What is a Patient Information Leaflet and why is it useful?

The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. It is written for patients and gives information about taking or using a medicine. It is possible that the leaflet in your medicine pack may differ from this version because it may have been updated since your medicine was packaged.

Black triangle. This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information.

Below is a text only representation of the Patient Information Leaflet. The original leaflet can be viewed using the link above.

The text only version may be available in large print, Braille or audio CD. For further information call emc accessibility on 0800 198 5000. The product code(s) for this leaflet are: EU/1/15/1015/003, EU/1/15/1015/004.


Strensiq 100mg/ml solution

Package leaflet: Information for the user

Strensiq 100 mg/ml solution for injection

(80 mg/0.8 ml)

Asfotase alfa

▼This medicine is subject to additional monitoring. This will allow quick identification of new safety information. You can help by reporting any side effects you may get. See the end of section 4 for how to report side effects.

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

  • Keep this leaflet. You may need to read it again.
  • If you have any further questions, ask your doctor, pharmacist or nurse.
  • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
  • If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

1. What Strensiq is and what it is used for
2. What you need to know before you use Strensiq
3. How to use Strensiq
4. Possible side effects
5. How to store Strensiq
6. Contents of the pack and other information

1. What Strensiq is and what it is used for

What is Strensiq

Strensiq is a medicine used to treat the inherited disease hypophosphatasia. It contains the active substance asfotase alfa.

What is hypophosphatasia

Patients with hypophosphatasia have low levels of an enzyme called alkaline phosphatase that is important for various body functions, including the proper hardening of bones and teeth. Patients have problems with bone growth and strength, which can lead to broken bones, bone pain, and difficulty walking, as well as difficulties with breathing and a risk of seizures (fits).

What is Strensiq used for

The active substance in Strensiq can replace the missing enzyme (alkaline phosphatase) in hypophosphatasia. It is used for long-term enzyme replacement treatment to manage symptoms.

What benefits of Strensiq have been shown in clinical studies

Strensiq has shown benefits for patients’ mineralization of the skeleton and growth.

2. What you need to know before you use Strensiq

Do not use Strensiq:

If you are allergic to asfotase alfa (see section ‘Warnings and precautions’ below) or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

  • Patients receiving asfotase alfa have had allergic reactions including life threatening allergic reactions requiring medical treatment similar to anaphylaxis. Patients who experienced anaphalaxis-like symptoms had difficulty breathing, choking sensation, nausea, swelling around the eyes, and dizziness. The reactions occurred within minutes after taking asfotase alfa, and can occur in patients who were taking asfotase alfa for more than one year. If you experience any of these symptoms, discontinue Strensiq and seek medical help immediately.
  • Should you experience anaphylactic reaction, or an event with similar symptoms, your doctor will discuss with you the next steps and the possibility to restart Strensiq under medical supervision. Always follow the instructions provided by your doctor.
  • The development of blood proteins against Strensiq, also called anti-drug antibodies, may occur during the treatment. Talk to your doctor if you experience decreased efficacy with Strensiq.
  • Localized lipodystrophy (fatty lumps or deceased fatty tissue on the surface of the skin) have been reported at injection sites after several months in patients using Strensiq. Read section 3 carefully to know the injection recommendations. This is important to rotate the injection from among the following sites to reduce the risk of lipodystrophy: abdominal area, thigh, or deltoid.
  • In studies, some eye-related side-effects have been reported both in patients using Strensiq and those who were not, probably associated with hypophosphatasia. Talk to your doctor in case of problems with your vision.
  • Early fusion of the bones of the head in children below 5 years of age has been reported in clinical studies of infants with hypophosphatasia, with and without use of Strensiq. Talk to your doctor if you notice any change in the shape of your infant’s head.
  • If you are treated with Strensiq, you may experience a reaction at the injection site (pain, nodule, rash, discolouration) during the injection of the medicine or during the hours following the injection. If you experience any severe reaction at the injection site, tell your doctor immediately.
  • Increase of parathyroid hormone concentration and low calcium levels have been reported in studies. As a consequence, your doctor may ask you to take supplements of calcium and oral vitamin D if needed.
  • Weight gain may occur during your treatment with Strensiq. Your doctor will provide dietary advice as necessary.

