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ARTGs
334800, 334801 and 334802
334800, 334801 and 334802
334800, 334801 and 334802
Device/Product name
Hulio
Active Ingredient
Adalimumab
Date of decision
Published
Submission type
New biosimilar medicine
ATC codes
L04AB04
Decision
Approved
What was the decision based on
The decision was based on quality (chemistry and manufacturing), nonclinical (pharmacology and toxicology), clinical (pharmacology, safety and efficacy) and risk management plan information submitted by the sponsor. The benefit-risk profile of Hulio was considered favourable for the therapeutic use approved.
What steps were involved in the decision process

Registration timeline

The following table summarises the key steps and dates for this application.

Description Date
Submission dossier accepted and first round evaluation commenced 2 June 2020
First round evaluation completed 2 November 2020
Sponsor provides responses on questions raised in first round evaluation 12 January 2021
Second round evaluation completed 16 February 2021
Delegate's overall benefit-risk assessment 15 March 2021
Sponsor's pre-Advisory Committee response Not applicable
Advisory Committee meeting Not applicable
Registration decision (Outcome) 7 April 2021
Completion of administrative activities and registration on ARTG 14 May 2021
Number of working days from submission dossier acceptance to registration decision* 172

*Statutory timeframe for standard applications is 255 working days

Date of entry onto ARTG
Original publication date
Black triangle scheme
No
Dose forms
Solution for injection
Strength
20 mg/0.4 mL and 40 mg/0.8 mL
Other ingredients
Monosodium glutamate monohydrate, sorbitol (E420), methionine, polysorbate 80, dilute hydrochloric acid and water for injections
Containers
Pre-filled pen and pre-filled syringe
Pack sizes
2 pre-filled syringes (0.4 mL sterile solution)1, 2 and 6 pre-filled syringes or pre-filled pens (0.8 mL sterile solution)
Routes of administration
Subcutaneous injection
Dosage

Dosage of Hulio is based on multiple factors, including the condition being treated, the age and the body weight of the patient.

For further information refer to the Product Information.

Pregnancy category
CDrugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.The use of any medicine during pregnancy requires careful consideration of both risks and benefits by the treating health professional. This must not be used as the sole basis of decision making in the use of medicines during pregnancy. The TGA does not provide advice on the use of medicines in pregnancy for specific cases. More information is available from obstetric drug information services in your State or Territory.
What was approved

Hulio (adalimumab) was approved for the following therapeutic use:

Rheumatoid arthritis

Hulio is indicated for reducing signs and symptoms, as well as inhibiting the progression of structural damage in adult patients with moderate to severely active rheumatoid arthritis. This includes the treatment of patients with recently diagnosed moderate to severely active disease who have not received methotrexate.

Hulio can be used alone or in combination with methotrexate.

Juvenile idiopathic arthritis

Polyarticular juvenile idiopathic arthritis

Hulio in combination with methotrexate is indicated for reducing the signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older who have had an inadequate response to one or more disease modifying antirheumatic drugs (DMARDs). HULIO can be given as monotherapy in case of intolerance to methotrexate or when continued treatment with methotrexate is inappropriate.

Enthesitis-related arthritis

Hulio is indicated for the treatment of enthesitis-related arthritis in children, who have had an inadequate response to, or who are intolerant to, conventional therapy.

Psoriatic arthritis

Hulio is indicated for the treatment of signs and symptoms, as well as inhibiting the progression of structural damage, of moderate to severely active psoriatic arthritis in adult patients where response to previous DMARDs has been inadequate.

Ankylosing spondylitis

Hulio is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.

Crohn's disease in adults and children (≥ 6 years)

Hulio is indicated for the treatment of moderate to severe Crohn's disease, to reduce the signs and symptoms of the disease and to induce and maintain clinical remission in patients;

  • who have had an inadequate response to conventional therapies or,
  • who have lost response to or are intolerant to infliximab.

Ulcerative colitis

Hulio is indicated for the treatment of moderate to severe ulcerative colitis in adult patients who have had an inadequate response to conventional therapy or who are intolerant to or have medical contraindications for such therapies. Patients should show a clinical response within 8 weeks of treatment to continue treatment beyond that time. (see 5.1 Pharmacodynamic properties - clinical trials).

