Natpar is the first and only licensed recombinant human parathyroid hormone therapy for chronic hypoparathyroidism
Zug, Switzerland - April 26, 2017 – Shire plc (LSE: SHP, NASDAQ: SHPG) today announced that the European Commission (EC) has granted Conditional Marketing Authorisation for Natpar (rhPTH[1-84]), the first recombinant human protein with the full length 84-amino acid sequence of endogenous parathyroid hormone (PTH). Natpar will be the first and only approved hormone therapy indicated as adjunctive treatment for adult patients with chronic hypoparathyroidism who cannot be adequately controlled with standard therapy alone.1 Hypoparathyroidism is a rare endocrine disease resulting from an inappropriately low circulating PTH concentration.2
‘‘As the first and only licensed recombinant parathyroid hormone treatment in Europe for chronic hypoparathyroidism, Natpar represents a historical and timely innovation for patients who cannot be adequately controlled on calcium and vitamin D alone,” said Philip J. Vickers, Ph.D., Global Head of Research and Development at Shire. “The approval of Natpar offers an important advance in the management of this rare endocrine disorder for patients in Europe.”
The Conditional Marketing Authorisation is based on the outcomes from the Phase III efficacy and safety of rhPTH(1-84) clinical trial (REPLACE) in patients aged 19-74 years with chronic hypoparathyroidism.1 The trial showed that Natpar maintained serum calcium while reducing oral calcium and active vitamin D supplemental doses.1
“Chronic hypoparathyroidism can carry a significant disease burden, and some patients are not well-controlled, showing fluctuations in their serum calcium levels,3” said Professor Maria Louisa Brandi, Department of Internal Medicine, University of Florence, Italy. “Clinical studies have shown Natpar maintains serum calcium while reducing the need for calcium and vitamin D for patients with chronic hypoparathyroidism.1”
With this approval, Shire is now authorized to market Natpar in the 28 Member States of the European Union (EU), as well as in Iceland, Liechtenstein and Norway. Natpar falls under the scope of European Commission Regulation as eligible for Conditional Marketing Authorisation because it is designated as an orphan medicinal product and fulfils an unmet medical need.
Hypoparathyroidism is a rare disease that occurs when inadequate levels of PTH are secreted by the parathyroid glands, resulting in a mineral imbalance in the body expressed by a low concentration of calcium (hypocalcemia) and a high concentration of phosphate (hyperphosphatemia) in the blood.
Guidelines from the European Society of Endocrinology (ESE) state that a diagnosis of chronic hypoparathyroidism should be considered in a patient with hypocalcemia and an inappropriately low PTH concentration. Guidelines recommend that treatment should aim to restore mineral homeostasis and prevent symptoms of hypocalcemia while optimizing overall well-being. Typical symptoms of hypocalcemia include muscle spasms and cramping.
To date, management of chronic hypoparathyroidism has focused on maintaining serum calcium with oral calcium and active vitamin D supplements; however, some patients are not adequately controlled and still have variations in their serum calcium levels.3-6
Natpar is a recombinant human PTH and will be available as a 25, 50, 75 and 100 micrograms once-daily injection as adjunctive treatment for adult patients with chronic hypoparathyroidism who cannot be adequately controlled with standard therapy alone.
Natpar is approved in the United States under the trade name Natpara® (parathyroid hormone).
About the REPLACE study
In the double-blind, placebo-controlled, randomized Phase III study 124 patients with hypoparathyroidism were randomized in a ratio of 2:1 to either 50 micrograms once daily of rhPTH(1-84) or placebo for 24 weeks. The primary endpoint was a 50 percent or greater reduction from baseline in their daily dose of oral calcium and active vitamin D while maintaining a stable albumin corrected serum calcium concentration greater than or equal to baseline concentration (baseline was 2.1 mmol/L for the rhPTH[1-84] group and 2.2 mmol/L for the placebo group) and less or equal to the upper limit of normal (normal range 2.1–2.6 mmol/L). At the end of the treatment period, 54.8 percent of the patients on rhPTH(1-84) achieved the primary endpoint compared with 2.5 percent of patients in the placebo group (p<0.0001).1 There were no differences in the proportion of patients maintaining a stable albumin corrected serum calcium concentration at the end of treatment between subjects randomized to rhPTH (1-84) and placebo.7
Natpar Safety Information for Europe
Please consult the Natpar Summary Product Characteristics (SmPC) before prescribing.
