Emgality

Galcanezumab-gnlm


Eli Lilly And Company
Human Prescription Drug
NDC 0002-1436
Emgality also known as Galcanezumab-gnlm is a drug for further processing labeled by 'Eli Lilly And Company'. National Drug Code (NDC) number for Emgality is 0002-1436. This drug is available in dosage form of Injection, Solution. The names of the active, medicinal ingredients in Emgality drug includes Galcanezumab - 120 mg/mL . The currest status of Emgality drug is Active.

Drug Information:

Drug NDC: 0002-1436
The labeler code and product code segments of the National Drug Code number, separated by a hyphen. Asterisks are no longer used or included within the product code segment to indicate certain configurations of the NDC.
Proprietary Name: Emgality
Also known as the trade name. It is the name of the product chosen by the labeler.
Product Type: Human Prescription Drug
Indicates the type of product, such as Human Prescription Drug or Human OTC Drug. This data element corresponds to the “Document Type” of the SPL submission for the listing.
Non Proprietary Name: Galcanezumab-gnlm
Also known as the generic name, this is usually the active ingredient(s) of the product.
Labeler Name: Eli Lilly And Company
Name of Company corresponding to the labeler code segment of the ProductNDC.
Dosage Form: Injection, Solution
The translation of the DosageForm Code submitted by the firm. There is no standard, but values may include terms like `tablet` or `solution for injection`.The complete list of codes and translations can be found www.fda.gov/edrls under Structured Product Labeling Resources.
Status: Active
FDA does not review and approve unfinished products. Therefore, all products in this file are considered unapproved.
Substance Name:GALCANEZUMAB - 120 mg/mL
This is the active ingredient list. Each ingredient name is the preferred term of the UNII code submitted.
Route Details:SUBCUTANEOUS
The translation of the Route Code submitted by the firm, indicating route of administration. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.

Marketing Information:

An openfda section: An annotation with additional product identifiers, such as NUII and UPC, of the drug product, if available.
Marketing Category: BLA
Product types are broken down into several potential Marketing Categories, such as New Drug Application (NDA), Abbreviated New Drug Application (ANDA), BLA, OTC Monograph, or Unapproved Drug. One and only one Marketing Category may be chosen for a product, not all marketing categories are available to all product types. Currently, only final marketed product categories are included. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.
Marketing Start Date: 27 Sep, 2018
This is the date that the labeler indicates was the start of its marketing of the drug product.
Marketing End Date: 11 Jan, 2025
This is the date the product will no longer be available on the market. If a product is no longer being manufactured, in most cases, the FDA recommends firms use the expiration date of the last lot produced as the EndMarketingDate, to reflect the potential for drug product to remain available after manufacturing has ceased. Products that are the subject of ongoing manufacturing will not ordinarily have any EndMarketingDate. Products with a value in the EndMarketingDate will be removed from the NDC Directory when the EndMarketingDate is reached.
Application Number: BLA761063
This corresponds to the NDA, ANDA, or BLA number reported by the labeler for products which have the corresponding Marketing Category designated. If the designated Marketing Category is OTC Monograph Final or OTC Monograph Not Final, then the Application number will be the CFR citation corresponding to the appropriate Monograph (e.g. “part 341”). For unapproved drugs, this field will be null.
Listing Expiration Date: 31 Dec, 2023
This is the date when the listing record will expire if not updated or certified by the firm.

OpenFDA Information:

An openfda section: An annotation with additional product identifiers, such as NUII and UPC, of the drug product, if available.
Manufacturer Name:Eli Lilly and Company
Name of manufacturer or company that makes this drug product, corresponding to the labeler code segment of the NDC.
RxCUI:2058872
2058877
2058885
2058887
2170611
2170613
The RxNorm Concept Unique Identifier. RxCUI is a unique number that describes a semantic concept about the drug product, including its ingredients, strength, and dose forms.
Original Packager:Yes
Whether or not the drug has been repackaged for distribution.
UNII:55KHL3P693
Unique Ingredient Identifier, which is a non-proprietary, free, unique, unambiguous, non-semantic, alphanumeric identifier based on a substance’s molecular structure and/or descriptive information.

Packaging Information:

Package NDCDescriptionMarketing Start DateMarketing End DateSample Available
0002-1436-111 SYRINGE in 1 CARTON (0002-1436-11) / 1 mL in 1 SYRINGE (0002-1436-01)27 Sep, 2018N/ANo
0002-1436-612 SYRINGE in 1 CARTON (0002-1436-61) / 1 mL in 1 SYRINGE27 Sep, 2018N/AYes
Package NDC number, known as the NDC, identifies the labeler, product, and trade package size. The first segment, the labeler code, is assigned by the FDA. Description tells the size and type of packaging in sentence form. Multilevel packages will have the descriptions concatenated together.

Product Elements:

Emgality galcanezumab-gnlm galcanezumab galcanezumab histidine histidine monohydrochloride monohydrate sodium chloride polysorbate 80 water emgality galcanezumab-gnlm galcanezumab galcanezumab histidine histidine monohydrochloride monohydrate sodium chloride polysorbate 80 water emgality galcanezumab-gnlm galcanezumab galcanezumab histidine histidine monohydrochloride monohydrate sodium chloride polysorbate 80 water

Indications and Usage:

1 indications and usage emgality ® is a calcitonin-gene related peptide antagonist indicated in adults for the: preventive treatment of migraine. ( 1.1 ) treatment of episodic cluster headache. ( 1.2 ) 1.1 migraine emgality is indicated for the preventive treatment of migraine in adults. 1.2 episodic cluster headache emgality is indicated for the treatment of episodic cluster headache in adults.

