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Myozyme

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Myozyme

Myozyme Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

Myozyme (alglucosidase alfa) contains an enzyme that is used to treat a glycogen storage disorder called Pompe disease, (also called GAA deficiency) in adults and children who are at least 8 years old. Common side effects include mild skin rash or itching, diarrhea, constipation, upset stomach, vomiting, sore throat, neck pain, pain or swelling in your arms or legs, or pain, swelling, burning, or irritation around the IV needle.

The recommended dosage regimen of Myozyme is 20 mg/kg body weight administered every 2 weeks as an intravenous infusion. Myozyme may interact with other drugs. Tell your doctor all medications and supplements you use. Myozyme is not expected to harm a fetus. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is unknown if this drug passes into breast milk or if it could harm a nursing baby. Consult your doctor before breastfeeding.

Our Myozyme (alglucosidase alfa) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is Patient Information in Detail?

Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.

Myozyme in Detail - Patient Information: Side Effects

Some people receiving an injection of alglucosidase alfa have had a reaction to the infusion. This type of reaction can occur when the medicine is injected into the vein, or as long as 3 hours after the injection. Tell your caregivers or get emergency medical help right away if you have any of these signs of a severe allergic reaction:

  • feeling like you might pass out, even while lying down;
  • feeling restless, nervous, dizzy, or nauseated;
  • pale skin, redness under your skin, sweating, feeling hot or cold;
  • fast or slow heart rate;
  • pain or tightness in your chest or throat;
  • wheezing, trouble breathing;
  • cold hands, blue lips;
  • back pain;
  • numbness, warmth, redness, or tingly feeling;
  • seizure (convulsions);
  • hives, severe skin rash; or
  • swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • pain or fullness in your ear, problems with hearing;
  • skin ulcers;
  • fast, slow, or uneven heartbeats;
  • urinating less than usual or not at all;
  • weak pulse, fainting, slow breathing (breathing may stop); or
  • chest pain or heavy feeling, pain spreading to the arm or shoulder, sweating, general ill feeling.

Less serious side effects may include:

  • mild skin rash or itching;
  • diarrhea, constipation, stomach pain or upset, vomiting;
  • sore throat, neck pain;
  • pain or swelling in your arms or legs; or
  • pain, swelling, burning, or irritation around the IV needle.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Myozyme (Alglucosidase Alfa) »

What is Prescribing information?

The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.

Myozyme FDA Prescribing Information: Side Effects
(Adverse Reactions)

SIDE EFFECTS

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in 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 clinical practice. The data described below reflect exposure of 39 Pompe disease patients to 20 or 40 mg/kg of MYOZYME administered every other week in 2 separate clinical trials for periods ranging from 1 to 106 weeks (mean 61 weeks). Patients were ages 1 month to 3.5 years at first treatment. The population was nearly evenly distributed in gender (18 females and 21 males).

The most serious adverse reactions reported with MYOZYME were anaphylactic reactions, acute cardiorespiratory failure, and cardiac arrest.

Anaphylactic reactions have been reported during and within 3 hours after MYOZYME infusion [see BOXED WARNING and WARNINGS AND PRECAUTIONS].

Acute cardiorespiratory failure has been observed in a few infantile-onset Pompe disease patients with underlying cardiac hypertrophy, possibly associated with fluid overload with intravenous administration of alglucosidase alfa [see BOXED WARNING and WARNINGS AND PRECAUTIONS and Instructions for Use].

The most common serious treatment-emergent adverse reactions occurring in > 10% of patients observed in clinical studies with MYOZYME were pneumonia, respiratory failure, respiratory distress, catheter-related infection, respiratory syncytial virus infection, gastroenteritis and fever.

The most common adverse reactions requiring intervention in clinical trials were infusion reactions [see WARNINGS AND PRECAUTIONS]. Twenty of 39 patients (51%) treated with MYOZYME in clinical studies developed infusion reactions. Infusion reactions, defined as an adverse reaction occurring during the infusion or within 2 hours after completion of the infusion, that occurred in more than 1 patient in clinical studies and the expanded access program include rash, flushing, urticaria, fever, cough, tachycardia, decreased oxygen saturations, vomiting, tachypnea, agitation, increased blood pressure, cyanosis, hypertension, irritability, pallor, pruritus, retching, rigors, tremor, hypotension, bronchospasm, erythema, face edema, feeling hot, headache, hyperhidrosis, increased lacrimation, livedo reticularis, nausea, periorbital edema, restlessness, and wheezing.

The most common treatment-emergent adverse reactions occurring in ≥ 20% of patients were fever, diarrhea, rash, vomiting, cough, pneumonia, otitis media, upper respiratory tract infection, gastroenteritis and decreased oxygen saturation.

Table 2 enumerates treatment-emergent adverse reactions that occurred in at least 20% of patients treated with MYOZYME in clinical trials described above. Reported frequencies of adverse events have been classified by MedDRA terms.

