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Idhifa

24 January 2020

The Australian Prescription Medicine Decision Summary provides a short overview of the TGA's evaluation process leading to the registration of a new prescription medicine on the Australian Register of Therapeutic Goods (ARTG).

More in-depth information about the evaluation will be available in the Australian Public Assessment Report (AusPAR) for a particular prescription medicine, which can be found on the AusPAR search page once published.

Australian prescription medicine decision summary

Summary of submission

Submission type
New chemical entity
Product name
Idhifa
Active ingredients
Enasidenib
ATC codes
L01XX59
Decision
Approved for provisional registration
Date of decision
15 January 2020
Date of entry onto ARTG
14 January 2020
ARTG numbers
311541, 311542
Black Triangle Scheme
Yes. As a provisionally registered product, this medicine will remain in the Black Triangle Scheme for the duration of its provisional registration.
Sponsor
Celgene Pty Ltd
Sponsor address
Level 15, 60 City Road, Southbank, VIC 3006
Dose forms
Film coated tablet
Strength
50 mg and 100 mg
Other ingredients

Tablet contents

Microcrystalline cellulose, Sodium starch glycollate, Hydroxypropyl cellulose, Colloidal silicon dioxide, Magnesium stearate, Hypromellose acetate succinate, Sodium lauryl sulphate (E487)

Tablet film coating

Polyvinyl alcohol, Titanium dioxide (E171), Polyethylene glycol 3350 (Macrogol 3350 / PEG 3350), Purified talc, Iron oxide yellow (E172)

Containers
Bottle
Pack sizes
30
Routes of administration
Oral
Dosage

Treatment with Idhifa must be initiated and monitored under the supervision of a registered Specialist Physician experienced in the management of haematological and oncological malignancies.

The recommended starting dose of Idhifa is 100 mg taken orally once daily. It is recommended to treat patients for a minimum of 6 months to allow time for clinical response and to continue treatment until disease progression or unacceptable toxicity.

For further information refer to the Product Information.

Pregnancy category

D

Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

The use of any medicine during pregnancy requires careful consideration of both risks and benefits by the treating health professional. This must not be used as the sole basis of decision making in the use of medicines during pregnancy. The TGA does not provide advice on the use of medicines in pregnancy for specific cases. More information is available from obstetric drug information services in your State or Territory.

What was approved?

Idhifa (enasidenib) was provisionally approved for the following therapeutic use:

This medicine has Provisional Approval in Australia for the treatment of adult patients with relapsed or refractory acute myeloid leukaemia who are ineligible for haematopoietic stem cell transplant, and who have an isocitrate dehydrogenase-2 (IDH2) mutation confirmed by a validated diagnostic test.

The decision to approve this indication has been made on the basis of preliminary clinical data from a Phase 1/2 clinical trial with a primary endpoint of overall response rate. An improvement in OS or PFS has not been established. The sponsor is required to submit further clinical data to confirm the efficacy and safety of the medicine.

The provisional registration period for the above medicine(s) is two years starting on the day specified in the ARTG certificate of registration.

What is this medicine and how does it work?

What was the decision based on?

What steps were involved in the decision process?

What post-market commitments will the sponsor undertake?

  • Idhifa (enasidenib) is to be included in the Black Triangle Scheme. The Product Information (PI) and Consumer Medicines Information (CMI) for Idhifa must include the black triangle symbol and mandatory accompanying text for the products entire period of provisional registration.
  • Confirmatory trial data (as identified in the sponsor’s plan to submit comprehensive clinical data on the safety and efficacy of the medicine before the end of the 6 years that would start on the day that registration would commence) must be provided.

    Specifically the sponsor must conduct studies as described in the clinical study plan in version 0.2 (date 8 January 2019) of the Australia-specific Annex. The following study report(s) should be submitted to TGA.

    • AG-221-AML-004 study as soon as it becomes available in 2020.

    The sponsor will provide the full clinical study reports of the following post-market studies required by the Food and Drug Administration (FDA), as soon as available:

    • Meta-analysis to characterise enasidenib related differentiation syndrome (PMR 3240-1).
    • To characterise the long-term safety of enasidenib in R/R AML, submit the final study report with 3 years of follow-up data of the AG221-C-001 trial. Include data from approximately 280 patients with R/R AML (PMR 3240-2).
    • A study sufficient to characterise the long-term safety of enasidenib compared to conventional care regimens in patients with AML (PMR 3240-3).
    • Pharmacokinetic trials to evaluate the effect of multiple doses of enasidenib on the single dose pharmacokinetics of sensitive substrates of CYP3A4, CYP2D6, CYP2C19, CYP2C9, UGTs, P-pg and BCRP to address the potential for excessive drug toxicity (PMR3240-4).
    • A clinical pharmacokinetic trial to determine the appropriate dose of enasidenib in patients with hepatic impairment.

    Further guidance for sponsors is available on the TGA website.

  • The Idhifa European Union-Risk Management Plan (EU-RMP) (version 0.2, dated 8 January 2019, data lock point 1 September 2017), with Australian Specific Annex (version 1.2, dated 8 January 2019), included with submission PM-2018-04819-1-6, and any subsequent revisions, as agreed with the TGA will be implemented in Australia.

    An obligatory component of risk management plans is routine pharmacovigilance. Routine pharmacovigilance includes the submission of periodic safety update reports (PSURs).

    Reports are to be provided in line with the current published list of EU reference dates and frequency of submission of PSURs until the period covered by such reports is not less than three years from the date of the approval letter.

    The reports are to at least meet the requirements for PSURs as described in the European Medicines Agency’s Guideline on Good Pharmacovigilance Practices (GVP) Module VII-periodic safety update report (Rev 1), Part VII.B Structures and processes. Note that submission of a PSUR does not constitute an application to vary the registration.

Further information

The latest Product Information (PI) and Consumer Medicines Information (CMI) can be found at: ARTG search.

Australian Public Assessment Reports (AusPARs) can be found at: AusPAR search.

The latest news and updates regarding therapeutic goods regulation can be found at: TGA news room.