Warnings and Cautions:

5 warnings and precautions hypersensitivity reactions: if a serious hypersensitivity reaction occurs, discontinue administration of emgality and initiate appropriate therapy. hypersensitivity reactions can occur days after administration, and may be prolonged. ( 5.1 ) 5.1 hypersensitivity reactions hypersensitivity reactions, including dyspnea, urticaria, and rash, have occurred with emgality in clinical studies and the postmarketing setting. cases of anaphylaxis and angioedema have also been reported in the postmarketing setting. if a serious or severe hypersensitivity reaction occurs, discontinue administration of emgality and initiate appropriate therapy [see contraindications ( 4 ), adverse reactions ( 6.1 ), and patient counseling information ( 17 )] . hypersensitivity reactions can occur days after administration and may be prolonged.

Dosage and Administration:

2 dosage and administration for subcutaneous use only. ( 2.1 , 2.2 , 2.3 ) migraine recommended dosage: 240 mg loading dose (administered as two consecutive injections of 120 mg each), followed by monthly doses of 120 mg. ( 2.1 ) episodic cluster headache recommended dosage: 300 mg (administered as three consecutive injections of 100 mg each) at the onset of the cluster period, and then monthly until the end of the cluster period. ( 2.2 ) administer in the abdomen, thigh, back of the upper arm, or buttocks subcutaneously. ( 2.3 ) 2.1 recommended dosing for migraine the recommended dosage of emgality is 240 mg (two consecutive subcutaneous injections of 120 mg each) once as a loading dose, followed by monthly doses of 120 mg injected subcutaneously. if a dose of emgality is missed, administer as soon as possible. thereafter, emgality can be scheduled monthly from the date of the last dose. 2.2 recommended dosing for episodic cluster headache the recommended dosage of emgality is 300 mg
(three consecutive subcutaneous injections of 100 mg each) at the onset of the cluster period, and then monthly until the end of the cluster period. if a dose of emgality is missed during a cluster period, administer as soon as possible. thereafter, emgality can be scheduled monthly from the date of the last dose until the end of the cluster period. 2.3 important administration instructions emgality is for subcutaneous use only. emgality is intended for patient self-administration. prior to use, provide proper training to patients and/or caregivers on how to prepare and administer emgality using the single-dose prefilled pen or single-dose prefilled syringe, including aseptic technique [see how supplied/storage and handling ( 16.2 ) and instructions for use] : protect emgality from direct sunlight. prior to subcutaneous administration, allow emgality to sit at room temperature for 30 minutes. do not warm by using a heat source such as hot water or a microwave. do not shake the product. inspect emgality visually for particulate matter and discoloration prior to administration, whenever solution and container permit [see dosage forms and strengths ( 3 ) and how supplied/storage and handling ( 16.1 )] . do not use emgality if it is cloudy or there are visible particles. administer emgality in the abdomen, thigh, back of the upper arm, or buttocks subcutaneously. do not inject into areas where the skin is tender, bruised, red, or hard. both the prefilled pen and prefilled syringe are single-dose and deliver the entire contents.

Dosage Forms and Strength:

3 dosage forms and strengths emgality is a sterile clear to opalescent, colorless to slightly yellow to slightly brown solution available as follows: injection: 120 mg/ml in a single-dose prefilled pen injection: 120 mg/ml in a single-dose prefilled syringe injection: 100 mg/ml in a single-dose prefilled syringe injection: 120 mg/ml solution in a single-dose prefilled pen ( 3 ) injection: 120 mg/ml solution in a single-dose prefilled syringe ( 3 ) injection: 100 mg/ml solution in a single-dose prefilled syringe ( 3 )

Contraindications:

4 contraindications emgality is contraindicated in patients with serious hypersensitivity to galcanezumab-gnlm or to any of the excipients [see warnings and precautions ( 5.1 )] . emgality is contraindicated in patients with serious hypersensitivity to galcanezumab-gnlm or to any of the excipients. ( 4 )

Adverse Reactions:

6 adverse reactions the following clinically significant adverse reactions are described elsewhere in the labeling: hypersensitivity reactions [see contraindications ( 4 ) and warnings and precautions ( 5.1 )] the most common adverse reactions (incidence ?2% and at least 2% greater than placebo) in emgality clinical studies were injection site reactions. ( 6.1 ) to report suspected adverse reactions, contact eli lilly and company at 1-800-lillyrx (1-800-545-5979) 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 with rates in clinical trials of another drug and may not reflect the rates observed in clinical practice. migraine the safety of emgality has been evaluated in 2586 patients with migraine who received at least one dose of emgality, representing 1487 patient-years of exposure. of these,
1920 patients were exposed to emgality once monthly for at least 6 months, and 526 patients were exposed for 12 months. in placebo-controlled clinical studies (studies 1, 2, and 3), 705 patients received at least one dose of emgality 120 mg once monthly, and 1451 patients received placebo, during 3 months or 6 months of double-blind treatment [see clinical studies ( 14.1 )] . of the emgality-treated patients, approximately 85% were female, 77% were white, and the mean age was 41 years at study entry. the most common adverse reaction was injection site reactions. in studies 1, 2, and 3, 1.8% of patients discontinued double-blind treatment because of adverse events. table 1 summarizes the adverse reactions that occurred within up to 6 months of treatment in the migraine studies. table 1: adverse reactions occurring in adults with migraine with an incidence of at least 2% for emgality and at least 2% greater than placebo (up to 6 months of treatment) in studies 1, 2, and 3 a injection site reactions include multiple related adverse event terms, such as injection site pain, injection site reaction, injection site erythema, and injection site pruritus. adverse reaction emgality 120 mg monthly (n=705) % placebo monthly (n=1451) % injection site reactions a 18 13 episodic cluster headache emgality was studied for up to 2 months in a placebo-controlled trial in patients with episodic cluster headache (study 4) [see clinical studies ( 14.2 )] . a total of 106 patients were studied (49 on emgality and 57 on placebo). of the emgality-treated patients, approximately 84% were male, 88% were white, and the mean age was 47 years at study entry. two emgality-treated patients discontinued double-blind treatment because of adverse events. overall, the safety profile observed in patients with episodic cluster headache treated with emgality 300 mg monthly is consistent with the safety profile in migraine patients. 6.2 immunogenicity as with all therapeutic proteins, there is potential for immunogenicity. 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 galcanezumab-gnlm in the studies described below with the incidence of antibodies in other studies or to other products may be misleading. the immunogenicity of emgality has been evaluated using an in vitro immunoassay for the detection of binding anti-galcanezumab-gnlm antibodies. for patients whose sera tested positive in the screening immunoassay, an in vitro ligand-binding immunoassay was performed to detect neutralizing antibodies. in controlled studies with emgality up to 6 months (study 1, study 2, and study 3), the incidence of anti-galcanezumab-gnlm antibody development was 4.8% (33/688) in patients receiving emgality once monthly (32 out of 33 of whom had in vitro neutralizing activity). with 12 months of treatment in an open-label study, up to 12.5% (16/128) of emgality-treated patients developed anti-galcanezumab-gnlm antibodies, most of whom tested positive for neutralizing antibodies. although anti-galcanezumab-gnlm antibody development was not found to affect the pharmacokinetics, safety or efficacy of emgality in these patients, the available data are too limited to make definitive conclusions. 6.3 postmarketing experience the following adverse reactions have been identified during post-approval use of emgality. 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 emgality exposure. immune system disorders — anaphylaxis, angioedema [see contraindications ( 4 ) and warnings and precautions ( 5.1 )] . skin and subcutaneous tissue disorders — rash.

