Takeda’s GAMMAGARD LIQUID® Approved by U.S. FDA for Adults with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
- FDA approval for GAMMAGARD LIQUID as an intravenous immunoglobulin therapy for adults with CIDP.
- Recent FDA approval of HYQVIA for maintenance therapy in adults with CIDP.
- The approval is based on a clinical study that evaluated the efficacy and safety of GAMMAGARD LIQUID in adults with CIDP.
- None.
Insights
The FDA's approval of GAMMAGARD LIQUID as an intravenous therapy for adults with chronic inflammatory demyelinating polyneuropathy (CIDP) represents a significant development in the treatment landscape for this rare neuromuscular disorder. CIDP is characterized by immune-mediated attack on the peripheral nerves, leading to varying degrees of weakness and sensory loss. The high responder rate of 94.4% observed in the ADVANCE-CIDP 2 study indicates a strong efficacy profile for the drug, which could make it a preferred option for induction therapy in CIDP patients experiencing a relapse.
From a medical research perspective, the lack of data on GAMMAGARD LIQUID in immunoglobulin-naive patients and for maintenance therapy beyond six months suggests an opportunity for further clinical studies. The drug's mechanism of action, while not fully elucidated, is believed to involve immunomodulatory effects, which is a common therapeutic approach for autoimmune conditions. This approval may stimulate additional research into the long-term efficacy and safety of IVIG therapies in this patient population.
With the approval of GAMMAGARD LIQUID, Takeda strengthens its position in the plasma-derived therapies market, particularly within the immunoglobulin (IG) segment. The approval could potentially expand the addressable market for Takeda by catering to the CIDP patient population that requires induction therapy. The company's ability to offer both induction and maintenance therapy options—following the recent approval of HYQVIA—allows for a more comprehensive treatment regimen that could be attractive to healthcare providers and patients seeking personalized treatment plans.
The unique standing of GAMMAGARD LIQUID as the only IVIG approved for multiple neuromuscular disorder indications in the U.S. may provide Takeda a competitive edge. However, market adoption will depend on factors such as insurance coverage, pricing strategies and the drug's integration into existing treatment protocols. The long-term impact on Takeda's financial performance will be contingent on the successful commercialization and the ability to leverage this approval to capture market share from competitors.
The approval of a new indication for GAMMAGARD LIQUID could have a positive impact on Takeda's financials, potentially leading to increased revenue streams from the expanded use of the therapy. As a rare disease with limited treatment options, CIDP represents a high-value niche market. The approval may enhance investor confidence in Takeda's research and development capabilities and its commitment to addressing unmet medical needs.
Investors should monitor Takeda's upcoming financial reports for indications of how this approval is translating into sales growth. It's also important to consider the potential costs associated with marketing and distribution of the new indication, as well as any post-marketing surveillance obligations that may arise. The company's strategic focus on plasma-derived therapies and rare diseases aligns with industry trends favoring specialization in high-margin areas, which could have long-term benefits for shareholder value.
- New Indication Delivers on Takeda’s Commitment to Expanding its Broad and Diverse Immunoglobulin (IG) Portfolio to Meet the Needs of People Living with CIDP
- Approval Supported by Phase 3 ADVANCE-CIDP Open-label Study Data Demonstrating Safety and Efficacy as an Intravenous Therapy for Adults with CIDP
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GAMMAGARD LIQUID [Immune Globulin Infusion (Human)
10% Solution] is the Only Intravenous IG (IVIG) Approved for the Treatment of Multiple Neuromuscular Disorder Indications in theU.S.