Table 2: Summary of Adverse Reactions by System Organ Class and Preferred Term Occurring in at Least 20% of Patients Treated with MYOZYME® in Clinical Trials

System Organ Class
Preferred Term
Number of Patients
(N=39)
n (%)
Number of Adverse Events
N
Any Adverse Events 39 (100) 1859
General disorders and administration site conditions 38 (97)
  Pyrexia 36 (92) 169
Respiratory, thoracic and mediastinal disorders 38 (97)
  Cough 18 (46) 69
  Respiratory distress 13 (33) 18
  Respiratory failure 12 (31) 24
  Rhinorrhea 11 (28) 16
  Tachypnea 9 (23) 15
Infections and infestations 37 (95)
  Pneumonia 18 (46) 43
  Otitis media 17 (44) 35
  Upper respiratory tract infection 17 (44) 39
  Gastroenteritis 16 (41) 17
  Pharyngitis 14 (36) 26
  Ear infection 13 (33) 23
  Oral candidiasis 12 (31) 20
  Catheter-related infection 11 (28) 15
  Bronchiolitis 9 (23) 10
  Nasopharyngitis 9 (23) 25
Gastrointestinal disorders 32 (82)
  Diarrhea 24 (62) 62
  Vomiting 19 (49) 62
  Gastroesophageal reflux disease 10 (26) 13
  Constipation 9 (23) 14
Skin and subcutaneous tissue disorders 32 (82)
  Rash 21 (54) 72
  Diaper dermatitis 14 (36) 34
  Urticaria 8 (21) 25
  Investigations 28 (72)
  Oxygen saturation decreased 16 (41) 44
Cardiac disorders 24 (62)
  Tachycardia 9 (23) 31
  Bradycardia 8 (21) 18
Injury, poisoning and procedural complications 22 (56)
  Post procedural pain 10 (26) 20
Blood and lymphatic system disorders   17 (44)
  Anemia 12 (31) 23
Vascular disorders 14 (36)
  Flushing 8 (21) 15

Five additional juvenile-onset Pompe disease patients were evaluated in a single-center, open-label, non-randomized, uncontrolled clinical trial. Patients were ages 5 to 15 years, ambulatory (able to walk at least 10 meters in 6 minutes), and not receiving invasive ventilatory support at study entry. All 5 patients received treatment with 20 mg/kg MYOZYME for 26 weeks. The most common treatment-emergent adverse reactions observed with MYOZYME treatment in this study were headache (4.1%), pharyngitis (9.1%), upper abdominal pain (15.2%), malaise (6.1%) and rhinitis (6.1%).

Immunogenicity

As with all therapeutic proteins, there is potential for immunogenicity. The majority of patients (34 of 38; 89%) in the two clinical trials tested positive for IgG antibodies to alglucosidase alfa. The data reflect the percentage of patients whose test results were considered positive for antibodies to alglucosidase alfa using an enzyme-linked immunosorbent assay (ELISA) and radioimmunoprecipitation (RIP) assay for alglucosidase alfa-specific IgG antibodies. Most patients who develop antibodies do so within the first 3 months of exposure. There is evidence to suggest that patients developing sustained titers ≥ 12,800 of anti-alglucosidase alfa antibodies may have a poorer clinical response to treatment, or may lose motor function as antibody titers increase. Treated patients who experience a decrease in motor function should be tested for neutralization of enzyme uptake or activity. Five patients with antibody titers ≥ 12,800 at Week 12 had an average increase in clearance of 50% from Week 1 to Week 12 [see CLINICAL PHARMACOLOGY].

Some patients who developed IgG antibodies to alglucosidase alfa in clinical studies or in the postmarketing setting were evaluated for the presence of inhibitory antibodies and tested positive for inhibition of enzyme activity and/or uptake in in vitro assays.

The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to alglucosidase alfawith the incidence of antibodies to other products may be misleading.

The effect of antibody development on the long-term efficacy of MYOZYME is not fully understood. However, CRIM-negative infants have shown poorer clinical response in the presence of high sustained IgG antibody titers and positive inhibitory antibodies.

Infusion reactions were reported in 20 of 39 patients (51%) treated with MYOZYME in clinical studies and appear to be more common in antibody-positive patients: 8 of 15 patients with high antibody titers experienced infusion reactions, whereas none of 3 antibody-negative patients experienced infusion reactions [see WARNINGS AND PRECAUTIONS].

Patients who develop IgE antibodies to alglucosidase alfa appear to be at a higher risk for the occurrence of anaphylaxis and severe allergic reactions [see WARNINGS AND PRECAUTIONS]. Therefore, these patients should be monitored more closely during administration of MYOZYME.

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of MYOZYME. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

In postmarketing experience with MYOZYME, severe and serious infusion reactions have been reported, some of which were life-threatening, including anaphylactic shock [see BOXED WARNING and WARNINGS AND PRECAUTIONS]. Acute cardiorespiratory failure, possibly associated with fluid overload, has been reported in infantile-onset Pompe disease patients with pre-existing hypertrophic cardiomyopathy [see BOXED WARNING and WARNINGS AND PRECAUTIONS]. In addition to the infusion reactions reported in clinical trials and expanded access programs, the following infusion reactions have been reported in patients during postmarketing use of MYOZYME: cardiac arrest, respiratory arrest, apnea, stridor, pharyngeal edema, peripheral edema, chest pain, chest discomfort, muscle spasm, fatigue and conjunctivitis [see WARNINGS AND PRECAUTIONS].

Additional adverse drug reactions included proteinuria and nephrotic syndrome [see WARNINGS AND PRECAUTIONS].

Recurrent reactions consisting of flu-like illness or a combination of events such as fever, chills, myalgia, arthralgia, pain, or fatigue occurring after completion of infusions and lasting for 1-3 days have been observed in some patients treated with alglucosidase alfa. The majority of patients were successfully rechallenged with alglucosidase alfa using lower doses and/or pretreatment with anti-inflammatory drugs and/or corticosteroids and were able to continue treatment under close clinical supervision.

Systemic and cutaneous immune mediated reactions, including ulcerative and necrotizing skin lesions, and nephrotic syndrome secondary to membranous glomerulonephritis have been reported in postmarketing safety experience with alglucosidase alfa [see WARNINGS AND PRECAUTIONS].

Read the entire FDA prescribing information for Myozyme (Alglucosidase Alfa) »

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