Other medicines and Strensiq

Tell your doctor or pharmacist if you are using, have recently used or might use any other medicines.

If you need to undergo laboratory tests (giving blood for testing), tell your doctor that you are treated with Strensiq. Strensiq may cause some tests to show wrongly higher or lower results. Therefore another type of test may need to be used if you are treated with Strensiq.

Pregnancy and breast-feeding

Strensiq should not be used during pregnancy or breast-feeding unless medically necessary.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

This medicine is not expected to have any effect on the ability to drive or use machines.

Important information about some of the ingredients of Strensiq

This medicine contains less than 1 mmol sodium (23 mg) per vial, which means it is essentially ‘sodium-free’.

3. How to use Strensiq

Always use this medicine exactly as described in this leaflet or as your doctor, or pharmacist or nurse has told you. Check with your doctor, pharmacist or nurse if you are not sure.

How to use Strensiq will be explained to you by a doctor who is experienced in the management of patients with metabolic or bone related diseases. After being trained by the doctor or specialized nurse, you can inject Strensiq yourself at home.

Dosage

  • The dose you receive is based on your body weight.
  • The correct dose will be calculated by your doctor and consists of a total of 6 mg of asfotase alfa per kg of body weight every week, administered by injection under the skin (subcutaneous), (see the dosing chart below for detailed information on the volume to be injected, and the type of vials to be used, based on your weight).
  • This total dose can be given either as an injection of 1 mg/kg asfotase alfa 6 times per week or as 2 mg/kg asfotase alfa 3 times per week depending on the recommendation of your doctor.
  • The maximum volume per injection should not exceed 1 ml. If more than 1 ml is required, you need to do multiple injections immediately one after the other.

The following applies when you are injecting 3x per week (patient body weight between 3kg and 40kg)

For individuals with body weight 3kg the volume to be injected is 0.15ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 4kg the volume to be injected is 0.20ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 5kg the volume to be injected is 0.25ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 6kg the volume to be injected is 0.30ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 7kg the volume to be injected is 0.35ml; the colour code of the vial to be used is orange.

For individuals with body weight 8kg the volume to be injected is 0.40ml; the colour code of the vial to be used is orange.

For individuals with body weight 9kg the volume to be injected is 0.45ml; the colour code of the vial to be used is orange.

For individuals with body weight 10kg the volume to be injected is 0.50ml; the colour code of the vial to be used is light blue.

For individuals with body weight 11kg the volume to be injected is 0.55ml; the colour code of the vial to be used is light blue.

For individuals with body weight 12kg the volume to be injected is 0.60ml; the colour code of the vial to be used is light blue.

For individuals with body weight 13kg the volume to be injected is 0.65ml; the colour code of the vial to be used is light blue.

For individuals with body weight 14kg the volume to be injected is 0.70ml; the colour code of the vial to be used is light blue.

For individuals with body weight 15kg the volume to be injected is 0.75ml; the colour code of the vial to be used is pink.

For individuals with body weight 16kg the volume to be injected is 0.80ml; the colour code of the vial to be used is pink.

For individuals with body weight 17kg the volume to be injected is 0.85ml; the colour code of the vial to be used is pink.

For individuals with body weight 18kg the volume to be injected is 0.90ml; the colour code of the vial to be used is pink.

For individuals with body weight 19kg the volume to be injected is 0.95ml; the colour code of the vial to be used is pink.

For individuals with body weight 20kg the volume to be injected is 1ml; the colour code of the vial to be used is pink.

For individuals with body weight 25kg the volume to be injected is 0.50ml; the colour code of the vial to be used is green.

For individuals with body weight 30kg the volume to be injected is 0.60ml; the colour code of the vial to be used is green.

For individuals with body weight 35kg the volume to be injected is 0.70ml; the colour code of the vial to be used is green.

For individuals with body weight 40kg the volume to be injected is 0.80ml; the colour code of the vial to be used is green.

