CHMP recommends EU marketing authorization for VEYVONDI® [vonicog alfa, recombinant von Willebrand factor] for adults with von Willebrand disease

• If approved, VEYVONDI^® [vonicog alfa, recombinant von Willebrand factor] would be the first and only recombinant von Willebrand Factor (rVWF) to treat hemorrhage and to treat/prevent surgical bleeding in adults (age 18 and older) with von Willebrand disease (VWD)¹
• VWD is the most common inherited bleeding disorder, affecting up to one percent of Europe²
• VEYVONDI is currently only approved in the US for adults with VWD

Zug, Switzerland – July 2, 2018 – Shire plc (LSE: SHP, NASDAQ: SHPG) the global biotech leader in rare diseases, announced today that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has issued a positive opinion recommending the granting of marketing authorization in the European Union (EU) for VEYVONDI [vonicog alfa, recombinant von Willebrand factor] (rVWF), for the treatment of bleeding events and treatment/prevention of surgical bleeding in adults (age 18 and older) with von Willebrand disease (VWD) when desmopressin (DDAVP) treatment alone is ineffective or not indicated. VEYVONDI should not be used in the treatment of Hemophilia A.¹ If approved, VEYVONDI will be the first and only recombinant von Willebrand Factor (rVWF) treatment in the EU for von Willebrand disease (VWD) that specifically addresses the primary deficiency or dysfunction of von Willebrand Factor (VWF) while also allowing the body to restore and maintain adequate Factor VIII (FVIII) plasma levels.¹

“This positive opinion moves us one step closer to bringing the first, targeted recombinant therapy to people living with von Willebrand disease who still have unmet medical needs,” said Andreas Busch, Head of Research and Development and Chief Scientific Officer, Shire. “As we continue our long-standing commitment to address unmet needs for people with bleeding disorders, we welcome the potential for individualized treatment of patients with VWD in need of replacement therapy.”

The CHMP submission was based on outcomes from three clinical trials of a total 80 patients with VWD exposed to VEYVONDI. These include a Phase 1 multicenter, controlled, randomized, single-blind, dose-escalation study of the safety, tolerability and pharmacokinectics (PK) of rVWF:rFVIII in subjects 18 to 60 years of age with severe VWD; a Phase 3 multicenter, open-label study to assess the PK, safety and efficacy of rVWF:rFVIII and rVWF in the treatment of bleeding episodes in adult subjects with severe VWD; and a Phase 3, prospective, open-label, uncontrolled, non-randomized, international multicenter study to assess the hemostatic efficacy and safety of rVWF with or without rFVIII in 15 adult subjects with severe VWD undergoing major, minor, or oral elective surgical procedures.²

VWD is the most common inherited bleeding disorder, affecting up to 1 percent of the global population or approximately 100,000 people in the EU.^3,4 VWD is caused by a deficiency or dysfunction of VWF, one of several types of proteins in the blood that are needed to facilitate proper blood clotting.⁵ Only a minor proportion of affected individuals have the severe form of the disease and are in need of VWF replacement.⁶

The CHMP's positive opinion will be reviewed by the European Commission, which has the authority to grant marketing authorization in the EU.

About von Willebrand disease (VWD)
VWD is the most common inherited bleeding disorder, affecting up to 1 percent of the global population.⁴ The majority of cases (70-80%) are due to partial quantitative VWF deficiency (Type 1 VWD).⁷ The most severe form of VWD (severe Type 3 VWD), has a much lower prevalence ranging from 0.1 to 5.3 cases per million population (0.00001-0.00053%) and an incidence of approximately 1 case per million population.⁸ VWD is caused by a deficiency or dysfunction of VWF, one of several types of proteins in the blood that are needed to facilitate proper blood clotting.⁵ Due to this deficiency or dysfunction in VWF, blood is not able to clot effectively in people with VWD, which results in heavy menstrual periods, easy bruising or frequent nose bleeds.⁵ Bleeding caused by VWD is unpredictable and its severity varies greatly among patients with this disease.⁹

About VEYVONDI
If approved, VEYVONDI will be indicated in adults (age 18 and older) with von Willebrand Disease (VWD), when desmopressin (DDAVP) treatment alone is ineffective or not indicated for the treatment of hemorrhage and treatment and prevention of surgical bleeding.¹

In the US the product is approved under the trade name VONVENDI^® [von Willebrand factor (Recombinant)] and indicated for use in adults (age 18 and older) diagnosed with von Willebrand disease for on-demand treatment and control of bleeding episodes or perioperative management of bleeding.

For full US Prescribing Information, including approved indication(s) and important safety information about marketed products, please visit http://www.shirecontent.com/PI/PDFs/VONVENDI_USA_ENG.pdf

VEYVONDI EU IMPORTANT SAFETY INFORMATION¹

WARNINGS AND PRECAUTIONS
Hypersensitivity Reactions
Hypersensitivity reactions (including anaphylaxis) may occur. Patients and/or their caregivers should be informed of the early signs of hypersensitivity reactions, which may include but are not limited to tachycardia, tightness of the chest, wheezing and/or acute respiratory distress, hypotension, generalised urticaria, pruritus, rhinoconjunctivitis, angioedema, lethargy, nausea, vomiting, paresthesia, restlessness, and may progress to anaphylactic shock. In case of shock, standard medical treatment for shock should be implemented.

