Cerliponase alfa

Generic name
Cerliponase alfa
Brand name
ATC Code
A16AB17

Cerliponase alfa

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information is present at this moment.

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Neuronal ceroid lipofuscinosis type 2 (CLN2)
  • Intraventricular
    • Term neonate
      • 100 mg/dose once every 2 weeks.
    • 1 month up to 6 months
      • 100 mg/dose once every 2 weeks.
    • 6 months up to 1 year
      • 150 mg/dose once every 2 weeks.
    • 1 year up to 2 years
      • Initial dose: First 4 doses: 200 mg/dose once every 2 weeks.
      • Maintenance dose: 300 mg/dose/dose once every 2 weeks.
    • ≥ 2 years
      • 300 mg/dose once every 2 weeks.
CAUTION:
  • Route of administration not applicable
    • 0 years up to 18 years
        • Administer only by professionals trained and proficient in intracerebroventricular administration of medication
        • Premedication: administer an antihistamine and possibly an antipyretic 30-60 minutes before the start of the infusion.
        • Doseadjustment:
          • If the infusion is not tolerated: consider reducing the dose by 50% and/or reducing the infusion rate.
          • If the infusion is interrupted because of a hypersensitivity reaction: restart the infusion at approximately half the original infusion rate.
          • If intracranial pressure may increase during infusion (e.g., headache, nausea, vomiting, decrease in consciousness): interrupt infusion and/or decrease infusion rate (especially in children < 3 years of age).
        • Administration: Cerliponase α is administered to the cerebrospinal fluid by infusion through a reservoir and catheter surgically implanted (intracerebroventricular access system). This access system must be implanted before the first infusion. The system must be suitable for access to the brain ventricles to administer drugs.
        • The infusion rate is 2.5 ml/hour.
        • After drug administration, administer the flushing drug at the same infusion rate. For detailed administration information, see the official product information

Renal impaiment in children > 3 months

No information available on dose adjustment in renal impairment.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Very common (> 10%): hypersensitivity. Upper respiratory tract infection. Irritability. Convulsions, headache. Vomiting. Fever. Increase or decrease in protein levels in cerebrospinal fluid, pleiocytosis in cerebrospinal fluid, ECG abnormalities.

Common (1-10%): anaphylactic reaction. Bradycardia. "Dropped head" syndrome. Blistering of oral mucosa and tongue, abdominal pain. Conjunctivitis, infection by the access system. Skin rash, urticaria. Nervousness.

In addition, meningitis has been reported.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications in children

  • life-threatening anaphylactic reaction to cerliponase α, if re-administration is unsuccessful;
  • ventriculoperitoneal shunt;
  • signs of acute leakage or failure of the intracerebroventricular access system, or infection associated with the access system.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Administration Precautions: Use caution with risk factors for complications due to intracerebroventricular administration such as obstructive hydrocephalus. Inspect the scalp for skin integrity before each infusion to ensure that the access system has not been compromised. Before administration, rule out leakage and/or failure of the intracerebroventricular access system.

Monitoring: Monitor vital signs before, periodically during and after infusion. Post-administration observation may be required for an extended period, especially in children < 3 years of age. Monitor ECG during infusion in patients with a history of bradycardia, cardiac arrhythmia or structural heart disease. In cardiac normal patients, perform an ECG every 6 months. Send CSF samples routinely for laboratory testing to detect subclinical infections due to the access system.

Be prepared for any anaphylactic reaction; observe the patient closely during and after infusion. Immediately discontinue administration in the event of an anaphylactic reaction. Use extra caution during re-administration if anaphylaxis has occurred previously.

Infections associated with the access system have been observed, including meningitis (symptoms: fever, headache, neck stiffness, photosensitivity, nausea, vomiting and changes in mental status) and subclinical infections. In clinical trials, antibiotics were administered, the access system was replaced and treatment with cerliponase α continued.

Degradation access system: After long-term use, degradation of the reservoir material of the intracerebroventricular access system occurs. In two clinical cases, the access system showed no signs of failure at the time of infusion, but degradation was demonstrated after removal. Consider replacement of the access system within 4 years of (regular) use.

Research data: There are few data on use in patients >8 years of age. Efficacy and safety in children < 3 years of age have not yet been established. There are few data for children aged 2 years and no clinical data for children < 2 years. Patients with advanced disease progression have been excluded from clinical trials. In advanced CLN2 and neonates, the integrity of the blood-brain barrier may be impaired; the effects of potentially increased peripheral exposure to the drug are unknown

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

OTHER ALIMENTARY TRACT AND METABOLISM PRODUCTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Amino acids and derivatives
A16AA06
A16AA05
A16AA01
A16AA04
Enzymes
A16AB03
A16AB04
A16AB07
A16AB13
A16AB22
A16AB08
A16AB09
A16AB02
A16AB05
A16AB14
A16AB10
Various alimentary tract and metabolism products
A16AX10
A16AX09
A16AX
A16AX18
A16AX06
A16AX04
A16AX07
A16AX
A16AX08
A16AX07
A16AX05
AMINO ACIDS AND DERIVATIVES
A16AA06
A16AA05
A16AA01
A16AA04

Reference

  1. BioMarin International Limited, SmPC Brineura (EU/1/17/1192/001) Rev6, 16-8-2022, www.ema.europa.eu

Changes

Therapeutic Drug Monitoring


Overdose