Adverse Reactions Table:

Table 1: Adverse Reactions Occurring in Adults with Migraine with an Incidence of at least 2% for EMGALITY and at least 2% Greater than Placebo (up to 6 Months of Treatment) in Studies 1, 2, and 3
a Injection site reactions include multiple related adverse event terms, such as injection site pain, injection site reaction, injection site erythema, and injection site pruritus.
Adverse ReactionEMGALITY 120 mg Monthly (N=705) %Placebo Monthly (N=1451) %
Injection site reactionsa18 13

Use in Specific Population:

8 use in specific populations 8.1 pregnancy pregnancy exposure registry there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to emgality during pregnancy. healthcare providers are encouraged to register pregnant patients, or pregnant women may enroll themselves in the registry by calling 1-833-464-4724 or by contacting the company at www.migrainepregnancyregistry.com. risk summary there are no adequate data on the developmental risk associated with the use of emgality in pregnant women. administration of galcanezumab-gnlm to rats and rabbits during the period of organogenesis or to rats throughout pregnancy and lactation at plasma exposures greater than that expected clinically did not result in adverse effects on development (see animal data) . in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% - 4% and 15% - 20%, respectively. the estimated rate of major bi
rth defects (2.2% - 2.9%) and miscarriage (17%) among deliveries to women with migraine are similar to rates reported in women without migraine. clinical considerations disease-associated maternal and/or embryo/fetal risk published data have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy. data animal data when galcanezumab-gnlm was administered to female rats by subcutaneous injection in two studies (0, 30, or 100 mg/kg; 0 or 250 mg/kg) prior to and during mating and continuing throughout organogenesis, no adverse effects on embryofetal development were observed. the highest dose tested (250 mg/kg) was associated with a plasma exposure (c ave, ss ) 38 or 18 times that in humans at the recommended human dose (rhd) for migraine (120 mg) or episodic cluster headache (300 mg), respectively. administration of galcanezumab-gnlm (0, 30, or 100 mg/kg) by subcutaneous injection to pregnant rabbits throughout the period of organogenesis produced no adverse effects on embryofetal development. the higher dose tested was associated with a plasma c ave, ss 64 or 29 times that in humans at 120 mg or 300 mg, respectively. administration of galcanezumab-gnlm (0, 30, or 250 mg/kg) by subcutaneous injection to rats throughout pregnancy and lactation produced no adverse effects on pre- and postnatal development. the higher dose tested was associated with a plasma c ave, ss 34 or 16 times that in humans at 120 mg or 300 mg, respectively. 8.2 lactation risk summary there are no data on the presence of galcanezumab-gnlm in human milk, the effects on the breastfed infant, or the effects on milk production. the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for emgality and any potential adverse effects on the breastfed infant from emgality or from the underlying maternal condition. 8.4 pediatric use safety and effectiveness in pediatric patients have not been established. 8.5 geriatric use clinical studies of emgality did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients.

Use in Pregnancy:

8.1 pregnancy pregnancy exposure registry there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to emgality during pregnancy. healthcare providers are encouraged to register pregnant patients, or pregnant women may enroll themselves in the registry by calling 1-833-464-4724 or by contacting the company at www.migrainepregnancyregistry.com. risk summary there are no adequate data on the developmental risk associated with the use of emgality in pregnant women. administration of galcanezumab-gnlm to rats and rabbits during the period of organogenesis or to rats throughout pregnancy and lactation at plasma exposures greater than that expected clinically did not result in adverse effects on development (see animal data) . in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% - 4% and 15% - 20%, respectively. the estimated rate of major birth defects (2.2% - 2.9%) and
miscarriage (17%) among deliveries to women with migraine are similar to rates reported in women without migraine. clinical considerations disease-associated maternal and/or embryo/fetal risk published data have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy. data animal data when galcanezumab-gnlm was administered to female rats by subcutaneous injection in two studies (0, 30, or 100 mg/kg; 0 or 250 mg/kg) prior to and during mating and continuing throughout organogenesis, no adverse effects on embryofetal development were observed. the highest dose tested (250 mg/kg) was associated with a plasma exposure (c ave, ss ) 38 or 18 times that in humans at the recommended human dose (rhd) for migraine (120 mg) or episodic cluster headache (300 mg), respectively. administration of galcanezumab-gnlm (0, 30, or 100 mg/kg) by subcutaneous injection to pregnant rabbits throughout the period of organogenesis produced no adverse effects on embryofetal development. the higher dose tested was associated with a plasma c ave, ss 64 or 29 times that in humans at 120 mg or 300 mg, respectively. administration of galcanezumab-gnlm (0, 30, or 250 mg/kg) by subcutaneous injection to rats throughout pregnancy and lactation produced no adverse effects on pre- and postnatal development. the higher dose tested was associated with a plasma c ave, ss 34 or 16 times that in humans at 120 mg or 300 mg, respectively.