The following applies when you are injecting 6 x per week (patient body weight between 6kg and 100kg).

For individuals with body weight 6kg the volume to be injected is 0.15ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 7kg the volume to be injected is 0.18ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 8kg the volume to be injected is 0.20ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 9kg the volume to be injected is 0.23ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 10kg the volume to be injected is 0.25ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 11kg the volume to be injected is 0.28ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 12kg the volume to be injected is 0.30ml; the colour code of the vial to be used is dark blue.

For individuals with body weight 13kg the volume to be injected is 0.33ml; the colour code of the vial to be used is orange.

For individuals with body weight 14kg the volume to be injected is 0.35ml; the colour code of the vial to be used is orange.

For individuals with body weight 15kg the volume to be injected is 0.38ml; the colour code of the vial to be used is orange.

For individuals with body weight 16kg the volume to be injected is 0.40ml; the colour code of the vial to be used is orange.

For individuals with body weight 17kg the volume to be injected is 0.43ml; the colour code of the vial to be used is orange.

For individuals with body weight 18kg the volume to be injected is 0.45ml; the colour code of the vial to be used is orange.

For individuals with body weight 19kg the volume to be injected is 0.48ml; the colour code of the vial to be used is light blue.

For individuals with body weight 20kg the volume to be injected is 0.50ml; the colour code of the vial to be used is light blue.

For individuals with body weight 25kg the volume to be injected is 0.63ml; the colour code of the vial to be used is light blue.

For individuals with body weight 30kg the volume to be injected is 0.75ml; the colour code of the vial to be used is pink.

For individuals with body weight 35kg the volume to be injected is 0.88ml; the colour code of the vial to be used is pink.

For individuals with body weight 40kg the volume to be injected is 1 ml; the colour code of the vial to be used is pink.

For individuals with body weight 50kg the volume to be injected is 0.50ml; the colour code of the vial to be used is green.

For individuals with body weight 60kg the volume to be injected is 0.60ml; the colour code of the vial to be used is green.

For individuals with body weight 70kg the volume to be injected is 0.70ml; the colour code of the vial to be used is green.

For individuals with body weight 80kg the volume to be injected is 0.80ml; the colour code of the vial to be used is green.

For individuals with body weight 90kg the volume to be injected is 0.90ml; the colour code of the vial to be used is green (x2).

For individuals with body weight 100kg the volume to be injected is 1 ml; the colour code of the vial to be used is green (x2).

Use in children and adolescents

As in adults, the recommended dosage of Strensiq in children and adolescents is 6 mg of asfotase alfa per kg weekly. Doses will need to be adjusted regularly by your doctor as the body weight changes.

Injection recommendations

  • You may experience a reaction at the injection site. Read section 4 carefully to know what side effects can occur before using this medicine
  • When injecting regularly, the injection site should be changed between different areas of the body to help reduce potential pain and irritation
  • Areas with a good amount of fat below the skin (thigh, arm) are the most suitable areas to inject. Please discuss with you doctor or nurse the best sites for you.

Before injecting Strensiq, please read the following instructions carefully

  • Each vial is for single use and should only be punctured once. Only clear and colourless to slightly yellow aqueous solution without visible signs of deterioration should be used. Any unused medicinal product or waste material should be disposed of immediately.
  • If you are injecting this medicine yourself, you will be shown how to prepare and inject the medicine by your doctor, pharmacist or nurse. Do not inject this medicine yourself unless you have received training and you understand the procedure.

How to inject Strensiq:

Wash your hands thoroughly with soap and water.

Remove the protective cap from the Strensiq vial.

After removal from the refrigerator Strensiq should be used within 1 hour maximum

Remove the protective plastic from the syringe to be used.

Always use a new syringe contained in a protective plastic.

Pay attention not to hurt yourself with the needle.

Withdraw the correct dose of Strensiq into the syringe. You may need to use several vials to withdraw the complete amount needed to reach the correct dose.

Control visually that the volume contained into the syringe is correct.

The volume per injection should not exceed 1 ml. If it is the case, multiple injections should be done at different sites.