This milestone follows the recent FDA approval of HYQVIA® [Immune Globulin Infusion
“The approval of GAMMAGARD LIQUID for treatment of CIDP is an encouraging validation of our decades-long commitment to advancing plasma-derived therapies on behalf of people living with rare neuromuscular disorders and bringing our portfolio of differentiated IG therapies to these patients,” said Richard Ascroft, senior vice president and head of Takeda’s
The approval is based on results from a prospective, open-label, single-arm, multicenter clinical study (ADVANCE-CIDP 2) that evaluated the efficacy and safety of GAMMAGARD LIQUID in adults with CIDP who developed a relapse in the randomized, double-blinded, placebo-controlled study evaluating efficacy, safety and tolerability of HYQVIA (ADVANCE-CIDP 1) in adults with CIDP. Efficacy in ADVANCE-CIDP 2 was based on responder rate, where a responder was defined as a subject who demonstrated an improvement of functional disability. The responder rate was
The most common adverse reactions observed in ≥
CIDP is a rare, acquired, immune-mediated neuromuscular disorder affecting the peripheral nervous system.3,4 It is characterized by progressive, symmetric symptoms such as weakness, tingling or loss of feeling in distal and proximal limbs, loss of reflexes and difficulty walking.3 Because its symptoms may overlap with other rare, neuromuscular conditions, CIDP may be misdiagnosed.5 The mechanism of action of immunoglobulins in the treatment of CIDP in adults has not been fully elucidated but may include immunomodulatory effects.1
“As the standard of care for the treatment of CIDP, IG therapy is thought to help normalize compromised immune systems through immunomodulatory mechanisms,” said Dr. Mamatha Pasnoor, professor in the Department of Neurology at the University of Kansas Medical Center. “Because CIDP is a progressive and complex disease, multiple treatment options are needed, and clinicians now have an additional therapy that can help adults with CIDP manage their disease.”
GAMMAGARD LIQUID is the only IVIG with multiple neuromuscular disorder indications in the
About GAMMAGARD LIQUID
GAMMAGARD LIQUID® [Immune Globulin Infusion (Human)
About HYQVIA
HYQVIA® [Immune Globulin Infusion
About ADVANCE-CIDP 2
ADVANCE-CIDP 2 was a prospective, open-label, single-arm, multicenter clinical study that evaluated the efficacy and safety of GAMMAGARD LIQUID in adults with CIDP who developed a relapse in the randomized, double-blinded, placebo-controlled study evaluating efficacy, safety and tolerability of HYQVIA (ADVANCE-CIDP 1) in adults with CIDP. The 18 patients who relapsed during ADVANCE-CIDP 1 were offered enrollment in ADVANCE-CIDP 2.
GAMMAGARD LIQUID was administered at an induction dose of 2 g/kg body weight, followed by maintenance infusions at every three weeks for a period of six months. The dose of GAMMAGARD LIQUID treatment could be adjusted at the investigator's discretion. Adjustments to the dosing interval of every three weeks were not allowed. All subjects completed the study. All dosed subjects were analyzed for efficacy and safety. Efficacy of ADVANCE-CIDP 2 was based on responder rate, where a responder is defined as subjects who had at least a one-point decrease in the adjusted Inflammatory Neuropathy Cause and Treatment (INCAT) disability score at the completion of the treatment period (six months). The responder rate was
Further information about the ADVANCE-CIDP 2 study is available at ClinicalTrials.gov under study identifier NCT02549170.
INDICATIONS
GAMMAGARD LIQUID is indicated as replacement therapy for Primary Humoral Immunodeficiency (PI) in adult and pediatric patients ≥2 years, as a maintenance therapy to improve muscle strength and disability in adult patients with Multifocal Motor Neuropathy (MMN), and as a therapy to improve neuromuscular disability and impairment in adult patients with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP).
LIMITATIONS OF USE (CIDP): GAMMAGARD LIQUID has not been studied in immunoglobulin-naive patients with CIDP. GAMMAGARD LIQUID maintenance therapy in CIDP has not been studied for periods longer than 6 months. After responding during an initial treatment period, not all patients require indefinite maintenance therapy with GAMMAGARD LIQUID in order to remain free of CIDP symptoms. Individualize the duration of any treatment beyond 6 months based upon the patient’s response and demonstrated need for continued therapy.
HYQVIA is indicated for the treatment of Primary Immunodeficiency (PI) in adults and pediatric patients two years of age and older and for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) as maintenance therapy to prevent relapse of neuromuscular disability and impairment in adults.
HYQVIA is for subcutaneous use only.
GAMMAGARD LIQUID for PI is for intravenous or subcutaneous use.
GAMMAGARD LIQUID for MMN and CIDP is for intravenous use only.
IMPORTANT SAFETY INFORMATION
WARNING: THROMBOSIS
HYQVIA and GAMMAGARD LIQUID
- Thrombosis may occur with immune globulin (IG) products, including HYQVIA and GAMMAGARD LIQUID. Risk factors may include advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling vascular catheters, hyperviscosity, and cardiovascular risk factors. Thrombosis may occur in the absence of known risk factors.