Pediatric Use:

8.4 pediatric use safety and effectiveness in pediatric patients have not been established.

Geriatric Use:

8.5 geriatric use clinical studies of emgality did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients.

Description:

11 description galcanezumab-gnlm is a humanized igg4 monoclonal antibody specific for calcitonin-gene related peptide (cgrp) ligand. galcanezumab-gnlm is produced in chinese hamster ovary (cho) cells by recombinant dna technology. galcanezumab-gnlm is composed of two identical immunoglobulin kappa light chains and two identical immunoglobulin gamma heavy chains and has an overall molecular weight of approximately 147 kda. emgality (galcanezumab-gnlm) injection is a sterile, preservative-free, clear to opalescent and colorless to slightly yellow to slightly brown solution, for subcutaneous use. emgality is supplied in a 1 ml single-dose prefilled pen to deliver 120 mg of galcanezumab-gnlm or a 1 ml single-dose prefilled syringe to deliver 100 mg or 120 mg of galcanezumab-gnlm. each ml of solution contains 100 mg or 120 mg of galcanezumab-gnlm; l-histidine (0.5 mg); l-histidine hydrochloride monohydrate (1.5 mg); polysorbate 80 (0.5 mg); sodium chloride (8.8 mg); water for injection, usp. the ph range is 5.3 - 6.3.

Clinical Pharmacology:

12 clinical pharmacology 12.1 mechanism of action galcanezumab-gnlm is a humanized monoclonal antibody that binds to calcitonin gene-related peptide (cgrp) ligand and blocks its binding to the receptor. 12.2 pharmacodynamics there are no relevant data on the pharmacodynamic effects of galcanezumab-gnlm. 12.3 pharmacokinetics galcanezumab-gnlm exhibits linear pharmacokinetics and exposure increases proportionally with doses between 1 and 600 mg. a loading dose of 240 mg achieved the serum galcanezumab-gnlm steady-state concentration after the first dose. a dose of 300 mg monthly would achieve steady-state concentration after the fourth dose. the time to maximum concentration is 5 days, and the elimination half-life is 27 days. there was no difference in pharmacokinetic parameters between healthy volunteers, patients with episodic or chronic migraine, and patients with episodic cluster headache. absorption following a subcutaneous dose of galcanezumab-gnlm, the time to maximum concentrat
ion was about 5 days. injection site location did not significantly influence the absorption of galcanezumab-gnlm. distribution the apparent volume of distribution (v/f) of galcanezumab-gnlm was 7.3 l (34% inter individual variability [iiv]). metabolism and elimination galcanezumab-gnlm is expected to be degraded into small peptides and amino acids via catabolic pathways in the same manner as endogenous igg. the apparent clearance (cl/f) of galcanezumab-gnlm was 0.008 l/h and the elimination half-life of galcanezumab was approximately 27 days. specific populations age, sex, weight, race, ethnicity the pharmacokinetics of galcanezumab-gnlm were not affected by age, sex, race, subtypes of migraine spectrum (episodic or chronic migraine), or headache diagnosis (migraine vs. episodic cluster headache) based on a population pharmacokinetics analysis. body weight has no clinically relevant effect on the pharmacokinetics of galcanezumab-gnlm. patients with renal or hepatic impairment renal and hepatic impairment are not expected to affect the pharmacokinetics of galcanezumab-gnlm. population pharmacokinetic analysis of integrated data from the galcanezumab-gnlm clinical studies revealed that creatinine clearance did not affect the pharmacokinetics of galcanezumab-gnlm in patients with mild or moderate renal impairment. patients with severe renal impairment (creatinine clearance <30 ml/min) have not been studied. based on a population pk analysis, bilirubin concentration did not significantly influence the cl/f of galcanezumab-gnlm. no dedicated clinical studies were conducted to evaluate the effect of hepatic impairment or renal impairment on the pharmacokinetics of galcanezumab-gnlm. drug interaction studies p450 enzymes galcanezumab-gnlm is not metabolized by cytochrome p450 enzymes; therefore, interactions with concomitant medications that are substrates, inducers, or inhibitors of cytochrome p450 enzymes are unlikely.

Mechanism of Action:

12.1 mechanism of action galcanezumab-gnlm is a humanized monoclonal antibody that binds to calcitonin gene-related peptide (cgrp) ligand and blocks its binding to the receptor.

Pharmacodynamics:

12.2 pharmacodynamics there are no relevant data on the pharmacodynamic effects of galcanezumab-gnlm.

Pharmacokinetics:

