a new non-stimulant clinical option for children and adolescents
from 6 to 17 years old with ADHD
Zug, Switzerland – 30 March 2017 – Shire plc (LSE: SHP, NASDAQ: SHPG) today announced that its partner in Japan, Shionogi & Co., Ltd, has received the approval of the Japanese Ministry of Health, Labor and Welfare to manufacture and market INTUNIV. INTUNIV is a new, once-daily non-stimulant indicated for the treatment of attention deficit hyperactivity disorder (ADHD),1 a common psychiatric disorder in children and adolescents.2,3
ADHD causes inattention, hyperactivity or impulsivity, or a combination of these symptoms,4,5 and can have substantial impact on all major areas of life, including: schooling, work and employment, behaviour, social functioning, self-esteem and health.6-9
INTUNIV is a selective alpha-2A adrenergic receptor agonist.1 With a unique mechanism of action, INTUNIV represents an additional treatment option in the management of ADHD.
“Shire is committed to ensuring that every person with ADHD is able to benefit from a treatment most suited to their needs,” said Philip J Vickers, PhD, Global Head of Shire Research and Development. “The approval of INTUNIV marks a significant advance in the treatment of ADHD in children and adolescents in Japan, who may benefit from a new treatment option.”
As part of the partnership, a Phase 3 placebo-controlled clinical study and long-term extension study evaluating the efficacy and safety of INTUNIV in 254 patients was conducted in Japan. In the trial, INTUNIV administered once daily showed significant improvements over placebo, as measured by ADHD-RS-IV total score, in all core symptoms of ADHD: hyperactivity/impulsivity, and inattention. The most common adverse events were somnolence in 146 patients (57.5%), decreased blood pressure in 39 patients (15.4%), and headache in 31 patients (12.2%).1
ADHD is a complex condition and approaches to treatment typically include educational methods, psychotherapy and medication.10 When required, either stimulants or non-stimulants are indicated as part of a comprehensive treatment programme for ADHD. Children and adolescents have a wide spectrum of individual needs as patients, so it is important that a range of treatment options are available. Non-stimulant medications are an important alternative to stimulants for some ADHD patients.10
Attention deficit hyperactivity disorder (ADHD) is recognised by the World Health Organization (WHO).2 Worldwide prevalence of ADHD is estimated to vary between 5.9% and 7.1%.3
Whilst the exact origin of ADHD is not fully understood, the area of the brain known as the prefrontal cortex is known to control several cognitive functions including attention and social behaviours,9, 11,12 and has been associated with some structural and functional abnormalities in individuals with ADHD.13-15
INTUNIV (guanfacine hydrochloride prolonged release) is a once-daily non-stimulant indicated for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents from 6 to 17 years old.1
INTUNIV provides significantly improved ADHD symptom control vs. placebo1,16 and has a well-documented safety profile across the dose range.1
INTUNIV contains the active substance guanfacine, a selective alpha-2A adrenergic receptor agonist.1 Studies suggest that guanfacine may exert physiological effects by selectively stimulating the alpha-2A adrenergic receptor in the prefrontal cortex.17-18
INTUNIV is currently approved by Shire in the US, Canada, and Europe. Please refer to the local label for the approved indication.
INTUNIV Safety Information for Japan1
Precautions on Indication
- The efficacy and safety of INTUNIV in children under 6 years of age or adults over 18 years of age have not been established.
- If INTUNIV is continued after age 18 in patients who started pharmacological treatment with this drug before the age of 18 years, it should be administered with caution after the therapeutic benefits are weighed against the possible risks. The efficacy and safety of INTUNIV should regularly be evaluated, and if INTUNIV is of no value, it should be considered for discontinuation and must not be administered without purpose.
- A diagnosis of ADHD must be made with caution, according to standard, established diagnostic criteria, including DSM* published by the American Psychiatric Association. INTUNIV must be used only in patients who meet such criteria.
*Diagnostic and Statistical Manual of Mental Disorders
Contraindication (INTUNIV is contraindicated in the following patients.)
- Patients with a history of hypersensitivity to any of the ingredients of this drug.
- Pregnant women or women who may possibly be pregnant.
- Patients with atrioventricular block second degree and third degree. [The condition may get worse because of the central bradycardia effect of this drug.]
- Careful Administration (INTUNIV should be administered with care in the following patients.)
1) Patients with a current or previous history of hypotension, orthostatic hypotension, bradycardia, or cardiovascular disease, or patients treating with drugs which can reduce blood pressure or pulse rate [INTUNIV may decrease blood pressure and heart rate.]
2) Patients with a current or previous history of hypertension [Blood pressure may increase when administration of this drug is abruptly discontinued.]
3) Patients with a current or previous history of arrhythmia, patients with congenital long QT syndrome or patients treating with drugs that are known to cause QT prolongation [QT prolongation may occur because of this drug.]
4) Patients with a current or previous history of ischaemic heart disease such as angina pectoris and myocardial infarction [If the acute reduction of blood pressure occurs, ischaemic heart disease may get worse because of the decreased coronary flow.]
5) Patients with cerebrovascular disorder such as cerebral infarction etc. [If the acute reduction of blood pressure occurs, the symptoms may be aggravated due to the decrease in cerebral blood flow.]
6) Patients with severe hepatic function disorder [The blood concentration of this drug may increase.]
7) Patients with severe renal function disorder [The blood concentration of this drug may increase.]
