Fosdenopterin

Patients with MoCD Type A have mutations in the MOCS1 gene leading to deficient MOCS1A/B dependent synthesis of the intermediate substrate, cPMP. Substrate replacement therapy with NULIBRY provides an exogenous source of cPMP, which is converted to molybdopterin.

• NULIBRY is indicated to reduce the risk of mortality in patients with molybdenum cofactor deficiency (MoCD) Type A. NULIBRY is cyclic pyranopterin monophosphate (cPMP) indicated to reduce the risk of mortality in patients with molybdenum cofactor deficiency (MoCD) Type A.

• None. None.contraindicated

Start NULIBRY if known or presumed MoCD Type A. Promptly discontinue if MoCD Type A is not confirmed by genetic testing. ( 2.1 ) NULIBRY is intended for administration by a healthcare provider. If deemed appropriate by a healthcare provider, NULIBRY may be administered at home by the patient's caregiver. ( 2.2 ) See the table below for the recommended dosage in patients less than one year of age. Administer NULIBRY by intravenous infusion once daily. For dose volumes less than 2 mL, consider administering by slow intravenous push. ( 2.3 ) Titration Duration Preterm Neonates (Gestational Age Less than 37 Weeks) Term Neonates (Gestational Age 37 weeks and Above) Initial Dosage 0.4 mg/kg once daily 0.55 mg/kg once daily Dosage at Month 1 and Month 2 0.7 mg/kg once daily 0.75 mg/kg once daily Dosage at Month 3 to Month 12 0.9 mg/kg once daily 0.9 mg/kg once daily Recommended Dosage in Patients One Year of Age or Older: 0.9 mg/kg given as an intravenous infusion once daily. ( 2.3 ) 2.1 Patient Selection Start NULIBRY if the patient has a diagnosis or presumptive diagnosis of MoCD Type A. In patients with a presumptive diagnosis of MoCD Type A, confirm the diagnosis of MoCD Type A immediately after initiation of NULIBRY treatment. In such patients, discontinue NULIBRY if the MoCD Type A diagnosis is not confirmed by genetic testing. 2.2 Important Recommendation Prior to NULIBRY Treatment NULIBRY is intended for administration by a healthcare provider. If deemed appropriate by a healthcare provider, NULIBRY may be administered at home by the patient's caregiver.

Potential for Photosensitivity : Advise patients/caregivers to avoid patient exposure to sunlight, and to have the patient wear sunscreen, protective clothing, and sunglasses when exposed to the sun. If photosensitivity occurs, advise caregivers/patients to seek medical attention immediately and consider a dermatological evaluation. ( 5.1 , 13.2 ) 5.1 Potential for Photosensitivity Animal studies have identified that NULIBRY has phototoxic potential [ see Nonclinical Toxicology ( 13.2 ) ]. Advise NULIBRY-treated patients or their caregivers to avoid or minimize patient exposure to direct sunlight and artificial UV light exposure (i.e., UVA or UVB phototherapy) and adopt precautionary measures (e.g., have the patient wear protective clothing and hats, use broad spectrum sunscreen with high sun protection factor (SPF) in patients 6 months of age and older, and wear sunglasses when exposed to the sun). If photosensitivity occurs, advise caregivers/patients to seek medical attention immediately and consider a dermatological evaluation.

The most common adverse reactions (>25%) were catheter-related complications, pyrexia, viral infection, pneumonia, otitis media, vomiting, cough/sneezing, viral upper respiratory infection, gastroenteritis, bacteremia, and diarrhea. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Sentynl Therapeutcis, Inc. at 888-507-5206 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Overview of Safety Evaluation The safety of NULIBRY was assessed in 37 pediatric patients and healthy adults who received at least one intravenous infusion of NULIBRY or an E. coli derived non-salt, anhydrous form of cPMP (recombinant cPMP or rcPMP, which has the same active moiety and therefore the same biologic activity as NULIBRY). Of these 37 patients/healthy adults, 13 were pediatric patients with MoCD Type A in Studies 1, 2, and 3 [ see Clinical Studies ( 14 )] , 6 were pediatric patients with presumptive MoCD Type A but who were later confirmed to not have MoCD Type A, and 18 were healthy adults (without MoCD Type A) in a Phase 1 study. Adverse Reactions Assessment of adverse reactions for NULIBRY is based on data from two open-label, single-arm studies, Study 1 (n=8) and Study 2 (n=1), in patients with a confirmed diagnosis of MoCD Type A (8 of the 9 patients were previously treated with rcPMP).

