Brineura® (cerliponase alfa) injection for intraventricular use is indicated to slow the loss of ambulation in symptomatic pediatric patients 3 years of age and older with late infantile neuronal ceroid lipofuscinosis type 2 (CLN2), also known as
tripeptidyl peptidase 1 (TPP1) deficiency.
Important Safety Information
Brineura is contraindicated in patients with acute intraventricular access device-related complications and with
ventriculoperitoneal shunts.
Brineura must only be administered via the intraventricular route and using aseptic technique to reduce the risk of
infection. Healthcare professionals should inspect the scalp for skin integrity to ensure the intraventricular access device
is not compromised prior to each infusion. Brineura is contraindicated if there are signs of acute intraventricular access
device-related complications (e.g., leakage, device failure or signs of device-related infection such as swelling, erythema
of the scalp, extravasation of fluid, or bulging of the scalp around or above the intraventricular access device). In case of
intraventricular access device complications, discontinue the Brineura infusion and refer to the manufacturer’s labeling for
further instructions. Routinely send cerebrospinal fluid (CSF) samples for testing to detect subclinical device infections.
Material degradation of the intraventricular access device reservoir may occur after approximately 105 perforations of the
intraventricular access device and may require replacement as soon as, or prior to, 105 administrations of Brineura.
Monitor vital signs before infusion starts, periodically during infusion, and post-infusion in a healthcare setting. Perform
electrocardiogram (ECG) monitoring during infusion in patients with a history of bradycardia, conduction disorder, or with
structural heart disease. In patients without cardiac abnormalities, regular 12-lead ECG evaluations should be performed
every 6 months.
Hypotension occurred in 2 patients during or up to 8 hours after Brineura infusion. Patients did not require alteration in
treatment, and reactions resolved spontaneously or after intravenous fluid administration.
One patient experienced hypoxia 8 hours after Brineura infusion, followed by a low mean arterial pressure at 15 hours
post infusion. Symptoms resolved after oxygen administration, airway repositioning, and normal saline infusion. One
patient reported decreased oxygen saturation, 45 minutes after starting Brineura, with associated low diastolic blood
pressure. Hypoxia resolved after oxygen administration. No treatment was administered for the low diastolic blood
pressure, which returned to normal while the patient continued to receive Brineura infusion without change to the infusion
rate or dose.
Due to the potential for anaphylaxis, appropriate medical support should be readily available when Brineura is
administered. If anaphylaxis occurs, immediately discontinue the infusion and initiate appropriate medical treatment.
Observe patients closely during and after the infusion.
Hypersensitivity reactions were reported in 11 patients during or within 24 hours after completion of the Brineura infusion.
The signs and symptoms observed concomitantly with hypersensitivity reactions include pyrexia, vomiting, pleocytosis, or
irritability. Patients were routinely premedicated with antihistamines with or without antipyretics or corticosteroids, prior to
infusion of Brineura.
The management of hypersensitivity reactions should be based on the severity of the reaction and may include
temporarily interrupting the infusion, and/or treatment with antihistamines, antipyretics, and/or corticosteroids. If a severe
hypersensitivity reaction occurs, immediately discontinue the infusion and initiate appropriate medical treatment.
Brineura has not been studied in pregnancy or lactation.
Safety and effectiveness in pediatric patients below 3 years of age have not been established.
In clinical trials, the most frequently reported adverse reactions (≥8%) were pyrexia, ECG abnormalities, CSF protein
decreased, vomiting, seizures, hypersensitivity, CSF protein increased, hematoma, headache, irritability, pleocytosis,
device-related infection, bradycardia, feeling jittery, and hypotension.
Seizures were reported in 12 patients and included atonic, generalized tonic-clonic, focal, and absence. Seizures were
managed with standard anticonvulsive therapies and did not result in discontinuation of Brineura treatment.
Device-related adverse reactions were reported in 12 patients and included infection, delivery system–related
complications, and pleocytosis. Intraventricular access device-related CNS infections were observed in 2 patients. In both
cases, antibiotics were administered, the intraventricular access device was replaced, and treatment continued. Device-related
complications did not result in discontinuation of Brineura treatment. Other device-related adverse reactions
included 1 patient with leakage of the intraventricular access device and 1 with pleocytosis.
Hematoma adverse reactions were reported in 5 patients and presented as hematoma, post procedural hematoma,
traumatic hematoma, and subdural hematoma. Hematomas did not require treatment and did not interfere with Brineura
infusion.
Anti-drug antibodies (ADAs) were detected in serum (79%) and CSF (33.3%) in patients treated with Brineura. No
association was found between serum or CSF ADA titers and incidence or severity of hypersensitivity.
Inform caregivers of the signs and symptoms of anaphylaxis, hypotension, bradycardia, and device-related complications. Instruct them to seek immediate medical care should any of these signs and symptoms occur.
To report SUSPECTED ADVERSE REACTIONS, contact BioMarin Pharmaceutical Inc. at 1-866-906-6100, or FDA
at 1-800-FDA-1088, or go to www.fda.gov/medwatch.
