Takeda’s HYQVIA® Approved by European Commission as Maintenance Therapy in Patients with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
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Insights
The recent European Commission approval of HYQVIA as a maintenance therapy for chronic inflammatory demyelinating polyneuropathy (CIDP) is a significant development in the field of neuroimmunological disorders. This therapy, which is already established in the United States, represents a novel subcutaneous delivery system that could potentially improve patient adherence and quality of life due to its less frequent dosing schedule and at-home administration capabilities. The pivotal Phase 3 ADVANCE-CIDP 1 trial data, which underpinned this approval, indicated a clinically meaningful reduction in CIDP relapse rates when compared to placebo, while maintaining a safety profile consistent with known characteristics of immunoglobulin therapies.
From a medical research perspective, the use of recombinant human hyaluronidase in facilitating the subcutaneous administration of large volume immunoglobulin is an innovative approach. It addresses the limitations associated with intravenous delivery and may reduce the burden on healthcare systems by allowing for at-home treatment. This can be particularly beneficial for patients with mobility issues or those living in remote areas. Furthermore, the therapy's broad immunomodulatory and anti-inflammatory effects align with current treatment guidelines for CIDP, reinforcing its potential role as a standard care option.
The approval of HYQVIA for maintenance therapy in CIDP patients expands Takeda's portfolio in a specialized market segment, potentially strengthening its position in the immunoglobulin therapy space. The ability to offer a differentiated product that caters to patient convenience and reduces treatment frequency may provide Takeda with a competitive advantage. This is particularly relevant given the chronic nature of CIDP, which necessitates long-term treatment strategies.
Market analysis would suggest that Takeda's strategic focus on neuroimmunological disorders could tap into unmet needs within this patient population. The company's commitment to providing personalized treatment experiences aligns with current trends in patient-centric healthcare. Additionally, the centralized marketing authorization for HYQVIA enables access across multiple European markets, which could lead to increased market penetration and revenue growth for Takeda. The long-term impact on Takeda's stock performance will likely depend on the uptake of HYQVIA in clinical practice and its ability to displace existing therapies.
The European Commission's approval of HYQVIA for CIDP introduces an alternative to traditional intravenous immunoglobulin therapy (IVIG), which may have economic implications for both healthcare systems and patients. The facilitated subcutaneous immunoglobulin (fSCIG) delivery system could lead to cost savings by reducing the need for frequent hospital visits and the associated healthcare resource utilization. Additionally, the potential for self-administration after proper training could decrease the overall cost of care for patients with CIDP.
However, the economic impact will also depend on the pricing strategy adopted by Takeda for HYQVIA. If the therapy is priced competitively in relation to IVIG and if the reduced frequency of administration translates to lower overall treatment costs, this could encourage payer adoption and support broader market access. Conversely, if the cost is prohibitive, it may limit uptake despite the clinical benefits. As healthcare systems continue to focus on cost-effectiveness, the value proposition of HYQVIA will be critical in determining its economic footprint within the CIDP treatment landscape.
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HYQVIA [Immune Globulin Infusion
10% (Human) with Recombinant Human Hyaluronidase] becomes the Only Facilitated Subcutaneous Immunoglobulin, Offering Patients an up to Once-Monthly Treatment Option - At-Home or In-Office Administration Provides CIDP Patients with a Personalized Treatment Experience
- Approval Expands Takeda’s Portfolio of Differentiated Immunoglobulin Therapies for Patients with Neuroimmunological Disorders
As the first and only facilitated subcutaneous immunoglobulin (fSCIG) for CIDP, HYQVIA offers the potential for patients to infuse up to once monthly (every two, three or four weeks), as the hyaluronidase component facilitates the dispersion and absorption of large immunoglobulin (IG) volumes in the subcutaneous space between the skin and the muscle. HYQVIA can be administered by a healthcare professional or self-administered in the comfort of a patient’s own home after appropriate training.3
“Following the FDA approval of the HYQVIA CIDP indication in January 2024, the EC’s approval of HYQVIA for CIDP is a critical step towards giving people in the EU living with CIDP access to a maintenance treatment with proven efficacy that can be administered up to once monthly, at-home or in-office,” said Kristina Allikmets, senior vice present and head of Research & Development for Takeda’s Plasma-Derived Therapies Business Unit. “This expanded indication for HYQVIA also reflects Takeda’s commitment to bring the benefits of our immunoglobulin therapies to people with neuroimmunological disorders and provide treatment options that have the potential to positively impact their lives and elevate the standard of care.”
