Talk:Vestronidase alfa

Requested edit from Ultragenyx

Vestronidase alfa-vjbk (MEPSEVII) Vestronidase alfa-vjbk (trade name MEPSEVII) is the only drug indicated in pediatric and adult patients for the treatment of Mucopolysaccharidosis VII (MPS VII, MPS 7, Sly syndrome). The effect of MEPSEVII on the central nervous system (brain and spinal cord) symptoms of MPS VII has not been determined. MEPSEVII is a recombinant form of the human enzyme beta-glucuronidase, which provides exogenous GUS (β-Glucuronidase) enzyme for uptake into cellular lysosomes via mannose-6 phosphate residues, to help catabolize the GAGs (glycosaminoglycans) that accumulate in the tissues throughout the body of patients with MPS VII. In the United States, it was approved in November 2017. The drug was developed by Ultragenyx Pharmaceutical. Contents Pathology of MPS VII Description Medical Use Indication Important Safety Information Pharmacology History References Pathology of MPS VII Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage disorders caused by the deficiency of one of the enzymes involved in the stepwise degradation of complex carbohydrates known as glycosaminoglycans (GAGs) that include dermatan sulfate (DS), chondroitin sulfate (CS), heparan sulfate (HS) and keratan sulfate (KS). One or more of these GAGs accumulate in lysosomes depending on which catabolic step is blocked by the deficiency of a specific lysosomal enzyme. MPS VII is an ultra-rare, progressively debilitating and life threatening lysosomal storage disease and one of the rarest of the mucopolysaccharidoses (estimated prevalence < 1/250,000), in which patients are deficient in one specific enzyme, betaglucuronidase (GUS). Clinical presentation may occur as early as prenatally or at birth with hydrops fetalis, or not until adolescence or adulthood with skeletal disease and other manifestations. The presence, severity and progression of these symptoms in MPS VII patients are highly variable. Description MEPSEVII is a recombinant human lysosomal beta-glucuronidase which is a purified human enzyme produced by recombinant DNA technology in a Chinese hamster ovary cell line. It is a homotetramer, with each monomer consisting of 629 amino acids. The calculated isotope average molecular mass of each non-glycosylated peptide chain is 72,562 Da. Medical Use MEPSEVII is used for the treatment of MPS VII in pediatric and adult patients. The recommended dosage is 4 mg/kg administered by a 4 hour intravenous infusion every two weeks. INDICATION MEPSEVII is indicated in pediatric and adult patients for the treatment of Mucopolysaccharidosis VII (MPS VII, Sly syndrome). The effect of MEPSEVII on the central nervous system manifestations of MPS VII has not been determined.

IMPORTANT SAFETY INFORMATION

What is the most important information to know about MEPSEVII? • A severe allergic reaction called anaphylaxis has occurred with MEPSEVII treatment, as early as the first dose. • Symptoms of an allergic reaction will be monitored closely while receiving MEPSEVII and for 60 minutes after the injection. • If anaphylaxis is experienced, the MEPSEVII infusion will be immediately discontinued.

What are the possible side effects of MEPSEVII? • The most common side effects of MEPSEVII are: o Leakage of MEPSEVII into the surrounding tissue during infusion o Diarrhea o Rash o Severe allergic reaction (anaphylaxis) o Infusion site swelling o Swelling around the infusion site o Severe itching of the skin • One patient experienced a seizure during a fever while taking MEPSEVII.

