Alert Service (only available in Japanese language), when important safety information regarding pharmaceuticals and medical devices including Dear Healthcare Professional Letters or Revision of Precautions is issued. This e-mail service will enable you to obtain safety information faster and more efficiently, free of charge. Please feel free to use this service for your faster information collection. See our website for details of the service. http://www.info.pmda.go.jp/info/idx-push.html 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 authorization holder. As medical and pharmaceutical providers, drugstore and pharmacy personnel are also required to report safety issues related to drugs and medical devices. Pharmaceuticals and Medical Devices Safety Information No. 320 - 2 - January 2015 Abbreviations ADR Adverse drug reaction Alb Albumin ALT Alanine aminotransferase ANC Absolute neutrophil count AST Aspartate aminotransferase BP Blood pressure BS Blood sugar BT Body temperature BUN Blood urea nitrogen CK Creatine kinase Cr Creatinine CRP C-reactive protein CRPC Castration-resistant prostate cancer CT Computed tomography CTR Cardio-thoracic ratio DBP Diastolic blood pressure EPPV Early Post-marketing Phase Vigilance FN Febrile neutropenia G-CSF Granulocyte colony-stimulating factor Glu Glucose Hb Hemoglobin HbA1c Hemoglobin A1c IU International unit KL-6 Krebs von den Lunge-6 LDH Lactate dehydrogenase Lt Left MAH Marketing authorization holder MHLW Ministry of Health, Labour and Welfare MRI Magnetic resonance imaging NCCN National Comprehensive Cancer Network NGSP National glycohemoglobin standardization program PD Progressive disease PLT Platelet PMDA Pharmaceuticals and Medical Devices Agency PCO2 Carbon dioxide partial pressure PO2 Oxygen partial pressure PS Performance status PSA Prostate-specific antigen RBC Red blood cell count Rt Right SBP Systolic blood pressure SpO2 Oxygen saturation TEN Toxic epidermal necrolysis TNM Tumour- node-metastasis T-P Total protein UA Uric acid WBC White blood cell count Pharmaceuticals and Medical Devices Safety Information No. 320 - 3 - January 2015 1 Cabazitaxel Acetonate and Severe Febrile Neutropenia Active ingredient Cabazitaxel acetonate Brand Name Jevtana 60 mg I.V. Infusion (Sanofi K.K.) (name of company) Therapeutic Category Antineoplastics-Plant extract preparations Indications Prostate cancer 1. Introduction Cabazitaxel acetonate (Jevtana 60 mg I.V. Infusion, hereinafter referred to as Jevtana) is a taxane antineoplastic thought to suppress tumor growth by accelerating tubulin polymerization and stabilizing microtubules to inhibit cell division. In Japan, Jevtana was approved for the indication for “prostate cancer” in July 2014. For febrile neutropenia (FN) associated with Jevtana, cautions have been included since approval in the package insert as well as in the guide for proper use included in the information materials prepared by the marketing authorization holder (MAH) based on the incidence reported in the clinical trials submitted for approval review. Since the launch on September 4 until December 17, 2014, Jevtana has been used in 208 patients, and serious FN has been reported in 28 cases, including 5 fatalities (including cases with causal relationship unknown due to insufficient information). Based on the reported serious cases, the Ministry of Health, Labour and Welfare (MHLW) instructed the MAH to revise the Precautions section of the package insert and take safety measures such as distribution of information materials to promote proper use of Jevtana on December 22, 2014. Details are described below. 2. Background The incidence of FN from the clinical trials submitted for approval review of Jevtana was 54.5% (24/44) in patients treated with cabazitaxel 25 mg/m2 in the Japanese phase I study (TED11576) and 7.5% (28/371) in the overseas phase III study (EFC6193). Based on the reported results, cautions against FN were included in the sections of Warnings, Important Precautions, and Clinically Significant Adverse Reactions of the package insert at the time of approval. Although no fatal case was reported in the Japanese phase I study, fatal FN cases were reported in the overseas phase III study; therefore, the Warnings section mentions the fatal case reports to raise caution. Since the launch in September 2014, cases of patients who had FN after using Jevtana have been reported in Japan and cases with fatal outcome have also been reported. As a result of thorough review of the fatal cases, appropriate antibiotics were not immediately used based on the FN treatment guidelines1-2) in some cases. Under instructions from the Pharmaceuticals and Medical Devices Agency (PMDA), the MAH prepared the material “Information on Proper Use of Jevtana”3) and has been distributing it to medical institutions since December 8, 2014 to advice on appropriate treatment of FN. After
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