Aldurazyme

laronidase

(la-ron-i-dase) ,

Aldurazyme

(trade name)

Classification

Therapeutic: replacement enzyme
Pharmacologic: enzymes
Pregnancy Category: B

Indications

Mucopolysaccharidosis 1 (MPS 1; specifically Hurler and Hurler-Scheie form or Scheie form) with moderate to severe symptoms.

Action

Replaces the naturally occurring enzyme α-L-iduronidase which is deficient in MPS 1. Without replacement, the glucosaminoglycans dermatan and heparan accumulate in tissues.

Therapeutic effects

Decreased cellular, tissue and organ damage due to mucopolysaccharide accumulation resulting in improved pulmonary function and walking capacity.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: 1.5–3.6 hr.

Time/action profile

ROUTEONSETPEAKDURATION
IVunknownunknown1 wk

Contraindications/Precautions

Contraindicated in: None known.
Use Cautiously in: Obstetric: Use during pregnancy only if clearly needed; Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • fatigue

Cardiovascular

  • edema

Respiratory

  • respiratory tract infections

Dermatologic

  • rash

Local

  • injection site reactions

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • infusion related reactions

Interactions

Drug-Drug interaction

None known.

Route/Dosage

Intravenous (Adults and Children) 0.58 mg/kg once weekly, pre-treat with antipyretics and/or antihistamines.

Availability

Solution for injection: 0.58 mg/mL

Nursing implications

Nursing assessment

  • Assess vital signs every 15 min during the first hr of the infusion and frequently during remainder of infusion.
  • Monitor for signs of anaphylaxis (dyspnea, rash, urticaria) during and for up to 3 hrs following infusion. May be treated by slowing infusion rate, additional antipyretics and antihistamines. If severe reaction occurs, discontinue infusion and institute treatment. Use caution when considering epinephrine; these patients have an increased prevalence of coronary artery disease.
  • Monitor for infusion-related reaction (flushing, fever, headache, rash). Treat by slowing infusion rate, temporarily stopping infusion, and/or administering antipyretics and antihistamines.

Potential Nursing Diagnoses

Impaired gas exchange (Indications)

Implementation

  • Administer antipyretics and antihistamines 60 min prior to infusion to prevent hypersensitivity reactions.
  • Intravenous Administration
  • Intermittent Infusion: Diluent: Dilute concentrated solution with 0.1% albumin and 0.9% NaCl using PVC containers. Determine number of vials needed based on patient weight and round to nearest whole vial. Remove required number of vials from refrigerator and allow to reach room temperature; do not heat or microwave vials. Solution in vials should be slightly opalescent and colorless to pale yellow and may contain a few translucent particles; do not use if discolored or contain particulate matter. Refrigerate, do not freeze. Laronidase administration must be completed within 36 hr of preparation. Do not use after expiration date.
    • Determine total volume of infusion based on weight. Final volume should be 100 mL if patient weighs ≤20 kg and 250 mL if patient weighs >20 kg.
    • To prepare infusion, remove and discard amount of 0.9% NaCl from infusion bag equal to amount of albumin to be added. If total volume is 100 mL, add 2 mL of albumin 5% or 0.4 mL of albumin 25%; if total volume is 250 mL, add 5 mL of albumin 5% or 1 mL of albumin 25%. Gently rotate infusion bag to ensure distribution of albumin.
    • Withdraw and discard a volume of 0.1% albumin in 0.9% NaCl equal to the volume of laronidase concentrate to be added. Slowly withdraw volume of laronidase from vial; avoid excessive agitation. Do not use a filter needle; may cause agitation and denature laronidase rendering it biologically inactive. Slowly add laronidase to 0.1% albumin in 0.9% NaCl solution. Gently rotate infusion bag to ensure distribution; do not shake.
  • Rate: Administer with a low-protein-binding infusion set equipped with an in-line, low-protein-binding 0.2 micrometer filter over 3–4 hr. Initial infusion rate of 10 mcg/kg/hr can be increased every 15 min during first hr, as tolerated, until a maximum rate of 200 mcg/kg/hr is reached; then maintain maximum infusion rate for remainder of infusion (2–3 hr).
  • Additive Incompatibility: Do not mix with other medications.