8.1 Pregnancy Risk Summary There are no available data on NULIBRY use in pregnant females to evaluate for a drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. In animal reproduction studies, no adverse developmental outcomes occurred at dose exposures 32-89 times the human exposure at the maximum recommended human dose (MRHD) of 0.9 mg/kg/day (see Data ). The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Data Animal Data In an embryofetal development study, intravenous administration of fosdenopterin to pregnant rabbits once daily during the period of organogenesis (GD 7 to GD 20) at doses up to 200 mg/kg/day (approximately 89 times the human exposure at the MRHD, based on AUC) did not result in adverse developmental effects.

Metabolism

The pharmacokinetics of fosdenopterin in healthy adult subjects following a single intravenous NULIBRY infusion are summarized in Table 3 . The area under the plasma concentration-time curve (AUC) and the maximum plasma concentration (C max ) of fosdenopterin increased in an approximately proportional manner with increasing doses.

• Feb 26, 2021NDANDA214018Sentynl Theraps Inc

1. 1Anaphylactic Reaction133%
2. 2Apnoea133%
3. 3Bacteraemia133%
4. 4Bradycardia133%
5. 5Cardio-respiratory Arrest133%
6. 6Deep Vein Thrombosis133%
7. 7Drug Ineffective133%
8. 8Gastrointestinal Haemorrhage133%
9. 9Hypothermia133%
10. 10Product Dose Omission Issue133%
11. 11Product Temperature Excursion Issue133%
12. 12Product Use In Unapproved Indication133%
13. 13Pyrexia133%
14. 14Suspected Product Quality Issue133%
15. 15Vasoconstriction133%

The 3 most recently updated of 3 ClinicalTrials.gov registrations naming Fosdenopterin as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

• Safety & Efficacy Study of ORGN001 (Formerly ALXN1101) in Pediatric Patients With MoCD Type A Currently Treated With rcPMP
  Completed · Phase 2 · Interventional · 8 enrolled · Origin Biosciences
  NCT02047461updated 2023-10-17
• A Retrospective, Observational, Noninterventional Data Collection Study for Patients With Molybdenum Cofactor Deficiency Who Have Been Previously Treated With Cyclic Pyranopterin Monophosphate (cPMP)
  Completed · Observational · 15 enrolled · Origin Biosciences
  NCT01640717updated 2019-03-19
• Study of cPMP (Precusor Z) to Treat Molybdenum Cofactor Deficiency (MoCD) Type A
  Withdrawn · Phase 1 · Phase 2 · Interventional · 10 enrolled · Orphatech Pharmaceuticals, GmbH
  NCT00957749updated 2011-02-01

Frequently asked questions

How does Fosdenopterin work?

Patients with MoCD Type A have mutations in the MOCS1 gene leading to deficient MOCS1A/B dependent synthesis of the intermediate substrate, cPMP. Substrate replacement therapy with NULIBRY provides an exogenous source of cPMP, which is converted to molybdopterin.

What is Fosdenopterin used for?

According to FDA labeling, Fosdenopterin carries indications including: NULIBRY is indicated to reduce the risk of mortality in patients with molybdenum cofactor deficiency (MoCD) Type A. NULIBRY is cyclic pyranopterin monophosphate (cPMP) indicated to reduce the risk of mortality in patients with molybdenum cofactor deficiency (MoCD) Type A.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.

What class of drug is Fosdenopterin?

Fosdenopterin is classified as Various alimentary tract and metabolism products, Cyclic Pyranopterin Monophosphate.

What are the brand names for Fosdenopterin?

Fosdenopterin is marketed under brand names including Nulibry.

What are the contraindications for Fosdenopterin?

Fosdenopterin labeling lists contraindications including: None. None.. Always consult the full prescribing information and a clinician.