Choose an injection site (thighs, abdomen, arms, buttocks). Your doctor will advise you on the possible injection sites.

NOTE: do not use any areas in which you feel lumps, firm knots, or pain; talk to your doctor about anything you find.

Gently pinch the skin of the chosen injection area between your thumb and index finger.

Holding the syringe like a pencil or a dart, insert the needle into the raised skin so it is at an angle of between 45° and 90° to the skin surface.For patients who have little fat under the skin or thin skin, a 45° angle may be preferable.

While continuing to hold the skin, push the syringe plunger to inject the medicine while counting slowly to 10.

Remove the needle, release the skin fold and gently place a piece of cotton wool or gauze over the injection site for a few seconds.

This will help seal the punctured tissue and prevent any leakage. Do not rub the injection site after injection. Please collect your syringes, vials and needle in a sharps container. Your doctor, pharmacist or nurse will advise you on how you can obtain a sharps container.

If you use more Strensiq than you should

If you suspect that you have been accidently administered a higher dose of Strensiq than prescribed, please contact your doctor for advice.

If you forget to use Strensiq

Do not inject a double dose to make up for a forgotten dose and contact your doctor for advice.

For more information, please consult: asfotasealfa-patienteducation.co.uk

If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you are not sure what the side effects below are, ask your doctor to explain them to you.

Very common: may affect more than 1 in 10 people

Reactions at the injection site during the injection of the medicine or during the hours following the injection (which can lead to redness, discolourations, itching, pain, fatty lumps or decreased fatty tissue on the surface of the skin, skin hypopigmentation, and/or swelling)

Fever (pyrexia), irritability

Skin redness (erythema)

Pain in hands and feet

Contusion (bruise)

Headache

Common: may affect up to 1 in 10 people

Chills

Stretched skin, skin discolouration

Feeling sick (nausea), numbness of the mouth (hypoaesthesia oral)

Aching muscles (myalgia)

Scar

Increased tendency to bruise

Hot flush

Infection of skin at injection site (injection site cellulitis)

Reduced levels of calcium in the blood (hypocalcaemia)

Kidney stones (nephrolithiasis)

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed below:

United Kingdom: via the Yellow Card Scheme. Website: https://yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the Google Play or Apple App Store.

Ireland:

HPRA Pharmacovigilance
Earlsfort Terrace
IRL - Dublin 2
Tel: +353 1 6764971
Fax: +353 1 6762517
Website: www.hpra.ie

Adverse events should also be reported to Alexion Pharma UK Ltd on [email protected], Freephone (UK): 0800 321 3902, Freephone (Ireland): 1 800 936 544. By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Strensiq

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and the vial label after EXP. The expiry date refers to the last day of that month.

Store in a refrigerator (2°C-8°C).

Do not freeze.

Store in the original package in order to protect from light.

After opening the vial, the product should be used immediately (within 1 hour maximum).

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Strensiq contains

The active substance is asfotase alfa. Each ml of solution contains 100 mg of asfotase alfa.

Each vial of 0.8 ml solution (100 mg/ml) contains 80 mg of asfotase alfa.

The other ingredients are sodium chloride, sodium phosphate monobasic monohydrate, sodium phosphate dibasic heptahydrate and water for injections.

What Strensiq looks like and contents of the pack

Strensiq is presented as a clear colourless to slightly yellow aqueous solution for injection in vials containing 0.8 ml of solution.

Pack sizes of 1 or 12 vials.

Not all pack sizes may be marketed in your country.

Marketing Authorisation Holder

Alexion Europe SAS
103-105 rue Anatole France
92300 Levallois-Perret
France

Manufacturer

Alexion Pharma International Operations Unlimited Company
College Business and Technology Park
Blanchardstown
Dublin 15
Ireland

This leaflet was last revised in 25 July 2019

This medicine has been authorised under ‘exceptional circumstances’.

This means that because of the rarity of this disease it has been impossible to get complete information on this medicine.

The European Medicines Agency will review any new information on this medicine every year and this leaflet will be updated as necessary.

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency web site: http://www.ema.europa.eu. There are also links to other websites about rare diseases and treatments.