- For patients at risk of thrombosis, administer HYQVIA and GAMMAGARD LIQUID at the minimum dose and infusion rate practicable. Ensure adequate hydration in patients before administration.
- Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk of hyperviscosity.
WARNING: RENAL DYSFUNCTION and ACUTE RENAL FAILURE
GAMMAGARD LIQUID
- Renal dysfunction, acute renal failure, osmotic nephrosis, and death may occur in predisposed patients with immune globulin intravenous (IGIV) products, including GAMMAGARD LIQUID. Patients predisposed to renal dysfunction include those with any degree of pre-existing renal insufficiency, diabetes mellitus, age greater than 65, volume depletion, sepsis, paraproteinemia, or patients receiving known nephrotoxic drugs. Renal dysfunction and acute renal failure occur more commonly in patients receiving IGIV products containing sucrose. GAMMAGARD LIQUID does not contain sucrose.
Contraindications
- HYQVIA and GAMMAGARD LIQUID are contraindicated in patients with a history of anaphylactic or severe systemic hypersensitivity reactions to human IG, and IgA-deficient patients with antibodies to IgA and a history of hypersensitivity to human IG. Anaphylaxis has been reported with intravenous (IV) use of GAMMAGARD LIQUID.
- Additionally, HYQVIA is contraindicated in patients with known systemic hypersensitivity to hyaluronidase including Recombinant Human Hyaluronidase of HYQVIA, and known systemic hypersensitivity to human albumin (in the hyaluronidase solution).
Warnings and Precautions
Hypersensitivity: Severe hypersensitivity reactions may occur, even in patients who have tolerated previous treatment with human IG. If a hypersensitivity reaction occurs, discontinue infusion immediately and institute appropriate treatment. IgA-deficient patients with antibodies to IgA are at greater risk of developing potentially severe hypersensitivity reactions, including anaphylaxis.
Renal Dysfunction/Failure: Acute renal dysfunction/failure, acute tubular necrosis, proximal tubular nephropathy, osmotic nephrosis, and death may occur with IV use of IG products, especially those containing sucrose. Acute renal dysfunction/failure has been reported in association with infusions of GAMMAGARD LIQUID. Ensure patients are not volume depleted prior to infusion. In patients at risk due to pre-existing renal insufficiency or predisposition to acute renal failure, assess renal function before initiation and throughout treatment, and consider lower, more frequent dosing. If renal function deteriorates, consider discontinuation.
Thrombosis: Has been reported to occur following treatment with IG products, including HYQVIA and in the absence of known risk factors. In patients at risk, administer at the minimum dose and infusion rate practicable. Ensure adequate hydration before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity.
Aseptic Meningitis Syndrome: Has been reported with use of IG, including HYQVIA and may occur more frequently in females. Conduct a thorough neurological exam on patients exhibiting signs and symptoms, to rule out other causes of meningitis. Discontinuing IG treatment has resulted in remission within several days without sequelae. The syndrome usually begins within several hours to two days following IG treatment.
Hemolysis: HYQVIA and GAMMAGARD LIQUID contain blood group antibodies, which may cause a positive direct antiglobulin reaction and hemolysis. Monitor patients for signs and symptoms of hemolysis and delayed hemolytic anemia and, if present, perform appropriate confirmatory lab testing.
Transfusion-Related Acute Lung Injury: Non-cardiogenic pulmonary edema has been reported with IV-administered IG, including GAMMAGARD LIQUID. Monitor patients for pulmonary adverse reactions. If suspected, perform appropriate tests for presence of anti-neutrophil and anti-HLA antibodies in both product and patient serum. May be managed using oxygen therapy with adequate ventilatory support.
Transmittable Infectious Agents: Because HYQVIA and GAMMAGARD LIQUID are made from human plasma, they may carry a risk of transmitting infectious agents (e.g., viruses, other pathogens). No confirmed cases of viral transmission of variant Creutzfeldt-Jakob disease (vCJD) have been associated with GAMMAGARD LIQUID, and no cases have been associated with HYQVIA.