CIDP is an acquired, immune-mediated condition affecting the peripheral nervous system that is characterized by progressive, symmetric weakness in distal and proximal limbs and impaired sensory function in the extremities.4 The role of IG therapy for this rare, debilitating and slowly progressing or relapsing disease has been well-established5 and is considered a standard of care for this complex and heterogeneous condition in guidelines from the European Academy of Neurology and Peripheral Nerve Society due to its broad immunomodulatory and anti-inflammatory effects.6
This approval is based on data from the pivotal Phase 3 ADVANCE-CIDP 1 trial, which was a multicenter, placebo-controlled, double-blinded study that evaluated the efficacy and safety of HYQVIA as a maintenance therapy to prevent relapse in patients with CIDP. The global study included 132 adults with a confirmed diagnosis of CIDP who had remained on a stable dosing regimen of IVIG therapy for at least three months prior to screening. Results showed a clinically significant reduction in CIDP relapse rate with HYQVIA versus placebo
While adverse events (AEs) were more frequent with HYQVIA (
The centralized marketing authorization for HYQVIA in CIDP is valid in all EU member states as well as in
About HYQVIA®
HYQVIA® [Immune Globulin Infusion
About the ADVANCE Clinical Program
ADVANCE-CIDP 1 was a Phase 3, multicenter, placebo-controlled, double-blinded study to evaluate the efficacy, safety and tolerability of HYQVIA® [Immune Globulin Infusion
The primary endpoint of the clinical trial was the proportion of subjects who experienced a worsening of functional disability, defined as an increase of ≥1 point relative to the pre-subcutaneous (SC) treatment baseline score in two consecutive adjusted Inflammatory Neuropathy Cause and Treatment (INCAT) disability scores. The primary efficacy analysis compared relapse rates using a continuity-corrected χ2 test conducted at the
Further information about the ADVANCE-CIDP 1 clinical trial is available at ClinicalTrials.gov under study identifier NCT02549170.
HyQvia® (Human normal immunoglobulin) 100 mg/ml solution for infusion for subcutaneous use PRESCRIBING INFORMATION
Always refer to the Summary of Product Characteristics (SmPC) and the local prescribing information of your country before prescribing.
Presentation: HyQvia is a dual vial unit consisting of one vial of
Indications: Replacement therapy in adults, children and adolescents (0-18 years) in: primary immunodeficiency syndromes (PID) with impaired antibody production; secondary immunodeficiencies (SID) in patients who suffer from severe or recurrent infections, ineffective antimicrobial treatment and either proven specific antibody failure (PSAF) or serum IgG level of <4 g/l. PSAF is a failure to mount at least a 2-fold rise in IgG antibody titre to pneumococcal polysaccharide and polypeptide antigen vaccines. Immunomodulatory therapy in adults, children and adolescents (0 to 18 years) in: chronic inflammatory demyelinating polyneuropathy (CIDP) as maintenance therapy after stabilization with IVIg.
Dosage and administration: For subcutaneous use only. Therapy should be initiated and monitored under the supervision of a physician experienced in the treatment of immunodeficiency/CIDP. The product should be brought to room temperature before use. Inspect both vials for discolouration and particulate matter before administration. Do not use heating devices including microwaves. Do not shake or mix the components of the two vials. Suggested infusion site(s) are the middle to upper abdomen and thighs. The two components of the medicinal product must be administered sequentially through the same needle beginning with the recombinant human hyaluronidase followed by Ig
Contraindications: Hypersensitivity to any ingredient or human IG especially in patients with antibodies against IgA; systemic hypersensitivity to hyaluronidase or human recombinant hyaluronidase; HyQvia must not be given IV or intramuscularly.
