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Trientine-Reddy's, Trientine-RZ, Trientine Dr.Reddy's and Trientine-DRLA

ARTGs
329314, 329315, 329316, 329317
329314, 329315, 329316, 329317
329314, 329315, 329316, 329317
329314, 329315, 329316, 329317
Device/Product name
Trientine-Reddy's, Trientine-RZ, Trientine Dr.Reddy's and Trientine-DRLA
Active Ingredient
Trientine dihydrochloride
Date of decision
Published
Submission type
New chemical entity
ATC codes
Not yet assigned
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 Trientine-Reddy's, Trientine-RZ, Trientine Dr.Reddy's and Trientine-DRLA 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
Designation (Orphan) 9 October 2019
Submission dossier accepted and first round evaluation commenced 31 March 2020
First round evaluation completed
Sponsor provides responses on questions raised in first round evaluation 2 September 2020
Second round evaluation completed 15 December 2020
Delegate's overall benefit-risk assessment 14 January 2021
Sponsor's pre-Advisory Committee response Not applicable
Advisory Committee meeting Not applicable
Registration decision (Outcome) 15 February 2021
Completion of administrative activities and registration on ARTG 29 March 2021
Number of working days from submission dossier acceptance to registration decision* 160

*Statutory timeframe for standard applications is 255 working days

Date of entry onto ARTG
Original publication date
Black triangle scheme
Yes. This product will remain in the scheme for 5 years, starting on the date the product is first supplied in Australia.
Dose forms
Capsule
Strength
250 mg
Other ingredients
Colloidal silicon dioxide, ferric oxide yellow, gelatin, magnesium stearate, polyethylene glycol, titanium dioxide and purified water as inactive ingredients. The imprinting ink (TekPrint SW-9008 black ink) contains black iron oxide, potassium hydroxide, propylene glycol and shellac
Containers
Bottle
Pack sizes
100
Routes of administration
Oral
Dosage

The doses are expressed in terms of trientine dihydrochloride and the equivalent dose of trientine free base. It should be noted that a dose of 250 mg trientine dihydrochloride corresponds to a dose of 167 mg trientine free base. This should be considered if a patient is transferred from one trientine formulation to another.

Children > 5 years

500 to 750 mg trientine dihydrochloride /day (2 to 3 capsules) given in divided doses two or three times daily. This may be increased to a maximum of 1500 mg/day for children aged > 5 years. The paediatric dosage in terms of trientine free base is 333 to 500 mg/day to a maximum of 1000 mg/day.

The initial dose for children > 5 years can be expressed on a weight basis as 20 mg/kg body weight trientine dihydrochloride in 2 to 3 divided doses, rounded up to the nearest number of whole capsules

Adults

750 to 1250 mg trientine dihydrochloride /day (3 to 5 capsules) given in divided doses two, three or four times daily. This may be increased to a maximum of 2000 mg/day for adults. The adult dosage in terms of trientine free base is 500 to 833 mg/day to a maximum of 1333 mg/day.

The daily dose of trientine dihydrochloride capsules should be increased only when the clinical response is not adequate or the concentration of free serum copper is persistently above 20 µg/dL (3.1 µmol/L). Optimal long-term maintenance dosage should be determined at 6 to 12 month intervals (see 4.4 special warnings and precautions for use; effects on laboratory tests).

It is important that trientine dihydrochloride capsules be given on an empty stomach, at least one hour before meals or two hours after meals and at least one hour apart from any other drug, food, or milk. The capsules should be swallowed whole with water and should not be opened or chewed.

For further information refer to the Product Information.

Pregnancy category
DDrugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. 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

Trientine-Reddy's, Trientine-RZ, Trientine Dr.Reddy's and Trientine-DRLA (trientine dihydrochloride) was approved for the following therapeutic use:

Trientine dihydrochloride capsules are indicated for the treatment of patients with Wilson's disease who are intolerant of penicillamine.
What is this medicine and how does it work
Wilson's disease (hepatolenticular degeneration) is an autosomal inherited metabolic defect resulting in an inability to maintain a near zero balance of copper. Excess copper accumulates possibly because the liver lacks the mechanism to excrete free copper into the bile. Hepatocytes store excess copper but when their capacity is exceeded copper is released into the blood and is taken up into extrahepatic sites. This condition is treated with a low copper diet and the use of chelating agents that bind copper to facilitate its excretion from the body.[1] Trientine is a copper chelating agent whose principal mechanism of action is to eliminate absorbed copper from the body by forming a stable complex that is then eliminated through urinary excretion. Trientine may also chelate copper in the intestinal tract and so inhibit copper absorption. Footnotes [1] Hedera, P. Wilson's Disease: A Master of Disguise, Parkinsonism Relat Disord, 2019; 59: 140-145.
What post-market commitments will the sponsor undertake
  • Trientine-DRLA, Trientine-RZ, Trientine-Reddy's, Trientine Dr. Reddy's (trientine dihydrochloride) is to be included in the Black Triangle Scheme. The Product Information (PI) and Consumer Medicines Information (CMI) for Trientine-DRLA, Trientine-RZ, Trientine-Reddy's, Trientine Dr. Reddy's must include the black triangle symbol and mandatory accompanying text for five years, which starts from the date that the sponsor notifies the TGA of supply of the product.
  • The trientine dihydrochloride Australian Risk Management Plan (RMP) (version 0.4, dated 22 December 2020, data lock point 31 March 2020), included with submission PM-2020-00155-1-3, 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).

    Unless agreed separately between the supplier who is the recipient of the approval and the TGA, the first report must be submitted to TGA no later than 15 calendar months after the date of this approval letter. The subsequent reports must be submitted no less frequently than annually from the date of the first submitted report until the period covered by such reports is not less than three years from the date of this approval letter. The annual submission may be made up of two PSURs each covering six months. If the sponsor wishes, the six monthly reports may be submitted separately as they become available.

    If the product is approved in the European Union (EU) during the three years period, reports can be provided in line with the published list of EU reference dates no less frequently than annually from the date of the first submitted report until the period covered by such reports is not less than three years from the date of this 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. Each report must have been prepared within ninety calendar days of the data lock point for that report.

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