Psoriasis in Adults and Children

Hulio is indicated for the treatment of moderate to severe chronic plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy.

Hulio is indicated for the treatment of severe chronic plaque psoriasis in children and adolescent patients from 4 years of age who have had an inadequate response to or are inappropriate candidates for topical therapy and phototherapy.

Hidradenitis Suppurativa in Adults and Adolescents (from 12 years of age)

Hulio is indicated for the treatment of active moderate to severe hidradenitis suppurativa (acne inversa) in patients with an inadequate response to conventional systemic hidradenitis suppurativa therapy.

Uveitis

Hulio is indicated for the treatment of non-infectious intermediate, posterior and pan-uveitis in adult patients who have had an inadequate response to corticosteroids, in patients in need of corticosteroid sparing, or in whom corticosteroid treatment is inappropriate.

What is this medicine and how does it work
Hulio (adalimumab) is a biosimilar medicine to Humira.Adalimumab binds to tumor necrosis factor (TNF) and neutralises the biological function of TNF by blocking its interaction with the p55 and p75 cell surface TNF receptors. TNF is a naturally occurring cytokine that is involved in normal inflammatory and immune responses. Elevated levels of TNF are found in the synovial fluid of rheumatoid arthritis (RA), including juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients and play an important role in both the pathologic inflammation and the joint destruction that are hallmarks of these diseases. Increased levels of TNF are also found in psoriasis (Ps) plaques, which contribute to the inflammatory response, to the proliferation and decreased maturation of keratinocytes and to the associated vascular damages that are characteristic of the disease.Adalimumab also modulates biological responses that are induced or regulated by TNF, including changes in the levels of adhesion molecules responsible for leukocyte migration (endothelial leucocyte adhesion molecule (ELAM)-1, vascular cell adhesion molecule (VCAM)-1, and intercellular adhesion molecule (ICAM)-1 with a half maximal inhibitory concentration (IC50) of 1-2 x 10-10 M).
What post-market commitments will the sponsor undertake
  • The Hulio European Union (EU)-risk management plan (RMP) (version 3.2, dated 6 August 2020, data lock point 24 December 2019), with Australian-specific Annex (version 3.0, dated 22 February 2021), included with submission PM 2020 01807 1 3, and any subsequent revisions, as agreed with the TGA will be implemented in Australia.

    An obligatory component of risk management plans is routine pharmacovigilance. Routine pharmacovigilance includes the submission of periodic safety update reports (PSURs).

    Reports are to be provided in line with the current published list of EU reference dates and frequency of submission of PSURs until the period covered by such reports is not less than three years from the date of the approval letter.

    The reports are to at least meet the requirements for PSURs as described in the European Medicines Agency's Guideline on Good Pharmacovigilance Practices (GVP) Module VII-periodic safety update report (Rev 1), Part VII.B Structures and processes. Note that submission of a PSUR does not constitute an application to vary the registration.

  • All batches of Hulio supplied in Australia must comply with the product details and specifications approved during evaluation and detailed in the Certified Product Details (CPD).

    When requested by the TGA, the sponsor should be prepared to provide product samples, specified reference materials and documentary evidence to enable the TGA to conduct laboratory testing on the Product. Outcomes of laboratory testing are published biannually in the TGA Database of Laboratory Testing Results, and periodically in testing reports on the TGA website.

    Certified Product Details

    The CPD, as described in Guidance 7: Certified product details of the australian regulatory guidelines for prescription medicines (ARGPM), in PDF format, for the above products should be provided upon registration of these therapeutic goods. In addition, an updated CPD should be provided when changes to finished product specifications and test methods are approved in a Category 3 application or notified through a self-assessable change.

    The CPD should be emailed to biochemistry.testing@health.gov.au as a single PDF document.

  • For all Hulio products, either:
    1. a 'pack insert' (being an abbreviated version of the TGA-approved Hulio Product Information (PI)) in a format acceptable to the TGA, or
    2. the approved Product Information, must be included with the products as a package insert.

    Where a 'pack insert' is provided as a package insert, there is a continuing obligation on the sponsor to ensure that the content is consistent with the PI.

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