Naglazyme

galsulfase

(gal-sul-fase) ,

Naglazyme

(trade name)

Classification

Therapeutic: replacement enzyme
Pharmacologic: enzymes
Pregnancy Category: B

Indications

Mucopolysaccharridosis VI (MPS IV).

Action

Replaces a deficient enzyme in MPS IV. Without replacement, glycoaminoglycans accumulate resulting in cell, organ and tissue dysfunction.

Therapeutic effects

Improved walking and stair climbing.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed.
Metabolism and Excretion: Unknown.
Half-life: 9 min (after one week of treatment, 26 min (after 24 weeks of treatment).

Time/action profile (inprove exercise parameters)

ROUTEONSETPEAKDURATION
IVunknown24 wkunknown

Contraindications/Precautions

Contraindicated in: None.
Use Cautiously in: Febrile or respiratory illness; Pediatric: Children <5 yr (safety not established); Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Cardiovascular

  • malaise (most frequent)

Ear, Eye, Nose, Throat

  • conjunctivitis (most frequent)
  • cornela opacification (most frequent)
  • ear pain

Respiratory

  • dyspnea (most frequent)

Cardiovascular

  • chest pain (most frequent)
  • ↑ BP

Dermatologic

  • facial edema (most frequent)

Gastrointestinal

  • gastroenteritis (most frequent)
  • abdominal pain

Musculoskeletal

  • areflexia (most frequent)

Neurologic

  • spinal/cervical cord compression (life-threatening)

Miscellaneous

  • infusion reactions
  • rigors (most frequent)

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Intravenous (Adults and Children >5 yr) 1 mg/kg once weekly.

Availability

Solution for IV administration (diluted prior to use): 5 mg/5 mL

Nursing implications

Nursing assessment

  • Assess for infusion reactions (fever, chills/rigors, headache, rash, mild to moderate urticaria); may occur in over half of patients. May also cause nausea, vomiting, elevated BP, retrosternal pain, abdominal pain, malaise, and joint pain. Severe reactions include angioneurotic edema, hypotension, dyspnea, bronchospasm, respiratory distress, apnea. May occur as late as week 55 of treatment. Patients should receive antihistamines and antipyretics prior to administration to minimize occurrence. Slowing or temporary interruption of infusion and administration of additional antihistamines, antipyretics, and occasionally corticosteroids usually stop symptoms. Most patients are able to complete infusion. Administer subsequent infusions at a slower rate additional prophylactic antihistamines, and, if reaction is severe, prophylactic corticosteroids. If severe reaction occurs, discontinue infusion immediately and treat symptoms. Consider risk versus benefit before re-administering galsulfase.
  • Assess for sleep apnea, common in patients with MPS VI, prior to therapy. Administration of pretreatment antihistamines may increase risk. Supplemental oxygen and continuous positive airway pressure (CPAP) should be available during infusion.
  • Assess vital signs and respiratory status prior to administration. Administration should be delayed in patients with an acute febrile or respiratory illness.
  • Monitor for signs and symptoms of spinal/cervical cord compression (back pain, paralysis of limbs below level of compression, urinary and fecal incontinence). Manage symptomatically.

Potential Nursing Diagnoses

Activity intolerance (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Pretreat with antihistamines with or without antipyretics 30–60 min prior to start of infusion.
  • Intravenous Administration
  • Intermittent Infusion: Diluent: 250 mL bag of 0.9% NaClDetermine number of vials to be diluted based on patient weight; round to nearest whole vial. Remove vials from refrigerator and allow to reach room temperature. Do not use after expiration date. Do not allow vials to remain at room temperature for longer than 24 hrs prior to dilution. Do not heat or microwave vials. Solution is clear to slightly opalescent and colorless to pale yellow; a few translucent particles may be present. Do not administer solutions that are discolored or contain particulate matter. Withdraw and discard amount equal to galsulfase from a 250 mL bag of 0.9% NaCl (not necessary if using 100 mL bag in patients susceptible to fluid volume overload). Slowly withdraw calculated volume from galsulfase vials using caution to avoid excessive agitation, may denature and render inactive. Do not use a filter needle. Slowly add galsulfase to 0.9% NaCl; avoid agitation. Gently rotate infusion bag to ensure distribution; do not shake. Discard unused portions. Use diluted solution immediately; storage should not exceed 48 hr from time of preparation to completion of administration. Use PVC containers and administer via PVC infusion set with an in-line low protein binding 0.2 micrometer filter.
  • Rate: Administer at a rate of 6 mL/hr for first hour. If infusion is well tolerated, rate may be increased to 80 mL/hr for next 3 hr. Administer total volume of infusion over no less than 4 hr. If 100 mL bag is used, decrease infusion rate so total volume is infused over at least 4 hrs. Infusion time can be extended for up to 20 hr if infusion reactions occur.
  • Additive Incompatibility: Do not admix or administer with other products.

Patient/Family Teaching

  • Inform patient that a Clinical Surveillance Program has been established to better understand the variability and progression of MPS VI and to evaluate long term effects of galsulfase. Encourage patients to participate; participation is voluntary and may be long term. For information visit www.MPSVI.com/CSP or call 866–906–6100.

Evaluation/Desired Outcomes

  • Improved walking and stair climbing capacity in patients with MPS VI.

Naglazyme

a trademark for galsulfase.
References in periodicals archive ?
Prior Information Notice: Supply of Naglazyme Naglazyme medicine.
Food and Drug Administration, the European Commission and other regulatory authorities concerning each of the described products and product candidates; the market for each of these products and particularly Aldurazyme, Naglazyme, Kuvan and Firdapse; actual sales of Aldurazyme, Naglazyme Kuvan and Firdapse; Merck Serono's activities related to Kuvan; and those factors detailed in BioMarin's filings with the Securities and Exchange Commission, including, without limitation, the factors contained under the caption "Risk Factors" in BioMarin's 2010 Annual Report on Form 10-K, and the factors contained in BioMarin's reports on Form 10-Q.
There are already more MPS IVA patients identified through this registry than there are MPS VI patients being treated with Naglazyme worldwide.
TSE: 4563) announced that on April 14 that the company launched Naglazyme (galsulfase) for patients with the genetic disease mucopolysaccharidosis VI (MPS VI; Maroteaux-Lamy syndrome).
lt;4563> announced August 13 that it submitted a Biologics License Application for Naglazyme (galsulfase) to the Ministry of Health, Labour and Welfare in Japan.
Its leading product, Aldurazyme, is used for treating the ultra-rare genetic disorder mucopolysaccharidosis-I (MPS-I) while its second product, Naglazyme, is approved for the treatment of MPS-VI.
Supply of active Galsulfase, trade name Naglazyme 1 mg / ml 5 mL vial.
He has replaced former Vice President and General Manager, William Aliski who played an instrumental role in the successful launch of Naglazyme in Europe and the establishment of BioMarin's first international commercial operation.
Naglazyme is a normal variant form of arylsulfatase B IUPAC name N-acetylgalactosamin 4-sulfatase) that is lacking in mucopolysaccharidosis VI patients.
The company recently gained FDA and European approval for another product, Naglazyme, for the treatment of MPS-VI and Orapred ODT for asthma in children.
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).