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  • Generic Name: inotersen injection
  • Brand Name: Tegsedi
  • Drug Class: Rheumatologics Antisense Oligonucleotides
Last updated on MDtodate: 10/12/2022


The following serious adverse reactions are discussed in greater detail in other sections of the labeling:

  • Thrombocytopenia
  • Glomerulonephritis and Renal Toxicity
  • Stroke and Cervicocephalic Arterial Dissection
  • Inflammatory and Immune Effects
  • Liver Injury
  • Hypersensitivity
  • Reducted Serum Vitamin A Levels and Recommended Supplementation

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of TEGSEDI cannot be directly compared to rates in clinical trials of other drugs and may not reflect the rates observed in practice.

A total of 112 adult patients with polyneuropathy caused by hereditary transthyretin-mediated amyloidosis (hATTR) received TEGSEDI in Study 1 and 60 patients received placebo. The, mean age of the study patients was 59 years (27 to 78 years of age). Of the TEGSEDI-treated patients, 69% were male and 94% were Caucasian, with a mean exposure of 385 days, and median exposure of 449 days. Baseline disease characteristics were largely similar in TEGSEDI-treated patients and patients in the placebo control group. Sixty-seven percent of patients were in Stage 1 of the disease at baseline, and 33% in Stage 2. Fifty-two percent of patients had Val30Met mutations in the TTR gene, with the remaining 48% comprised of 26 different other point mutations.

Table 2 presents common adverse reactions that occurred in at least 5% of TEGSEDI-treated patients and that occurred at least 5% more frequently or two times more frequently than on placebo.

The most common adverse reactions that occurred in at least 20% of TEGSEDI-treated patients and more frequently than on placebo were injection site reactions, nausea, headache, fatigue, thrombocytopenia, and fever. Serious adverse reactions were more frequent in TEGSEDI-treated patients (32%) than in patients on placebo (21%). The most common adverse reactions leading to discontinuation were thrombocytopenia and cachexia.

Table 1: Adverse Reactions Reported in At Least 5% TEGSEDI-Treated Patients and that Occurred At Least 5% More Frequently or At Least Two Times More Frequently than Placebo Patients (Study 1)

Injection site reactionsa 49 10
Nausea 31 12
Headache 26 12
Fatigue 25 20
Thrombocytopenia 24 2
Fever 20 8
Peripheral edema 19 10
Chills 18 3
Anemia 17 3
Vomiting 15 5
Myalgia 15 10
Decreased renal function 14 5
Arrhythmiab 13 5
Arthralgia 13 8
Pre-syncope or syncope 13 5
Decreased appetite 10 0
Paresthesia 10 3
Dyspnea 9 3
Elevated liver function test 9 3
Orthostasis 8 2
Influenza-like illness 8 3
Contusion 7 2
Bacterial infectionc 7 3
Eosinophilia 5 0
Dry mouth 5 2
a Includes bruising, erythema, hematoma, hemorrhage, induration, inflammation, mass, edema, pain, pruritus, rash, swelling, and urticaria.
b Includes arrhythmia, atrial fibrillation, atrial flutter, bradyarrhythmia, bradycardia, extrasystoles, sinus arrhythmia, sinus bradycardia, supraventricular extrasystoles, tachycardia, and ventricular extrasystoles.
c Includes bacteremia, cellulitis staphylococcal, clostridium difficile infection, conjunctivitis bacterial, cystitis Escherichia, Helicobacter gastritis, Helicobacter infection, Staphylococcal infection.



The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. In addition, 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 TEGSEDI in the studies described below with the incidence of antibodies in other studies or to other products may be misleading.

In Study 1, 30% of TEGSEDI-treated patients tested positive for anti-drug antibodies (ADA) following 65 weeks of treatment. However, the assay measured only IgG isotypes and the existence of other isotypes may be possible. In many cases adverse reactions occurred in patients with ADA, although the available data are too limited to make definitive conclusions about the relationship.



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