Patient/Family Teaching

  • Explain MPS I registry to patient and encourage participation. Purpose is to better understand the variability and progression of MPS I disease and to continue to monitor and evaluate treatments. Advise patients that participation may involve long-term follow-up. Information regarding the registry program can be found at www.MPSIregistry.com or by calling (800) 745-4447.
  • Advise patient of risk of anaphylaxis. Caution patient to inform health care professional immediately if side effects occur.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Improvement in pulmonary function and walking capacity. Full benefits may not be evident for several months to several years.

Aldurazyme

a trademark for laronidase.

Aldurazyme

A recombinant DNA enzyme used as replacement therapy in Hurler and Hurler-Scheie forms of mucopolysaccharidosis I (MPS I).
Mentioned in ?
References in periodicals archive ?
Prior Information Notice: Supply of Aldurazyme medicine.
including, without limitation, statements about: the expectations of revenue and sales related to Naglazyme, Kuvan, Firdapse, and Aldurazyme; the financial performance of the BioMarin as a whole; the timing of BioMarin's clinical trials of GALNS, Firdapse, PEG-PAL, BMN-673, BMN-701 and other product candidates; the continued clinical development and commercialization of Aldurazyme, Naglazyme, Kuvan, Firdapse, and its product candidates; and actions by regulatory authorities.
The drugs, which are used to treat rare enzyme disorders, include: Cerezyme, Fabrazyme, Myozyme, Aldurazyme and Thyrogen.
2006 Revenue Guidance for Naglazyme and Aldurazyme Provided - Conference Call to be Held Today at 5:00 p.
Novato, CA) announced that Aldurazyme (laronidase) is now available in the United States as the first specific treatment for people with the rare genetic disease mucopolysaccharidosis I (MPS I).
Aldurazyme is an investigational enzyme replacement therapy for patients with mucopolysaccharidosis I (MPS I).
Increased expenses in support of the Aldurazyme joint venture with Genzyme and the MPS-VI and burn debridement programs were the major factors in the growth of research and development expenses.
Nasdaq:BMRN)(Swiss SWX New Market:BMRN) and joint venture partner, Genzyme General (Nasdaq:GENZ) have announced that they will conduct a confirmatory phase III clinical trial of Aldurazyme enzyme replacement therapy for mucopolysaccharidosis-I (MPS-I) prior to seeking marketing approval from the FDA.
The product portfolio at BioMarin currently has four marketed products, Naglazyme, Kuvan, Aldurazyme and Firdapse.
Approved products include Naglazyme (galsulfase) for mucopolysaccharidosis VI (MPS VI), a product wholly developed and commercialized by BioMarin; Aldurazyme (laronidase) for mucopolysaccharidosis I (MPS I), a product which BioMarin developed through a 50/50 joint venture with Genzyme Corporation; Kuvan (sapropterin dihydrochloride) Tablets, for phenylketonuria (PKU), developed in partnership with Merck Serono, a division of Merck KGaA of Darmstadt, Germany; and Firdapse(TM) (amifampridine), which has been approved by the European Commission for the treatment of Lambert Eaton Myasthenic Syndrome (LEMS).
Novato, CA; 415-884-6777) announced that the United States Patent and Trademark Office has issued United States Patent 6,426,208 covering Aldurazyme (laronidase) for the treatment of mucopolysaccharidosis I (MPS I).
In the second half of 2001, we will unblind data from our first two clinical programs: our Phase III trial of Aldurazyme for the treatment of MPS-I and our Phase I trial of rhASB for the treatment of MPS-VI.