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Cerezyme® (imiglucerase) Safety Profile and Side Effects


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Cerezyme has an established safety profile1

Safety was evaluated in clinical trials and a long-term observational monitoring database1,2

Adverse reactions

The following adverse reactions associated with the use of imiglucerase were identified in clinical studies or postmarketing reports. Because some of these reactions were 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.

System Organ Class

Adverse Reactions

Nervous system disordersDizziness, headache
Cardiac disordersTachycardia
Vascular disordersCyanosisa, flushinga, hypotensiona, hypertensiona
Respiratory, thoracic, and mediastinal disordersCougha, dyspneaa, pneumonia, pulmonary hypertension
Gastrointestinal disordersAbdominal pain, diarrhea, nausea, vomiting
Immune system disordersAnaphylaxisa, hypersensitivity
Skin and subcutaneous tissue disordersAngioedemaa, pruritusa, rash, urticariaa
Musculoskeletal and connective tissue disordersBack pain
General disorders and administration site conditionsChest discomforta, chills, fatigue, infusion-site burning, infusion-site discomfort, infusion-site swelling, pyrexia

aSigns and symptoms suggestive of hypersensitivity reactions, including anaphylaxis, and other infusion-associated reactions.1

Adverse reactions reported in pediatric patients 2 years of age and older were similar to adults.1

10-year analysis of an international safety monitoring database1

A retrospective, observational, 10-year analysis reviewed the safety profile of Cerezyme established over 10 years after approval (1994–2004) based on worldwide postmarketing experience and data collected through immunosurveillance.a

The most frequently reported treatment-related AEs fell under 3 body systems

These AEs were nonserious, infusion-associated reactions, and most AEs showed a consistent distribution across the time intervals.

Top 3 system organ-class categories of related AEs and the 3 most frequently reported AEs for those categories for Cerezyme from 1997 to 20041,b

 

Treatment-related AEs    

All AEs

Total 852 2931 
General disorders and administration site reactions 161455 
 Pyrexia 25 80 
 Chills2155 
Chest discomfort2244
Skin and subcutaneous tissue disorders117325 
Pruritus28 82 
Rash2367 
Urticaria2460 
Respiratory, thoracic, and mediastinal disorders88298 
Dyspnea2875 
Cough1232 
Throat irritation911 

aSmall-scale production limited the use of Cerezyme during the early postapproval period of 1994 to 1997, resulting in a small number of treated patients and reported AEs during this time period.1

bEach of these events was found to occur in <1% of the total patient population. Each event may have occurred more than once in any individual patient.

Most of the related AEs were temporally related to the infusion of Cerezyme and typical of immune-mediated reactions.1

  • These types of AEs were predominantly self-limited and effectively managed by either decreasing the rate of infusion or pretreatment with antihistamines, which generally decreased the frequency of these events
  • In patients with significant reactions, temporary modifications in dose were made in addition to lowering the infusion rate and pretreatment with antihistamines
    • Over time, most patients tolerated Cerezyme at the regular infusion rate without additional pretreatment with antihistamine
  • Only 4 patients with significant infusion reactions subsequently discontinued enzyme replacement therapy

Cerezyme showed consistent rates of reported events over time.1

AE=adverse event.

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Indication

Indication and Usage:

Cerezyme® (imiglucerase) for injection is indicated for treatment of adults and pediatric patients 2 years of age and older with Type 1 Gaucher disease that results in one or more of the following conditions:

  • anemia
  • thrombocytopenia
  • bone disease
  • hepatomegaly or splenomegaly

Important Safety Information

WARNING: HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS

Patients treated with enzyme replacement therapies have experienced life-threatening hypersensitivity reactions, including anaphylaxis. Anaphylaxis has occurred during the early course of enzyme replacement therapy and after extended duration of therapy.

Initiate CEREZYME in a healthcare setting with appropriate medical monitoring and support measures, including access to cardiopulmonary resuscitation equipment. If a severe hypersensitivity reaction (e.g., anaphylaxis) occurs, discontinue CEREZYME and immediately initiate appropriate medical treatment, including use of epinephrine. Inform patients of the symptoms of life-threatening hypersensitivity reactions, including anaphylaxis, and to seek immediate medical care should symptoms occur.

Warnings and Precautions:

Hypersensitivity Reactions Including Anaphylaxis: See Boxed WARNING.
Patients with antibody to imiglucerase have a higher risk of hypersensitivity reactions. Consider periodic monitoring during the first year of treatment for lgG antibody formation.

Consider risks and benefits of readministering Cerezyme to individual patients following a severe reaction. Consider reducing the rate of infusion, pretreat with antihistamines and/or corticosteroids, and monitor patients for new signs and symptoms of a severe hypersensitivity reaction.

Infusion-Associated Reactions:
Infusion associated reactions (IARs) have been observed in patients treated with Cerezyme. If an IAR occurs, decreasing the infusion rate, temporarily stopping the infusion and/or administering antihistamines and/or antipyretics may ameliorate the symptoms. Closely monitor patients who have experienced IARs when re-administering Cerezyme.

Adverse Reactions:
Adverse reactions reported in adults include back pain, chills, dizziness, fatigue, headache, hypersensitivity reactions, nausea, pyrexia, and vomiting.

Adverse reactions reported in pediatric patients 2 years of age and older are similar to adults.

Please see full Prescribing Information, including Boxed WARNING.

Indication

Important Safety Information

References: 1. Starzyk K, Richard S, Yee J, Smith SE, Kinga W. Mol Genet Metab. 2007;90(2):157-163. 2. Cerezyme (imiglucerase). Prescribing information. Genzyme Corporation, Cambridge, MA.

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