Interference with Lab Tests: False positive serological test results and certain assay readings, with the potential for misleading interpretation, may occur as the result of passively transferred antibodies.
Additional Warnings and Precautions for HYQVIA
Immunogenicity of Recombinant Human Hyaluronidase (rHuPH20): Non-neutralizing antibodies to the Recombinant Human Hyaluronidase component can develop. The clinical significance of these antibodies or whether they interfere with fertilization in humans is unknown.
Spread of Localized Infection: Do not infuse HYQVIA into or around an infected area due to potential risk of spreading a localized infection.
Additional Warnings and Precautions for GAMMAGARD LIQUID
Hyperproteinemia, increased serum viscosity, and hyponatremia may occur. It is critical to distinguish true hyponatremia from a pseudohyponatremia because certain treatments may lead to volume depletion, a further increase in serum viscosity, and a predisposition to thromboembolic events.
Adverse Reactions
HYQVIA
The most common adverse reactions observed in >
PI: local adverse reactions including pain, erythema, edema, and pruritus, and systemic adverse reactions including, headache, antibody formation against Recombinant Human Hyaluronidase (rHuPH20), fatigue, nausea, pyrexia, and vomiting.
CIDP: local reactions, headache, pyrexia, nausea, fatigue, erythema, pruritus, increased lipase, abdominal pain, back pain, and pain in extremity.
GAMMAGARD LIQUID
The most serious adverse reactions observed in clinical studies in PI was aseptic meningitis, and in MMN were pulmonary embolism and blurred vision.
The most common adverse reactions observed in ≥
IV administration for PI: Headache, fatigue, pyrexia, nausea, chills, rigors, pain in extremity, diarrhea, migraine, dizziness, vomiting, cough, urticaria, asthma, pharyngolaryngeal pain, rash, arthralgia, myalgia, oedema peripheral, pruritus, and cardiac murmur.
Subcutaneous administration for PI: Infusion site (local) event (rash, erythema, edema, hemorrhage, and irritation), headache, fatigue, heart rate increased, pyrexia, abdominal pain upper, nausea, vomiting, asthma, blood pressure systolic increased, diarrhea, ear pain, aphthous stomatitis, migraine, oropharyngeal pain, and pain in extremity.
IV administration for MMN: Headache, chest discomfort, muscle spasms, muscular weakness, nausea, oropharyngeal pain, and pain in extremity.
IV administration for CIDP: Headache, pyrexia, anemia, leukopenia, neutropenia, illness, blood creatinine increased, dizziness, migraine, somnolence, tremor, nasal dryness, abdominal pain upper, vomiting, chills, nasopharyngitis, and pain in extremity.
Drug Interactions
Passive transfer of antibodies may transiently interfere with the immune responses to live attenuated virus vaccines (e.g., measles, mumps, rubella, and varicella).
Use In Specific Populations
Pregnancy: Limited human data are available on the use of HYQVIA during pregnancy. The effects of antibodies to the Recombinant Human Hyaluronidase on the human embryo or fetal development are unknown. It is not known whether HYQVIA can cause fetal harm when administered to a pregnant woman or if it can affect reproductive capacity. HYQVIA should be given to a pregnant woman only if clearly needed.
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About Takeda
Takeda is focused on creating better health for people and a brighter future for the world. We aim to discover and deliver life-transforming treatments in our core therapeutic and business areas, including gastrointestinal and inflammation, rare diseases, plasma-derived therapies, oncology, neuroscience and vaccines. Together with our partners, we aim to improve the patient experience and advance a new frontier of treatment options through our dynamic and diverse pipeline. As a leading values-based, R&D-driven biopharmaceutical company headquartered in
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1 GAMMAGARD LIQUID® [Immune Globulin Infusion (Human)
2 HYQVIA® [Immune Globulin Infusion
3 Dalakas MC. Nat Rev Neurol. 2011;7(9):507–17.
4 GBS CIDP Foundation International. Voice of the Patient Report. August 26, 2022. www.gbs-cidp.org. Accessed August 2022.
5 Broers MC, Bunschoten C, Nieboer D, Lingsma HF, Jacobs BC. Eur J Neurol. 2021;28(6):2065-2073.
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Lauren Padovan
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Source: Takeda Pharmaceutical Company Limited
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