12.3 pharmacokinetics galcanezumab-gnlm exhibits linear pharmacokinetics and exposure increases proportionally with doses between 1 and 600 mg. a loading dose of 240 mg achieved the serum galcanezumab-gnlm steady-state concentration after the first dose. a dose of 300 mg monthly would achieve steady-state concentration after the fourth dose. the time to maximum concentration is 5 days, and the elimination half-life is 27 days. there was no difference in pharmacokinetic parameters between healthy volunteers, patients with episodic or chronic migraine, and patients with episodic cluster headache. absorption following a subcutaneous dose of galcanezumab-gnlm, the time to maximum concentration was about 5 days. injection site location did not significantly influence the absorption of galcanezumab-gnlm. distribution the apparent volume of distribution (v/f) of galcanezumab-gnlm was 7.3 l (34% inter individual variability [iiv]). metabolism and elimination galcanezumab-gnlm is expected to be
degraded into small peptides and amino acids via catabolic pathways in the same manner as endogenous igg. the apparent clearance (cl/f) of galcanezumab-gnlm was 0.008 l/h and the elimination half-life of galcanezumab was approximately 27 days. specific populations age, sex, weight, race, ethnicity the pharmacokinetics of galcanezumab-gnlm were not affected by age, sex, race, subtypes of migraine spectrum (episodic or chronic migraine), or headache diagnosis (migraine vs. episodic cluster headache) based on a population pharmacokinetics analysis. body weight has no clinically relevant effect on the pharmacokinetics of galcanezumab-gnlm. patients with renal or hepatic impairment renal and hepatic impairment are not expected to affect the pharmacokinetics of galcanezumab-gnlm. population pharmacokinetic analysis of integrated data from the galcanezumab-gnlm clinical studies revealed that creatinine clearance did not affect the pharmacokinetics of galcanezumab-gnlm in patients with mild or moderate renal impairment. patients with severe renal impairment (creatinine clearance <30 ml/min) have not been studied. based on a population pk analysis, bilirubin concentration did not significantly influence the cl/f of galcanezumab-gnlm. no dedicated clinical studies were conducted to evaluate the effect of hepatic impairment or renal impairment on the pharmacokinetics of galcanezumab-gnlm. drug interaction studies p450 enzymes galcanezumab-gnlm is not metabolized by cytochrome p450 enzymes; therefore, interactions with concomitant medications that are substrates, inducers, or inhibitors of cytochrome p450 enzymes are unlikely.

Nonclinical Toxicology:

13 nonclinical toxicology 13.1 carcinogenesis, mutagenesis, impairment of fertility carcinogenesis the carcinogenic potential of galcanezumab-gnlm has not been assessed. mutagenesis genetic toxicology studies of galcanezumab-gnlm have not been conducted. impairment of fertility when galcanezumab-gnlm (0, 30, or 250 mg/kg) was administered to male rats by subcutaneous injection prior to and during mating, no adverse effects on fertility was observed. the higher dose tested was associated with a plasma exposure (c ave, ss ) 8 or 4 times that in humans at the recommended human dose (rhd) for migraine (120 mg) or episodic cluster headache (300 mg), respectively. when galcanezumab-gnlm was administered to female rats by subcutaneous injection in two studies (0, 30, or 100 mg/kg; 0 or 250 mg/kg) prior to and during mating and continuing throughout organogenesis, no adverse effects on fertility were observed. the highest dose tested (250 mg/kg) was associated with a plasma c ave, ss 38 or 18
times that in humans at 120 mg or 300 mg, respectively.

Carcinogenesis and Mutagenesis and Impairment of Fertility:

13.1 carcinogenesis, mutagenesis, impairment of fertility carcinogenesis the carcinogenic potential of galcanezumab-gnlm has not been assessed. mutagenesis genetic toxicology studies of galcanezumab-gnlm have not been conducted. impairment of fertility when galcanezumab-gnlm (0, 30, or 250 mg/kg) was administered to male rats by subcutaneous injection prior to and during mating, no adverse effects on fertility was observed. the higher dose tested was associated with a plasma exposure (c ave, ss ) 8 or 4 times that in humans at the recommended human dose (rhd) for migraine (120 mg) or episodic cluster headache (300 mg), respectively. when galcanezumab-gnlm was administered to female rats by subcutaneous injection in two studies (0, 30, or 100 mg/kg; 0 or 250 mg/kg) prior to and during mating and continuing throughout organogenesis, no adverse effects on fertility were observed. the highest dose tested (250 mg/kg) was associated with a plasma c ave, ss 38 or 18 times that in humans at 12
0 mg or 300 mg, respectively.

Clinical Studies:

14 clinical studies 14.1 migraine the efficacy of emgality was evaluated as a preventive treatment of episodic or chronic migraine in three multicenter, randomized, double-blind, placebo-controlled studies: two 6-month studies in patients with episodic migraine (studies 1 and 2) and one 3-month study in patients with chronic migraine (study 3). episodic migraine study 1 (nct02614183) and study 2 (nct02614196) included adults with a history of episodic migraine (4 to 14 migraine days per month). all patients were randomized in a 1:1:2 ratio to receive once-monthly subcutaneous injections of emgality 120 mg, emgality 240 mg, or placebo. all patients in the 120 mg emgality group received an initial 240 mg loading dose. patients were allowed to use acute headache treatments, including migraine-specific medications (i.e., triptans, ergotamine derivatives), nsaids, and acetaminophen during the study. the studies excluded patients on any other migraine preventive treatment, patients with medi
cation overuse headache, patients with ecg abnormalities compatible with an acute cardiovascular event and patients with a history of stroke, myocardial infarction, unstable angina, percutaneous coronary intervention, coronary artery bypass grafting, deep vein thrombosis, or pulmonary embolism within 6 months of screening. the primary efficacy endpoint for studies 1 and 2 was the mean change from baseline in the number of monthly migraine headache days over the 6-month treatment period. key secondary endpoints included response rates (the mean percentages of patients reaching at least 50%, 75%, and 100% reduction from baseline in the number of monthly migraine headache days over the 6-month treatment period), the mean change from baseline in the number of monthly migraine headache days with use of any acute headache medication during the 6-month treatment period, and the impact of migraine on daily activities, as assessed by the mean change from baseline in the average migraine-specific quality of life questionnaire version 2.1 (msq v2.1) role function-restrictive domain score during the last 3 months of treatment (months 4 to 6). scores are scaled from 0 to 100, with higher scores indicating less impact of migraine on daily activities. in study 1, a total of 858 patients (718 females, 140 males) ranging in age from 18 to 65 years, were randomized. a total of 703 patients completed the 6-month double-blind phase. in study 2, a total of 915 patients (781 female, 134 male) ranging in age from 18 to 65 years, were randomized. a total of 785 patients completed the 6-month double-blind phase. in study 1 and study 2, the mean migraine frequency at baseline was approximately 9 migraine days per month, and was similar across treatment groups. emgality 120 mg demonstrated statistically significant improvements for efficacy endpoints compared to placebo over the 6-month period, as summarized in table 2 . emgality treatment with the 240 mg once-monthly dose showed no additional benefit over the emgality 120 mg once-monthly dose. table 2: efficacy endpoints in studies 1 and 2 a p<0.001 b n = 189 for emgality 120 mg and n = 377 for placebo in study 1; n = 213 for emgality 120 mg and n = 396 for placebo in study 2. study 1 study 2 emgality 120 mg n = 210 placebo n = 425 emgality 120 mg n = 226 placebo n = 450 monthly migraine headache days (over months 1 to 6) baseline migraine headache days 9.2 9.1 9.1 9.2 mean change from baseline -4.7 -2.8 -4.3 -2.3 difference from placebo a -1.9 -2.0 ?50% migraine headache days responders (over months 1 to 6) % responders a 62% 39% 59% 36% ?75% migraine headache days responders (over months 1 to 6) % responders a 39% 19% 34% 18% 100% migraine headache days responders (over months 1 to 6) % responders a 16% 6% 12% 6% monthly migraine headache days that acute medication was taken (over months 1 to 6) mean change from baseline (days) a -4.0 -2.2 -3.7 -1.9 msq role function-restrictive domain score (over months 4 to 6) baseline 51.4 52.9 52.5 51.4 mean change from baseline b 32.4 24.7 28.5 19.7 difference from placebo a 7.7 8.8 figure 1: change from baseline in monthly migraine headache days in study 1 a a least-square means and 95% confidence intervals are presented. figure 2: change from baseline in monthly migraine headache days in study 2 a a least-square means and 95% confidence intervals are presented. figure 3 shows the distribution of change from baseline in the mean number of monthly migraine headache days in bins of 2 days, by treatment group, in study 1. a treatment benefit over placebo for emgality is seen across a range of changes from baseline in monthly migraine headache days. figure 3: distribution of change from baseline in mean monthly migraine headache days over months 1 to 6 by treatment group in study 1 figure 4 shows the distribution of change from baseline in the mean number of monthly migraine headache days in bins of 2 days, by treatment group, in study 2. a treatment benefit over placebo for emgality is seen across a range of changes from baseline in monthly migraine headache days. figure 4: distribution of change from baseline in mean monthly migraine headache days over months 1 to 6 by treatment group in study 2 figure 1 figure 2 figure 3 figure 4 chronic migraine study 3 (nct02614261) included adults with a history of chronic migraine (?15 headache days per month with ?8 migraine days per month). all patients were randomized in a 1:1:2 ratio to receive once-monthly subcutaneous injections of emgality 120 mg, emgality 240 mg, or placebo over a 3-month treatment period. all patients in the 120 mg emgality group received an initial 240 mg loading dose. patients were allowed to use acute headache treatments including migraine-specific medications (i.e., triptans, ergotamine derivatives), nsaids, and acetaminophen. a subset of patients (15%) was allowed to use one concomitant migraine preventive medication. patients with medication overuse headache were allowed to enroll. the study excluded patients with ecg abnormalities compatible with an acute cardiovascular event, and patients with a history of stroke, myocardial infarction, unstable angina, percutaneous coronary intervention, coronary artery bypass grafting, deep vein thrombosis, or pulmonary embolism within 6 months of screening. the primary endpoint was the mean change from baseline in the number of monthly migraine headache days over the 3-month treatment period. the secondary endpoints were response rates (the mean percentages of patients reaching at least 50%, 75% and 100% reduction from baseline in the number of monthly migraine headache days over the 3-month treatment period), the mean change from baseline in the number of monthly migraine headache days with use of any acute headache medication during the 3-month treatment period, and the impact of migraine on daily activities as assessed by the mean change from baseline in the msq v2.1 role function-restrictive domain score at month 3. scores are scaled from 0 to 100, with higher scores indicating less impact of migraine on daily activities. in study 3, a total of 1113 patients (946 female, 167 male) ranging in age from 18 to 65 years, were randomized. a total of 1037 patients completed the 3-month double-blind phase. the mean number of monthly migraine headache days at baseline was approximately 19. emgality 120 mg demonstrated statistically significant improvement for the mean change from baseline in the number of monthly migraine headache days over the 3-month treatment period, and in the mean percentage of patients reaching at least 50% reduction from baseline in the number of monthly migraine headache days over the 3-month treatment period, as summarized in table 3 . emgality treatment with the 240 mg once-monthly dose showed no additional benefit over the emgality 120 mg once-monthly dose. table 3: efficacy endpoints in study 3 a p<0.001 emgality 120 mg n = 273 placebo n =538 monthly migraine headache days (over months 1 to 3) baseline migraine headache days 19.4 19.6 mean change from baseline -4.8 -2.7 difference from placebo a -2.1 ?50% migraine headache days responders (over months 1 to 3) % responders a 28% 15% study 3 utilized a sequential testing procedure to control the type-i error rate for the multiple secondary endpoints. once a secondary endpoint failed to reach the required level for statistical significance, formal hypothesis testing was terminated for subsequent endpoints, and p-values were considered nominal only. in study 3, emgality 120 mg was not significantly better than placebo for the proportion of patients with ?75% or 100% reduction in migraine headache days. patients treated with emgality 120 mg showed a nominally greater reduction in the number of monthly migraine headache days that acute medication was taken (-4.7 for emgality 120 mg vs. -2.2 for placebo; nominal p-value <0.001), and the mean change from baseline in the msq role function-restrictive domain score at month 3 was nominally greater in patients treated with emgality 120 mg than in patients on placebo (21.8 for emgality 120 mg vs. 16.8 for placebo; nominal p-value <0.001). figure 5: change from baseline in monthly migraine headache days in study 3 a a least-square means and 95% confidence intervals are presented. figure 6 shows the distribution of change from baseline in the mean number of monthly migraine headache days for the 3-month study period in bins of 3 days by treatment group. a treatment benefit over placebo for emgality is seen across a range of changes from baseline in monthly migraine headache days. figure 6: distribution of change from baseline in mean monthly migraine headache days over months 1 to 3 by treatment group in study 3 figure 6 figure 6 14.2 episodic cluster headache the efficacy of emgality was evaluated for the treatment of episodic cluster headache in a randomized, 8-week, double-blind, placebo-controlled study (study 4). study 4 (nct02397473) included adults who met the international classification of headache disorders 3 rd edition (beta version) diagnostic criteria for episodic cluster headache and had a maximum of 8 attacks per day, a minimum of one attack every other day, and at least 4 attacks during the prospective 7-day baseline period. all patients were randomized in a 1:1 ratio to receive once-monthly subcutaneous injections of emgality 300 mg or placebo. patients were allowed to use certain specified acute/abortive cluster headache treatments, including triptans, oxygen, acetaminophen, and nsaids during the study. the study excluded patients on other treatments intended to reduce the frequency of cluster headache attacks; patients with medication overuse headache; patients with ecg abnormalities compatible with an acute cardiovascular event or conduction delay; and patients with a history of myocardial infarction, unstable angina, percutaneous coronary intervention, coronary artery bypass grafting, deep vein thrombosis, or pulmonary embolism within 6 months of screening. in addition, patients with any history of stroke, intracranial or carotid aneurysm, intracranial hemorrhage, or vasospastic angina; clinical evidence of peripheral vascular disease; or diagnosis of raynaud’s disease were excluded. the primary efficacy endpoint for study 4 was the mean change from baseline in weekly cluster headache attack frequency across weeks 1 to 3. a secondary endpoint was the percentage of patients who achieved a response (defined as a reduction from baseline of 50% or greater in the weekly cluster headache attack frequency) at week 3. in study 4, a total of 106 patients (88 males, 18 females) ranging in age from 19 to 65 years were randomized and treated. a total of 90 patients completed the 8-week double-blind phase. in the prospective baseline phase, the mean number of weekly cluster headache attacks was 17.5, and was similar across treatment groups. emgality 300 mg demonstrated statistically significant improvements for efficacy endpoints compared to placebo, as summarized in table 4 . table 4: efficacy endpoints in study 4 emgality 300 mg n = 49 placebo n = 57 mean reduction in weekly cluster headache attack frequency (over weeks 1 to 3) prospective baseline cluster headache attack frequency 17.8 17.3 mean change from baseline -8.7 -5.2 difference from placebo -3.5 p-value 0.036 ?50% weekly cluster headache attack frequency responders (at week 3) % responders 71.4% 52.6% difference from placebo 18.8% p-value 0.046 figure 7: mean change in weekly cluster headache attack frequency over weeks 1 to 3 in study 4 a a abbreviations: bl = baseline; ls = least square; se = standard error. figure 8 shows the distribution of the average percent change from baseline in weekly cluster headache attack frequency across weeks 1 to 3 in bins of 25%, by treatment group, in study 4. figure 8: distribution of the average percent change from baseline in weekly cluster headache attack frequency over weeks 1 to 3 in study 4 a a n = number of intent to treat patients with non-missing average percentage change from baseline in weekly cluster headache attack frequency over weeks 1 to 3. figure 7 figure 8