Warnings and precautions: If HyQvia is accidentally administered into a blood vessel, patients could develop shock. The recommended infusion rate given in the SmPC should be adhered to. Infuse slowly and monitor closely throughout the infusion period, particularly patients starting therapy. Patients may require monitoring for up to 1 hour after administration. Manage infusion related events by slowing the infusion rate or stopping the infusion. Treatment will depend on the nature and severity of the adverse event. Patients should be reminded to report chronic inflammation and nodules which occur at the infusion site or other locations. For home treatment, patients should have the support of another responsible person in case of adverse reactions. Record treatment with HyQvia and batch number in patients’ notes.
Hypersensitivity: Hypersensitivity reactions are possible in patients with anti-IgA antibodies who should only be treated with HyQvia if alternative treatments are not possible and under close medical supervision. In case of hypersensitivity, shock or anaphylactic-like reactions, discontinue the infusion immediately and treat the patient for shock. Rarely, human normal IG can induce a fall in blood pressure with anaphylactic reaction. In high-risk patients HyQvia should only be administered where supportive care is available for life threatening reactions. Patients should be informed of the early signs of anaphylaxis/ hypersensitivity. Pre-medication may be used as a preventative measure.
Hypersensitivity to recombinant human hyaluronidase: Any suspicion of allergic or anaphylactic like reactions following recombinant human hyaluronidase administration requires immediate discontinuation of the infusion and standard medical treatment should be administered, if necessary.
Immunogenicity of recombinant human hyaluronidase: Development of non-neutralising antibodies and neutralizing antibodies to the recombinant human hyaluronidase component has been reported in patients receiving HyQvia in clinical studies.
Thromboembolism: Thromboembolic events including myocardial infarction, stroke, deep venous thrombosis and pulmonary embolism have been observed with IG treatment and cannot be excluded with use of HyQvia. Ensure adequate hydration prior to treatment. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk. Patients should be informed about initial symptoms and advised to contact their physician immediately upon onset.
Haemolytic anaemia: IG products contain antibodies to blood groups (e.g. A, B, D) which may act as haemolysins. Monitor for signs and symptoms of haemolysis.
Aseptic meningitis syndrome: has been reported, symptoms usually begin within several hours to 2 days following treatment. Patients should be informed about initial symptoms. Discontinuation of IG treatment may result in remission within several days without sequelae.
Interference with serological testing: After infusion of immunoglobulins, the transitory rise of the various passively transferred antibodies in the patient’s blood may result in misleading positive results in serological testing. Passive transmission of antibodies to erythrocyte´s surface antigens may interfere with some serological tests for red cell antibodies. Infusions of immunoglobulin products may lead to false positive readings in assays that depend on detection of β-D glucans for diagnosis of fungal infections.
Transmissible agents: Infectious diseases due to the transmission of infective agents cannot be totally excluded.
Sodium content: The recombinant human hyaluronidase component contains 4.03 mg sodium/mL. To be taken into consideration by patients on a controlled sodium diet.
Traceability: The name and the batch number of the administered product should be clearly recorded.
Interactions: Live attenuated virus vaccines – postpone vaccination for 3 months after treatment with HyQvia. For measles vaccine, impairment may persist for up to 1 year, so check antibody status. Please see the SmPC for details.
Fertility, pregnancy and lactation: Safety during pregnancy has not been established and immunoglobulins are excreted into the milk, therefore use with caution in pregnant and breastfeeding mothers.
Effects on ability to drive and use machines: The ability to drive and operate machines may be impaired by some adverse reactions e.g., dizziness associated with this medicinal product. Patients who experience adverse reactions during treatment should wait for these to resolve before driving or operating machines.