Patients should be closely monitored and carefully observed for any symptoms throughout the infusion period. If signs and symptoms of severe allergic reactions occur, immediately discontinue administration of VEYVONDI and provide appropriate supportive care. Adequate medical treatment and provisions should be available for immediate use for a potential anaphylactic reaction, especially for patients with a history of allergic reactions.

VEYVONDI contains trace amounts of mouse immunoglobulin G (MuIgG) and Hamster proteins (less than or equal to 2 ng/IU VEYVONDI). Patients treated with this product may develop hypersensitivity reactions to these non-human mammalian proteins. VEYVONDI contains trace amounts of recombinant coagulation factor VIII.

Thrombosis and Embolism
There is a risk of occurrence of thrombotic events, particularly in patients with known clinical or laboratory risk factors for thrombosis including low ADAMTS13 levels. Therefore, patients at risk have to be monitored for early signs of thrombosis, and prophylaxis measures against thromboembolism should be instituted according to current recommendations and standard of care.

In patients requiring frequent doses of VEYVONDI in combination with recombinant factor VIII, plasma levels for FVIII:C activity should be monitored to avoid sustained excessive FVIII:C plasma levels, which may increase the risk of thrombotic events. Any FVIII that would be administered along with VEYVONDI should be a pure FVIII product. A combination with a FVIII product containing VWF would pose an additional risk of thrombotic events.

Neutralizing Antibodies (Inhibitors)
Patients with VWD, especially Type 3, may develop neutralising antibodies (inhibitors) to von Willebrand factor. If the expected plasma levels of (VWF:RCo) are not attained, or if bleeding is not controlled with an appropriate dose, an appropriate assay should be performed to determine if a von Willebrand factor inhibitor is present. In patients with high levels of anti-VWF antibodies, von Willebrand factor therapy may not be effective and other therapeutic options should be considered.

Treatment of VWD patients who have high-titer binding antibodies may require a higher dose to overcome the binding antibody effect and such patients could be managed clinically by administration of higher doses of vonicog alfa based on the PK data for each individual patient.

ADVERSE REACTIONS
In clinical trials, the most common adverse reactions observed in ≥2% of subjects (n=80) were generalized pruritus, nausea, vomiting, vertigo and dizziness.

One subject treated with VEYVONDI in perioperative setting developed deep vein thrombosis after undergoing total hip replacement surgery.

References

¹ Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 25-28 June 2018: Summary of Opinion for Veyvondi. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/004454/WC500251151.pdf
² Recombinant von Willebrand Factor; rVWF; vonicog alfa; BAX 111. Clinical Overview. May 2017.
³ World Federation of Hemophilia. What is von Willebrand disease (VWD)? Available at: https://www.wfh.org/en/page.aspx?pid=673.
⁴ European Medicines Agency. EU/3/10/814. Available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/orphans/2010/12/human_orphan_000865.jsp&mid=WC0b01ac058001d12b
⁵ National Hemophilia Foundation. Von Willebrand Disease. Available at: https://www.hemophilia.org/Bleeding-Disorders/Types-of-Bleeding-Disorders/Von-Willebrand-Disease.
⁶ National Organization for Rare Disorders. Von Willebrand Disease. Available at: https://rarediseases.org/rare-diseases/von-willebrand-disease/
⁷ Kujovic, J.L. Von Willebrand’s Disease and Menorrhagia: Prevalence, Diagnosis, and Management. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajh.20372
⁸ Verma, A., Yaish, H. et al. Type 3 Von Willebrand Disease with Alloantibodies and Its Challenging Management During Episode of Bleeding. Available at: http://www.bloodjournal.org/content/116/21/1405
⁹ National Hemophilia Foundation. "VWD Summit Highlights." HEMAWARE website. https://hemaware.org/story/vwd-summit-highights.

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NOTES TO EDITORS

About Shire

Shire is the global biotechnology leader serving patients with rare diseases and specialized conditions. We seek to push boundaries through discovering and delivering new possibilities for patient communities who often have few or no other champions. Relentlessly on the edge of what’s next, we are serial innovators with a diverse pipeline offering fresh thinking and new hope. Serving patients and partnering with healthcare communities in over 100 countries, we strive to be part of the entire patient journey to enable earlier diagnosis, raise standards of care, accelerate access to treatment, and support patients. Our Rare Disease and Neuroscience divisions support our diverse portfolio of therapeutic areas, including Immunology, Hematology, Genetic Diseases, Internal Medicine, Ophthalmics, Oncology, and neuropsychiatry disorders.

Championing patients is our call to action - it brings the opportunity - and responsibility - to change people’s lives.

www.shire.com

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