Posology : מינונים

2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dosage
Treatment-naïve patients: The recommended dosage for treatment-naïve adult and pediatric patients above 2 years of age and older is 60 units per kg of body weight administered every other week as a 60 to 120 minute intravenous infusion.

Patients switching from imiglucerase: Patients currently being treated with imiglucerase for Type 1 Gaucher disease can be switched to ELELYSO®. Patients previously treated on a stable dosage of imiglucerase are recommended to begin treatment with ELELYSO® at that same dosage when they switch from imiglucerase to ELELYSO® Dosage adjustments can be made based on achievement and maintenance of each patient’s therapeutic goals [see Clinical Studies (14.2)].

2.2 Preparation Instructions
ELELYSO® should be reconstituted, diluted, and administered under the supervision of a healthcare professional.

Each vial of ELELYSO® provides 200 units of taliglucerase alfa and is intended for single use only. Do not use the vial more than one time. The reconstitution and dilution steps must be completed using aseptic technique.

ELELYSO® should be reconstituted with Sterile Water for Injection and diluted with 0.9% Sodium Chloride Injection, USP, to a final volume of 100 mL to 200 mL, and delivered by intravenous infusion.

Prepare ELELYSO® according to the following steps. Use aseptic technique.
 a. Determine the number of vials to be reconstituted based on the patient’s weight and the recommended dose of 60 units/kg, using the following calculations (1-3): 

(1) Total dose in units = Patient's weight (kg) x dose (units/kg)
(2) Total number of vials = Total dose in units divided by 200 units/vial 
(3) Round up to the next whole vial.
 b. Remove the required number of vials from the refrigerator. Do not leave these vials at room temperature longer than 24 hours prior to reconstitution. Do not heat or microwave these vials.
 c. Reconstitute each vial of ELELYSO® with 5.1 mL of Sterile Water for Injection to yield a reconstituted product with a concentration of 40 units/mL and an extractable volume of 5 mL. Upon reconstitution, mix vials gently. DO NOT SHAKE. Prior to further dilution, visually inspect the solution in the vials; the solution should be clear and colorless. Do not use if the solution is discolored or if foreign particulate matter is present.
 d. Withdraw the calculated dose of drug from the appropriate number of vials and dilute with 0.9% Sodium Chloride Injection, USP, to a final volume of 100 to 200 mL.
i. For pediatric patients, a final volume of 100 to 120 mL should be used.
ii.   For adult patients, a final volume of 130 to 150 mL may be used. However, if the volume of reconstituted product alone is equal to or greater than 130 to 150 mL, then the final volume should not exceed 200 mL.
 e. Mix gently. DO NOT SHAKE. Since this is a protein solution, slight flocculation (described as translucent fibers) occurs occasionally after dilution.

2.3 Administration Instructions

After reconstitution and dilution, the preparation should be administered via intravenous infusion and filtered through an in-line low protein-binding 0.2 μm filter.
•   For pediatric patients: An initial infusion rate of 1 mL/minute should be used. After tolerability to ELELYSO® is established, the infusion rate may be increased, but should not exceed the maximum recommended infusion rate of 2 mL/minute. The total volume of the infusion should be delivered over a minimum of 60 minutes.
•   For adult patients: An initial infusion rate of 1.2 mL/minute should be used. After tolerability to ELELYSO® is established, the infusion rate may be increased, but should not exceed the maximum recommended infusion rate of 2.2 mL/minute. The total volume of the infusion should be delivered over a minimum of 60 minutes.

As ELELYSO® contains no preservative, the product should be used immediately once reconstituted. If immediate use is not possible, the reconstituted product may be stored for up to 24 hours at 2 to 8 °C (36 to 46 °F) under protection from light. The diluted product may be stored for up to 24 hours at 2 to 8 °C (36 to 46 °F) under protection from light. Storage of the reconstituted product and the diluted product should not exceed a total of 24 hours. Do not freeze. Discard any unused product.