8) Patients in depressed state [The symptom may get worse because of the sedative effects of this drug.]
- Important Precautions
1) Before prescribing INTUNIV, the physician or healthcare professional should fully inform the patient and his/her parent or other appropriate representative of its therapeutic position and potential risks, including adverse reactions to the drug, and instruct the patient on the proper administration method.
2) During long-term use of INTUNIV, the value of ongoing treatment should be periodically assessed and patients should not be administered without purpose.
3) Since syncope may occur when advanced decreases in blood pressure or pulse rate are observed, blood pressure and pulse rate should be measured prior to initiation of treatment of INTUNIV and 1-2 weeks after changing the dosage. Blood pressure and pulse rate should also be measured at intervals of once in 4 weeks after setting an optimal dose. Also, dehydration along with the administration of INTUNIV should be fully cautioned. If any dehydration symptoms are observed, proper care such as fluid replacement should be taken.
4) Since the effects on cardiovascular system (advanced bradycardia, hypotension, QT prolongation etc.) may appear, the following points should be cautioned before and during treatment with INTUNIV.
(i)The presence or absence of abnormality in ECG should be confirmed before treatment with INTUNIV. If any abnormality in ECG is observed, the initiation of administration should be carefully judged.
(ii)When INTUNIV is administered to patients with cardiovascular disease or with a medical history of cardiovascular disease, or any abnormality in ECG is observed before treatment with INTUNIV, patients’ condition should be carefully observed by conducting routine ECG and so on.
(iii)Patients’ cardiovascular condition should be cautioned during treatment with INTUNIV. If any symptoms suggesting the effects on cardiovascular system (bradycardia, syncope, dizziness, palpitations, etc.) appear, proper care should be taken by conducting ECG and so on.
5) Since suicidal ideation or behavior may occur, patient’s condition should be carefully observed. Also, patients, the parents or other appropriate representative should be instructed to contact a medical institution immediately, if any suicidal symptoms occur.
6) While hostility and aggression are frequently observed in AD/HD patients, occurrence of these events during treatment has been also reported. The occurrence or worsening of these events should be carefully monitored during treatment.
7) Since INTUNIV may cause weight increase, body weight should be monitored regularly. If any symptom of obesity appears, proper care should be taken such as food therapy, movement therapy, etc.
8) Since sleepiness, sedation, etc. may occur, patients should be cautioned not to engage in operating potentially hazardous machinery, including automobiles during treatment.
This drug is primarily metabolized by the hepatic metabolizing enzymes CYP3A4 and CYP3A5.
Out of 254 patients evaluated for safety before NDA approval, adverse reactions (including abnormal changes in laboratory values) were observed in 190 patients (74.8%). Main adverse reactions were somnolence in 146 patients (57.5%), decreased blood pressure in 39 patients (15.4%), and headache in 31 patients (12.2%).
- Clinically significant adverse reactions
1) Hypotension (≧5%), bradycardia (≧5%): Since advanced hypotension or/and bradycardia may occur and lead to syncope, patients’ condition should be carefully monitored, measuring blood pressure and pulse rate regularly. If any of these symptoms appears, proper care such as dose reduction, interruption, or discontinuation should be taken.
2) Syncope (Incidence unknownNote 1): Since syncope may occur, patients should be fully observed. If any abnormality is observed, proper care such as discontinuation of administration should be taken.
3) Atrioventricular block (<0.5%): Since atrioventricular block may occur, proper care such as dose reduction, interruption, or discontinuation should be taken if any abnormality is observed.
- Other adverse reactions
If the following adverse reactions occur, appropriate measures such as dose reduction, interruption, or discontinuation should be taken as necessary.
||Incidence unknownNote 1
||Hypersensitivity, rash, pruritus
||Increased blood pressure
||Tachycardia, sinus arrhythmia, pallor, hypertensive encephalopathy
||Somnolence, headache, insomnia, dizziness
||Nightmare, affect lability, agitation, sedation, asthenia
||Anxiety, depression, lethargy, convulsion, hypersomnia
||Decreased appetite, nausea, constipation, diarrhea, thirst, vomiting
||Abdominal discomfort, dyspepsia
||Enuresis, increased weight
||Pollakiuria, increased ALT (GPT)
||Asthma, chest pain, dehydration
Note 1: The incidence of adverse reactions on the basis of overseas clinical studies and spontaneous reports is unknown.
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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.
Our employees come to work every day with a shared mission: to develop and deliver breakthrough therapies for the hundreds of millions of people in the world affected by rare diseases and other high-need conditions, and who lack effective therapies to live their lives to the fullest.
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a further list and description of risks, uncertainties and other matters can be found in Shire’s most recent Annual Report on Form 10-K and in Shire’s subsequent Quarterly Reports on Form 10-Q, in each case including those risks outlined in “ITEM 1A: Risk Factors”, and in Shire’s subsequent reports on Form 8-K and other Securities and Exchange Commission filings, all of which are available on Shire’s website.
All forward-looking statements attributable to us or any person acting on our behalf are expressly qualified in their entirety by this cautionary statement. Readers are cautioned not to place undue reliance on these forward-looking statements that speak only as of the date hereof. Except to the extent otherwise required by applicable law, we do not undertake any obligation to update or revise forward-looking statements, whether as a result of new information, future events or otherwise.
- INTUNIV Prescribing Information, Shionogi & Co., Ltd 2017.
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