Undesirable effects: Very common (≥1/10 patients): Headache, Blood pressure increased and Hypertension, Nauseam Diarrhoea, Vomiting, Arthralgia, Local reactions (Infusion site discomfort, Infusion site pain, Injection site pain, Puncture site pain and Tenderness; infusion site erythema and Injection site erythema; Infusion site oedema, Injection site oedema, infusion site swelling, Injection site swelling and Swelling (local), Feeling hot, Asthenia, Fatigue, Lethargy and Malaise.
Common (≥1/100, <1/10 patients): Migraine, Tremor, Paraesthesia, Sinus tachycardia and Tachycardia, Hypotension, Dyspnoea, Abdominal distension, Erythema, Pruritus, Rash, Rash erythematous, Rash macular, Rash maculo-papular and Rash popular Urticaria, Myalgia, Limb discomfort and Pain in extremity, Back pain, Joint stiffness, Musculoskeletal chest pain, Groin pain, Hemosiderinuria, Infusion related reaction, Infusion site bruising, Injection site bruising, Infusion site haematoma, Injection site haematoma, Infusion site haemorrhage and Vessel puncture site bruise, Infusion site reaction, Injection site reaction and Puncture site reaction, Infusion site mass, Injection site mass and Infusion site nodule, Infusion site discoloration, Infusion site rash and Injection site rash, Infusion site induration and Injection site induration, Infusion site warmth, Infusion site paraesthesia and Injection site paraesthesia, Infusion site inflammation, Chills, Oedema, Oedema peripheral and Swelling (systemic), Localised oedema, Peripheral swelling and Skin oedema, Gravitational oedema, Oedema genital, Scrotal swelling and Vulvovaginal swelling, Hyperhidrosis, Coombs direct test positive and Coombs test positive.
Uncommon (≥ 1/1 000 to < 1/100): Cerebrovascular accident and Ischaemic stroke, Burning sensations.
Other undesirable effects (rare or unknown frequency): Meningitis aseptic, Hypersensitivity, Direct Coombs’ test positive, Infusion site leakage, Influenza-like illness.
Refer to the SmPC for details on full side effect and interactions.
Marketing Authorisation (MA) numbers: 2.5g EU/1/13/840/001, 5g EU/1/13/840/002, 10g EU/1/13/840/003, 20g EU/1/13/840/004, 30g EU/1/13/840/005. Name and address of MA holder: Baxalta Innovations GmbH, Industriestrasse 67, A-1221
PI approval code: PI-02941
Date of preparation: January 2024.
Further information is available on request.
Adverse events should be reported to the authorities in your country as required by local law. Adverse events should also be reported to Takeda at: GPSE@takeda.com.
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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 Takeda Pharmaceuticals. (2023 December 15). Takeda Receives Positive CHMP Opinion for HYQVIA® as Maintenance Therapy in Patients with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) [Press Release]. Available here. Last accessed January 2024.
2 Takeda Pharmaceuticals. (2024 January 16).
3 European Medicines Agency. HyQvia 100 mg/mL solution for infusion for subcutaneous use Summary of Product Characteristics. Available at https://www.ema.europa.eu/en/documents/product-information/hyqvia-epar-product-information_en.pdf.
4 Dalakas MC; Medscape. Advances in the diagnosis, pathogenesis and treatment of CIDP. Nat Rev Neurol. 2011;7(9):507-517.
5 Eftimov F, et al. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev. 2013;(12):CD001797.
6 Van den Bergh PYK, et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force-Second revision [published correction appears in J Peripher Nerv Syst. 2022 Mar;27(1):94].
7 Bril V, et al. Hyaluronidase-facilitated subcutaneous immunoglobulin
8 European Medicines Agency. HyQvia product information. Available here. Last Accessed January 2024
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Source: Takeda Pharmaceutical Company Limited
FAQ
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