How Supplied:

16 how supplied/storage and handling 16.1 how supplied emgality (galcanezumab-gnlm) injection is a sterile, preservative-free, clear to opalescent, colorless to slightly yellow to slightly brown solution for subcutaneous administration. emgality is not made with natural rubber latex. emgality is supplied as follows: pack size ndc prefilled pen 120 mg/ml single-dose carton of 1 0002-1436-11 120 mg/ml single-dose carton of 2 0002-1436-27 prefilled syringe 100 mg/ml single-dose carton of 3 0002-3115-09 120 mg/ml single-dose carton of 1 0002-2377-11 120 mg/ml single-dose carton of 2 0002-2377-27 16.2 storage and handling store refrigerated at 2°c to 8°c (36°f to 46°f) in the original carton to protect emgality from light until use. do not freeze. do not shake. emgality may be stored out of refrigeration in the original carton at temperatures up to 30°c (86°f) for up to 7 days. once stored out of refrigeration, do not place back in the refrigerator. if these conditions are exceeded, e
mgality must be discarded. discard the emgality single-dose prefilled pen or syringe after use in a puncture-resistant container.

16.1 how supplied emgality (galcanezumab-gnlm) injection is a sterile, preservative-free, clear to opalescent, colorless to slightly yellow to slightly brown solution for subcutaneous administration. emgality is not made with natural rubber latex. emgality is supplied as follows: pack size ndc prefilled pen 120 mg/ml single-dose carton of 1 0002-1436-11 120 mg/ml single-dose carton of 2 0002-1436-27 prefilled syringe 100 mg/ml single-dose carton of 3 0002-3115-09 120 mg/ml single-dose carton of 1 0002-2377-11 120 mg/ml single-dose carton of 2 0002-2377-27

Information for Patients:

17 patient counseling information advise the patient to read the fda-approved patient labeling (patient information and instructions for use). instructions on self-administration : provide guidance to patients and/or caregivers on proper subcutaneous injection technique, including aseptic technique, and how to use the prefilled pen or prefilled syringe correctly [see instructions for use] . instruct patients and/or caregivers to read and follow the instructions for use each time they use emgality. hypersensitivity reactions : advise patients to seek immediate medical attention if they experience any symptoms of serious or severe hypersensitivity reactions [see warnings and precautions ( 5.1 )] . pregnancy exposure registry : advise patients that there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to emgality during pregnancy [see use in specific populations ( 8.1 )] . for more information go to www.emgality.com or call 1-833-emgality (1-833-364-2548
). literature revised: 03/2021 eli lilly and company, indianapolis, in 46285, usa us license number 1891 copyright © 2018, 2021, eli lilly and company. all rights reserved. emg-0006-uspi-20210311

Spl Patient Package Insert:

