Australian Public Assessment Report for Rotigotine Proprietary Product Name: Neupro Sponsor: UCB Australia Pty Ltd January 2011 Therapeutic Goods Administration About the Therapeutic Goods Administration (TGA) · The TGA is a division of the Australian Government Department of Health and Ageing, and is responsible for regulating medicines and medical devices. · 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. About AusPARs · An Australian Public Assessment Record (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, in that it will provide 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 2011 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General’s Department, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca AusPAR Neupro Rotigotine UCB Australia Pty Ltd PM-2009-01999-3-1 Page 2 of 86 Date of Finalisation 8 October 2010 Therapeutic Goods Administration Contents I. Introduction to Product Submission .............................................................. 4 Submission Details........................................................................................................ 4 Product Background ..................................................................................................... 4 Regulatory Status .......................................................................................................... 6 Product Information ...................................................................................................... 7 II. Quality Findings .................................................................................................. 7 Drug Substance (active ingredient)............................................................................ 7 Drug Product .................................................................................................................. 7 Quality Summary and Conclusions............................................................................ 8 III. Nonclinical Findings .......................................................................................... 8 Nonclinical Summary and Conclusions .................................................................... 8 IV. Clinical Findings ................................................................................................. 8 Introduction..................................................................................................................... 8 Pharmacodynamics ....................................................................................................... 9 Pharmacokinetics ........................................................................................................ 10 Efficacy .......................................................................................................................... 21 Safety ............................................................................................................................. 45 Clinical Summary and Conclusions ......................................................................... 58 V. Pharmacovigilance Findings .......................................................................... 59 Risk Management Plan ............................................................................................... 59 VI. Overall Conclusion and Risk/Benefit Assessment .................................... 62 Quality ............................................................................................................................ 62 Nonclinical .................................................................................................................... 62 Clinical ........................................................................................................................... 62 Risk Management Plan ............................................................................................... 66 Risk-Benefit Analysis .................................................................................................. 66 Outcome ........................................................................................................................ 67 Attachment 1. Product Information ...................................................................... 67 AusPAR Neupro Rotigotine UCB Australia Pty Ltd PM-2009-01999-3-1 Page 3 of 86 Date of Finalisation 8 October 2010 Therapeutic Goods Administration I. Introduction to Product Submission Submission Details Type of Submission Extension of Indications Registration of Two New Strengths Decision: Approved Date of Decision: 8 October 2010 Active ingredient(s): Rotigotine Product Name(s): Neupro Sponsor’s Name and UCB Australia Pty Ltd Address: Level 1, 1155 Malvern Road Malvern Vic 3144 Dose form(s): Transdermal patch Strength(s): 1 mg/24 h, 2 mg/24 h, 3 mg/24 h, 4 mg/24 h, 6 mg/24 h and 8 mg/24 h Container(s): Sachet containing one patch Pack size(s): Each strength is available in a pack of 7, 28 or 100 sachets Approved Therapeutic use: Parkinson's disease Neupro is indicated as monotherapy, or in combination with levodopa, for the treatment of idiopathic Parkinson’s disease from early stage to advanced disease. Restless Legs Syndrome Neupro is indicated for the symptomatic treatment of moderate to severe idiopathic Restless Legs Syndrome in adults. Route(s) of administration: Transdermal Dosage: Dosage is dependent on the indication and for Parkinson’s disease, the stage of the disease. For the newly approved indication, Restless Legs Syndrome, a single daily dose should be initiated at 1 mg/24 h. Depending on the individual patient response, the dose may be increased in weekly increments of 1 mg/24 h to a maximal dose of 3 mg/24 h. ARTG Number (s) 131370, 131381, 131382, 131383, 163987, 163988 Product Background Neupro (rotigotine) is currently indicated for the treatment of the signs and symptoms of early-stage idiopathic Parkinson’s disease (PD) as monotherapy (without levodopa) or in combination with levodopa, over the course of the disease, through to late stages when the effect of levodopa wears off or becomes inconsistent and fluctuations of the therapeutic effect occur (end of dose or ‘on-off’ fluctuations). In the current submission, the sponsor proposes to expand the indication of rotigotine to include the symptomatic treatment of moderate to severe idiopathic Restless Legs Syndrome (RLS). AusPAR Neupro Rotigotine UCB Australia Pty Ltd PM-2009-01999-3-1 Page 4 of 86 Date of Finalisation 8 October 2010 Therapeutic Goods Administration Restless Legs Syndrome can be described as a neurological sensorimotor disorder with irresistible leg movements that are often accompanied by creeping sensations deep in the limbs. The symptoms of RLS are not confined to the legs, but can also occur in the upper limbs. The majority of symptoms of RLS occur in the evening and at night. Lying down in bed is associated with increased paraesthesia and an irresistible urge to move, often accompanied by periodic limb movements which interfere with sleep onset and with consolidation of sleep. Restless Legs Syndrome is one of the most frequent neurological diseases, with an estimated prevalence of 7% to 11% of the general population. 1 In recent years, the International Restless Legs Syndrome Study Group (IRLSSG) has developed and validated the International Restless Legs Syndrome Study Group Rating Scale (IRLS), a subject-based rating scale that assesses the severity of RLS (Walters et al, 2003).2 The IRLS has been used in clinical trials with dopamine agonists (for example, cabergoline, pergolide, ropinirole, and pramipexole) and represents an increasingly accepted international standard for the clinical assessment of RLS severity (Trenkwalder et al, 2004; Freeman et al, 2001, Winkelman et al, 2006).3,4,5 This scale is used as an inclusion criterion to assess the severity of disease and as one of the main outcome measures in the clinical trials presented. The Clinical Global Impression (CGI) rating scales