The recommended dosage of Lumizyme® (alglucosidase alfa) is 20 mg per kg of body weight, administered every two weeks as an intravenous infusion. The total volume of infusion is determined by the patient’s body weight and should be administered over approximately 4 hours. If severe infusion or allergic reactions occur, immediate discontinuation of the administration of Lumizyme should be considered, and appropriate medical treatment should be initiated. Appropriate medical support should be readily available when Lumizyme is administered.
A patient's dose and the vials required for that dose can be calculated with the following formulas:
For example, if a patient weighs 68 kg:
Lumizyme is supplied as a sterile, nonpyrogenic, white to off-white lyophilized cake or powder that must first be reconstituted before administration. For more details on Lumizyme reconstitution and dilution, see the Handling & Preparation page.
Once prepared, the diluted Lumizyme solution should be filtered through a 0.2 μm, low protein-binding, in-line filter during administration to remove any visible particles. These filters are NOT provided in the product package.
Lumizyme should not be infused in the same intravenous line with other products, and the solution should be protected from light.
Infusions should be administered in a step-wise manner using an infusion pump. The initial infusion rate should be no more than 1 mg/kg/hr. The infusion rate may be increased by 2 mg/kg/hr every 30 minutes, after patient tolerance to the infusion rate is established, until a maximum rate of 7 mg/kg/hr is reached. Consult the following chart for infusion rates at each step:
Patient Weight Range (kg) | Total Infusion Volume (ml) | Step 1 1 mg/kg/hr (mL/hr) |
Step 2 3 mg/kg/hr (mL/hr) |
Step 3 5 mg/kg/hr (mL/hr) |
Step 4 7 mg/kg/hr (mL/hr) |
---|---|---|---|---|---|
1.25 – 10 |
50 |
3 |
8 |
13 |
18 |
10.1 – 20 |
100 |
5 |
15 |
25 |
35 |
20.1 -30 |
150 |
8 |
23 |
38 |
53 |
30.1 - 35 |
200 |
10 |
30 |
50 |
70 |
35.1 - 50 |
250 |
13 |
38 |
63 |
88 |
50.1 - 60 |
300 |
15 |
45 |
75 |
105 |
60.1 -100 |
500 |
25 |
75 |
125 |
175 |
100.1 -120 |
600 |
30 |
90 |
150 |
210 |
120.1 - 140 |
700 |
35 |
105 |
175 |
245 |
140.1 - 160 |
800 |
40 |
120 |
200 |
280 |
160.1 - 180 |
900 |
45 |
135 |
225 |
315 |
180.1 - 200 |
1000 |
50 |
150 |
250 |
350 |
LUMIZYME® (alglucosidase alfa) is a hydrolytic lysosomal glycogen-specific enzyme indicated for patients with Pompe disease (GAA deficiency).
WARNING: RISK OF ANAPHYLAXIS, HYPERSENSITIVITY AND IMMUNE-MEDIATED REACTIONS, AND RISK OF CARDIORESPIRATORY FAILURE
Anaphylaxis and Hypersensitivity Reactions: Life-threatening anaphylaxis and hypersensitivity reactions have been observed in some patients during and after treatment with alglucosidase alfa. If anaphylaxis or severe hypersensitivity reactions occur, immediately discontinue infusion and institute appropriate medical treatment. Appropriate medical support and monitoring measures should be available during infusion.
Immune-Mediated Reactions: Monitor patients for the development of systemic immune-mediated reactions involving skin and other organs. If immune-mediated reactions occur, consider discontinuation of the administration of alglucosidase alfa, and initiate appropriate medical treatment.
Risk of Acute Cardiorespiratory Failure: Patients with acute underlying respiratory illness or compromised cardiac and/or respiratory function may be at risk of serious exacerbation of their cardiac or respiratory compromise during infusions. Appropriate medical support and monitoring measures should be readily available during alglucosidase alfa infusion, and some patients may require prolonged observation times that should be individualized based on the needs of the patient.
Risk of Cardiac Arrhythmia and Sudden Cardiac Death during General Anesthesia for Central Venous Catheter Placement: Administration of general anesthesia can be complicated by the presence of severe cardiac and skeletal (including respiratory) muscle weakness. Therefore, caution should be used when administering general anesthesia. Ventricular arrhythmias and bradycardia, resulting in cardiac arrest or death, or requiring cardiac resuscitation or defibrillation have been observed in infantile-onset Pompe disease patients with cardiac hypertrophy during general anesthesia for central venous catheter placement.
Risk of Antibody Development: Patients with infantile-onset Pompe disease should have a cross-reactive immunologic material (CRIM) assessment early in their disease course and be managed by a clinical specialist knowledgeable in immune tolerance induction in Pompe disease to optimize treatment. CRIM status has been shown to be associated with immunogenicity and patients’ responses to enzyme replacement therapies. There is evidence to suggest that some patients who develop high and sustained IgG antibody titers, including CRIM-negative patients, may experience reduced clinical alglucosidase alfa treatment efficacy.
Monitoring: Laboratory Tests: Patients should be monitored for IgG antibody formation every 3 months for 2 years and then annually thereafter.
The most frequently reported adverse reactions (≥ 5%) in clinical trials were hypersensitivity reactions and included: anaphylaxis, rash, pyrexia, flushing/feeling hot, urticaria, headache, hyperhidrosis, nausea, cough, decreased oxygen saturation, tachycardia, tachypnea, chest discomfort, dizziness, muscle twitching, agitation, cyanosis, erythema, hypertension/increased blood pressure, pallor, rigors, tremor, vomiting, fatigue, and myalgia.
Please see the Full Prescribing Information for complete details, including boxed WARNING.
References