This patient information has been approved by the u.s. food and drug administration revised: 03/2021 patient information emgality ® (em-gal-it-?) (galcanezumab-gnlm) injection, for subcutaneous use what is emgality? emgality is a prescription medicine used in adults for the: preventive treatment of migraine. treatment of episodic cluster headache. it is not known if emgality is safe and effective in children. who should not use emgality? do not use emgality if you are allergic to galcanezumab-gnlm or any of the ingredients in emgality. see the end of this patient information for a complete list of ingredients in emgality. before you use emgality, tell your healthcare provider if you: are pregnant or plan to become pregnant. it is not known if emgality will harm your unborn baby. pregnancy registry : there is a pregnancy registry for women who take emgality. the purpose of this registry is to collect information about the health of you and your baby. you may enroll yourself by calling
1-833-464-4724 or by visiting www.migrainepregnancyregistry.com. or you may talk to your healthcare provider about how you can take part in this registry. are breastfeeding or plan to breastfeed. it is not known if emgality passes into your breast milk. talk to your healthcare provider about the best way to feed your baby while using emgality. tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. know the medicines you take. keep a list of your medicines with you to show your healthcare provider and pharmacist when you get a new medicine. how should i use emgality? see the instructions for use that come with emgality prefilled pen or prefilled syringe about how to use emgality the right way. use emgality exactly as your healthcare provider tells you to. emgality is given by injection under the skin (subcutaneous injection). inject emgality in your stomach area (abdomen), thigh, back of the upper arm, or buttocks. your healthcare provider should show you or a caregiver how to prepare and inject emgality the right way before you start to use it. emgality comes in 2 different types of devices: a single-dose (1 time) prefilled pen a single-dose (1 time) prefilled syringe your healthcare provider will prescribe the type that is best for you. if you have questions about injecting the medicine, talk to your pharmacist or healthcare provider. if you are using the emgality 120 mg prefilled pen or prefilled syringe for migraine: inject emgality 1 time each month. for the first dose (loading dose), you will get 2 separate injections one time, right after each other. you will need 2 prefilled pens or 2 prefilled syringes for your first dose (1-time loading dose). for your regular monthly dose, you will get 1 injection. you will need 1 prefilled pen or 1 prefilled syringe for your regular monthly dose. if you miss a dose of emgality, inject the missed dose as soon as possible. then inject emgality 1 month from the date of your last dose to get back on a monthly dosing schedule. if you have questions about your schedule, ask your healthcare provider. if you are using the emgality 100 mg prefilled syringe for episodic cluster headache: you will get 3 separate injections, right after each other, using 3 prefilled syringes for each of your doses. use emgality at the start of a cluster period and then every month until the end of the cluster period. if you miss a dose of emgality, inject the missed dose as soon as possible. then, if the cluster headache period has not yet ended, inject emgality 1 month after your last dose to get back on a monthly dosing schedule. if you have questions about when you should use emgality, ask your healthcare provider. what are the possible side effects of emgality? emgality may cause serious side effects, including: allergic reactions. allergic reactions, including itching, rash, hives, and trouble breathing, can happen after receiving emgality. this can happen days after using emgality. call your healthcare provider or get emergency medical help right away if you have any of the following symptoms, which may be part of an allergic reaction: swelling of the face, mouth, tongue, or throat trouble breathing the most common side effects of emgality include: injection site reactions tell your healthcare provider if you have any side effect that bothers you or that does not go away. these are not all of the possible side effects of emgality. for more information, ask your healthcare provider or pharmacist. call your healthcare provider for medical advice about side effects. you may report side effects to fda at 1-800-fda-1088. how should i store emgality? store emgality in the refrigerator between 36°f to 46°f (2°c to 8°c). emgality may be stored out of the refrigerator in the original carton at temperatures up to 86°f (30°c) for up to 7 days. after storing out of the refrigerator, do not place emgality back in the refrigerator. do not freeze emgality. keep emgality in the carton it comes in to protect it from light until time of use. do not shake emgality. throw away emgality if any of the above conditions are not followed. keep emgality and all medicines out of the reach of children. general information about the safe and effective use of emgality. medicines are sometimes prescribed for purposes other than those listed in the patient information. do not use emgality for a condition for which it was not prescribed. do not give emgality to other people, even if they have the same symptoms you have. it may harm them. you can ask your pharmacist or healthcare provider for information about emgality that is written for health professionals. what are the ingredients in emgality? active ingredient: galcanezumab-gnlm inactive ingredients: l-histidine, l-histidine hydrochloride monohydrate, polysorbate 80, sodium chloride, and water for injection, usp. emgality prefilled pen and prefilled syringes are not made with natural rubber latex. emgality ® is a registered trademark of eli lilly and company. eli lilly and company indianapolis, in 46285, usa us license number 1891 copyright © 2018, 2021, eli lilly and company. all rights reserved. emg-0005-ppi-20210311 for more information, call 1-833-emgality (1-833-364-2548) or go to www.emgality.com.

Package Label Principal Display Panel:

Package carton – emgality autoinjector 120 mg ndc 0002-1436-11 emgality ® (galcanezumab-gnlm) injection 120 mg/ml 1 x 120 mg/ml single-dose prefilled pen for subcutaneous use only single-dose only rx only lilly package carton – emgality autoinjector 120 mg

Package carton – emgality prefilled syringe 120 mg ndc 0002-2377-11 emgality ® (galcanezumab-gnlm) injection 120 mg/ml 1x 120 mg/ml single-dose prefilled syringe for subcutaneous use only single-dose only rx only lilly package carton – emgality prefilled syringe 120 mg

Package carton – emgality prefilled syringe 100 mg ndc 0002-3115-09 emgality ® (galcanezumab-gnlm) 100 mg/ml injection all 3 syringes must be administered to receive the 300 mg dose. 3 x 100 mg/ml single-dose prefilled syringe for subcutaneous use only single-dose only rx only lilly package carton – emgality prefilled syringe 100 mg


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* Data of this site is collected from www.fda.gov. This page is for informational purposes only. Always consult your physician with any questions you may have regarding a medical condition.