Before receiving MEPSEVII, doctors should be informed about all medical conditions, including if: • One is pregnant, thinks she may be pregnant, or plans to become pregnant. There is not enough experience to know if MEPSEVII may harm an unborn baby. • One is breastfeeding or plans to breastfeed. There is not enough experience to know if MEPSEVII passes into breast milk. Women should talk with their doctor about the best way to feed their babies while receiving MEPSEVII. These are not all the possible side effects of MEPSEVII. Doctors should be contacted for medical advice about side effects. Side effects may be reported to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. Side effects may also be reported to Ultragenyx at 1-888-756-8657. Please see full Prescribing Information for additional Important Safety Information including serious side effects. Pharmacology MEPSEVII is a recombinant form of human GUS and is intended to provide exogenous GUS enzyme for uptake into cellular lysosomes. Mannose-6-phosphate (M6P) residues on the oligosaccharide chains allow binding of the enzyme to cell surface receptors, leading to cellular uptake of the enzyme, targeting to lysosomes and subsequent catabolism of accumulated GAGs in affected tissues. History Dr. William Sly, of the Saint Louis University School of Medicine, first described the condition now known as MPS VII or “Sly syndrome” in 1973, recognizing it as distinct from other MPS disorders. In 1967, biochemist and geneticist Elizabeth Neufeld showed that deficient enzymes resulting in lysosomal storage disorders such as MPS could be replaced at the cellular level, potentially restoring normal cell functions. In the early 1990s, the genes were cloned, allowing studies of recombinant enzyme replacement in mouse models of MPS diseases, including MPS VII. Researchers at Saint Louis University produced a high-uptake, recombinant beta-glucuronidase enzyme (known scientifically as rhGUS) in 1993. They showed that the enzyme could be infused into MPS VII mice to reduce the lysosomal storage of GAGs and result in other improvements. However, even with the early animal-model data, development of a clinically viable ERT for MPS VII languished for almost two decades. The rarity and heterogeneity of the disease made it impractical to utilize traditional study designs, which require large sample sizes and challenging clinical endpoints. Development of a treatment began in 2010, when biotechnology start-up Ultragenyx in-licensed rhGUS from Saint Louis University. In 2014, a Phase 1/2 study in three patients determined the optimal dose and safety using a dose-finding scheme. This study was followed in 2014 by a 12-patient Phase 3 study (UX003-CL301) utilizing a novel and more powerful randomized start trial design that maximizes the amount of data collected from a small cohort of patients while achieving objectivity. Based on the clinical evidence, the FDA approved vestronidase alfa-vjbk (under the trade name MEPSEVII) for the treatment of MPS VII in November 2017. In the EU, the Committee for Medicinal Products for Human Use (CHMP)—the scientific committee of the European Medicines Agency (EMA)—adopted a positive opinion recommending the marketing authorization of MEPSEVII in June 2018.

https://www.ultragenyx.com/file.cfm/28/docs/FINAL%20Mepsevii%20(vestronidase%20alfa-vjbk)%20USPI.pdf

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=925d4e21-fd98-474d-a34d-a0b3558ed750

https://www.fda.gov/Drugs/ucm587055.htm

https://www.ncbi.nlm.nih.gov/pubmed/29478819

https://www.ncbi.nlm.nih.gov/pubmed/26908836

https://www.ncbi.nlm.nih.gov/pubmed/25468648

http://www.mepsevii.com/en/

http://mpsviiinfocus.com/

Gary at Ultragenyx (talk) 20:27, 2 August 2018 (UTC)Gary at Ultragenyx

The content above is simply copy and pasted from various sources. Wikipedia is an encyclopedia, not a pharmaceutical package insert. The article content should, in general, follow guidelines describe at Wikipedia:WikiProject Pharmacology/Style guide. -- Ed (Edgar181) 01:28, 21 November 2018 (UTC)

Revised Edits Recommended - Ultragenyx

Vestronidase alfa-vjbk (MEPSEVII) Vestronidase alfa-vjbk (trade name MEPSEVII) is the only drug indicated in pediatric and adult patients for the treatment of Mucopolysaccharidosis VII (MPS VII, MPS 7, Sly syndrome). The effect of MEPSEVII on the central nervous system (brain and spinal cord) symptoms of MPS VII has not been determined.2 MPS VII is a form of Mucopolysaccharidoses (MPS). 7,8 MEPSEVII is a recombinant form of the human enzyme beta-glucuronidase, which provides exogenous GUS (β-Glucuronidase) enzyme for uptake into cellular lysosomes via mannose-6 phosphate residues, to help catabolize the GAGs (glycosaminoglycans) that accumulate in the tissues throughout the body of patients with MPS VII.2,3,4 In the United States, it was approved in November 2017. The drug was developed by Ultragenyx Pharmaceutical.