Natpar treatment should be supervised by a physician or other qualified healthcare professional experienced in the management of patients with hypoparathyroidism.
Natpar is contraindicated in patients with hypersensitivity to the active substance or to any of the excipients, who are receiving or who have previously received radiation therapy to the skeleton, with skeletal malignancies or bone metastases, who are at increased baseline risk for osteosarcoma, with unexplained elevations of bone-specific alkaline phosphatase, with pseudohypoparathyroidism.
Warnings and Precautions
Monitoring of patients during treatment pre-dose and in some cases post-dose serum calcium levels must be monitored during treatment with Natpar.
Hypercalcemia this was reported in clinical trials with Natpar. Hypercalcemia commonly occurred during the titration period, during which doses of oral calcium, active vitamin D, and Natpar were being adjusted. Hypercalcemia may be minimized by following the recommended dosing, the monitoring information and asking patients about any symptoms of hypercalcemia. If severe hypercalcemia develops, hydration and temporarily stopping Natpar, calcium and active vitamin D should be considered until serum calcium returns to the normal range. Then consider resuming Natpar, calcium and active vitamin D at lower doses.
Hypocalcemia a common clinical manifestation of hypoparathyroidism, was reported in clinical trials with Natpar. Most of the hypocalcemic events occurring in the clinical trials were mild to moderate severity. The risk for serious hypocalcemia was greatest after the withdrawal of Natpar. Temporary or permanent discontinuation of Natpar must be accompanied by monitoring of serum calcium levels and increase of exogenous calcium and/or vitamin D sources as necessary. Hypocalcemia may be minimized by following the recommended dosing, the monitoring information, and asking patients about any symptoms of hypocalcemia.
Concomitant use with cardia glycosides Hypercalcaemia of any cause may predispose to digitalis toxicity, monitor serum calcium and cardiac glycoside levels and patients for signs and symptoms of digitalis toxicity.
Severe renal or hepatic disease Natpar should be used with caution in patients with severe renal or hepatic disease because they have not been evaluated in clinical trials.
Use in young adults Natpar should be used with caution in young adult patients with open epiphyses.
Tachyphylaxis the calcium-raising effect of Natpar may diminish over time in some patients. The response of serum calcium concentration to administration of Natpar should be monitored at intervals to detect this and the diagnosis of tachyphylaxis considered.
The most commonly observed adverse events with Natpar treatment were hypercalcaemia, hypocalcaemia, headache, diarrhea, vomiting, paraesthesia, hypoesthesia and hypercalciuria.
Hypercalcemia, hypocalcaemia, headache, hypoesthesia, paraesthesia, diarrhoea, nausea, vomiting, arthralgia, and muscle spasms.
Hypomagnesaemia, tetany, anxiety, insomnia, somnolence, palpitations, hypertension, cough, abdominal pain upper, muscle twitching, musculoskeletal pain, myalgia, neck pain, pain in extremity, hypercalciuria, pollakiuria, asthenia, chest pain, fatigue, injection site reactions, thirst, anti-PTH antibody positive, blood 25-hydroxycholecalciferol decreased, vitamin D decreased.
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NOTES TO EDITORS
Shire is the leading global biotechnology company focused on serving people with rare diseases and other highly specialized conditions. We strive to develop best-in-class products, many of which are available in more than 100 countries, across core therapeutic areas including Hematology, Immunology, Neuroscience, Ophthalmics, Lysosomal Storage Disorders, Gastrointestinal / Internal Medicine / Endocrine and Hereditary Angioedema; and a growing franchise in Oncology.
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