Contents Medical Uses

• Bulleted list item

Use in Specific Populations

• Bulleted list item

Pediatric Use

• Bulleted list item

Geriatric Use Indication Side Effects / Adverse Events Pharmacology History References

Medical Uses

MEPSEVII is indicated in pediatric and adult patients for the treatment of Mucopolysaccharidosis VII (MPS VII, Sly syndrome).^2,3,4 The effect of MEPSEVII on the central nervous system manifestations of MPS VII has not been determined.²

1. Specific Populations a. Pediatric Use i. The safety and effectiveness of MEPSEVII have been established in pediatric patients less than 18 years of age.² b. Geriatric Use i. Clinical trials of MEPSEVII did not include any patients aged 65 and over. It is not known whether elderly patients respond differently from younger patients. ²

Indication

MEPSEVII is indicated in pediatric and adult patients for the treatment of Mucopolysaccharidosis VII (MPS VII, Sly syndrome).^2,3,4 The effect of MEPSEVII on the central nervous system manifestations of MPS VII has not been determined.²

Side Effects / Adverse Events

The most common side effects of MEPSEVII include:

• Bulleted list item

Leakage of MEPSEVII into the surrounding tissue during infusion²

• Bulleted list item

Diarrhea²

• Bulleted list item

Rash²

• Bulleted list item

Severe allergic reaction (anaphylaxis)²

• Bulleted list item

Infusion site swelling²

• Bulleted list item

Swelling around the infusion site²

• Bulleted list item

Severe itching of the skin²

Adverse events reported include:

• Bulleted list item

A severe allergic reaction called anaphylaxis has occurred with MEPSEVII treatment, as early as the first dose.²

• Bulleted list item

Symptoms of an allergic reaction should be monitored closely while receiving MEPSEVII and for 60 minutes after the injection.²

• Bulleted list item

If anaphylaxis is experienced, the MEPSEVII infusion should immediately discontinued.²

• Bulleted list item

One patient experienced a seizure during a fever while taking MEPSEVII.²

A comprehensive list of important safety information can be found, here.²

Pharmacology MEPSEVII is a recombinant form of human GUS and is intended to provide exogenous GUS enzyme for uptake into cellular lysosomes. Mannose-6-phosphate (M6P) residues on the oligosaccharide chains allow binding of the enzyme to cell surface receptors, leading to cellular uptake of the enzyme, targeting to lysosomes and subsequent catabolism of accumulated GAGs in affected tissues.2,3,4

History Dr. William Sly, of the Saint Louis University School of Medicine, first described the condition now known as MPS VII or “Sly syndrome” in 1973, recognizing it as distinct from other MPS disorders. In 1967, biochemist and geneticist Elizabeth Neufeld showed that deficient enzymes resulting in lysosomal storage disorders such as MPS could be replaced at the cellular level, potentially restoring normal cell functions. In the early 1990s, the genes were cloned, allowing studies of recombinant enzyme replacement in mouse models of MPS diseases, including MPS VII. Researchers at Saint Louis University produced a high-uptake, recombinant beta-glucuronidase enzyme (known scientifically as rhGUS) in 1993. They showed that the enzyme could be infused into MPS VII mice to reduce the lysosomal storage of GAGs and result in other improvements.

However, even with the early animal-model data, development of a clinically viable ERT for MPS VII languished for almost two decades. The rarity and heterogeneity of the disease made it impractical to utilize traditional study designs, which require large sample sizes and challenging clinical endpoints.

Development of a treatment began in 2010, when biotechnology start-up Ultragenyx in-licensed rhGUS from Saint Louis University. In 2014, a Phase 1/2 study in three patients determined the optimal dose and safety using a dose-finding scheme. This study was followed in 2014 by a 12-patient Phase 3 study (UX003-CL301) utilizing a novel and more powerful randomized start trial design that maximizes the amount of data collected from a small cohort of patients while achieving objectivity. Based on the clinical evidence, the FDA approved vestronidase alfa-vjbk (under the trade name MEPSEVII) for the treatment of MPS VII in November 2017. In the EU, the Committee for Medicinal Products for Human Use (CHMP)—the scientific committee of the European Medicines Agency (EMA)—adopted a positive opinion recommending the marketing authorization of MEPSEVII in June 2018.7

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Jfoster2019 (talk) 20:46, 25 February 2019 (UTC)

Rename the page to Vestronidase alfa

I suggest renaming the page to Vestronidase alfa. Whywhenwhohow (talk) 04:13, 10 December 2019 (UTC)