Prescription Drug Information: KYNMOBI (Page 4 of 4)
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenesis
Lifetime carcinogenicity studies of apomorphine were conducted in male (0.1, 0.3, or 0.8 mg/kg/day) and female (0.3, 0.8, or 2 mg/kg/day) rats. Apomorphine was administered by subcutaneous injection for 22 months or 23 months, respectively. In males, there was an increase in Leydig cell tumors at the highest dose tested. This finding is of questionable significance because the endocrine mechanisms believed to be involved in the production of Leydig cell tumors in rats are not relevant to humans. No drug-related tumors were observed in females.
In a 26-week carcinogenicity study in P53-knockout transgenic mice, there was no evidence of carcinogenic potential when apomorphine was administered by subcutaneous injection at doses up to 20 mg/kg/day (male) or 40 mg/kg/day (female).
Mutagenesis
Apomorphine was mutagenic in the in vitro bacterial reverse mutation (Ames) and the in vitro mouse lymphoma tk assays. Apomorphine was clastogenic in the in vitro chromosomal aberration assay in human lymphocytes and in the in vitro mouse lymphoma tk assay. Apomorphine was negative in the in vivo micronucleus assay in mice.
Impairment of Fertility
Apomorphine was administered subcutaneously at doses up to 3 mg/kg/day to male and female rats prior to and throughout the mating period and continuing in females through gestation day 6. There was no evidence of adverse effects on fertility or on early fetal viability. A significant decrease in testis weight was observed in a 39-week study in cynomolgus monkey at all subcutaneous doses tested (0.3, 1, or 1.5 mg/kg/day).
In a published fertility study, apomorphine was administered to male rats at subcutaneous doses of 0.2, 0.8, or 2 mg/kg prior to and throughout the mating period. Fertility was reduced at the highest dose tested.
14 CLINICAL STUDIES
The efficacy of KYNMOBI for the acute, intermittent treatment of “off” episodes in patients with Parkinson’s disease was established in one randomized, double-blind, placebo-controlled, parallel-group study (Study 1; NCT02469090).
The study enrolled patients with a mean duration of Parkinson’s disease of approximately 9 years (range: 2 years to 22 years) who were Hoehn and Yahr Stage III or less in the “on” state, and who were all receiving concomitant levodopa with a stable dose for at least 4 weeks before screening. The most commonly used concomitant Parkinson’s disease medications in addition to levodopa were oral dopaminergic agonists (51%), monoamine oxidase B inhibitors (41%), amantadine derivatives (21%), and other dopaminergic agents (8%).
At baseline, the mean number of daily “off” episodes was 4 and the mean duration of “off” episodes was slightly over an hour in both groups. The study included a titration phase and a 12-week maintenance phase. Patients were titrated to the dose that achieved a full “on” response and was tolerated during the titration phase. Patients were treated with an oral antiemetic starting 3 days before the titration phase. In the titration phase, patients (N=141) arrived at the study site in an “off” state having not taken their regular morning dose of carbidopa/levodopa or any other adjunctive PD medications, as well as having taken their last dose of carbidopa/levodopa and any other adjunctive PD medications no later than midnight the night before. Treatment was initiated in the clinic with a 10 mg dose of KYNMOBI. If the patient responded to treatment and tolerated the 10 mg KYNMOBI dose, the patient was randomized in a blinded fashion to KYNMOBI or placebo in a 1:1 ratio. If the patient tolerated the dose but did not adequately respond, the patient was asked to return to the clinic within 3 days and the dose was increased by 5 mg. The titration process was continued up to a maximum KYNMOBI dose of 35 mg or until a full “on” was achieved as determined by the investigator and the patient [see Dosage and Administration (2.2)]. Dose administration was permitted up to 5 times per day in the maintenance phase. The Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, Part III (MDS-UPDRS III) (motor examination) was measured predose, and at 15, 30, 45, 60, and 90 minutes postdose.
The primary endpoint of the study was the mean change from predose to 30 minutes postdose in the MDS-UPDRS III at the 12-week visit of the maintenance phase.
A total of 54 patients were randomized to KYNMOBI and 55 patients to placebo. The KYNMOBI treatment group showed a least-square mean improvement (i.e., reduction in score) of -11.1 points (95% CI: -14.0, -8.2), versus -3.5 points for the placebo group (95% CI: -6.1, -0.9). The least-square mean treatment difference between KYNMOBI and placebo was -7.6 (95% CI: -11.5, -3.7; p = 0.0002) (Table 2).
Treatment | Number of Patients at Week 12 | Observed Predose MDS-UPDRS III Score at Week 12 | Least-Square Mean Change from Predose to 30 Minutes Postdose | Least-Square Mean Difference from placebo |
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Placebo | 46 | 42.2 | – 3.5 | N/A |
KYNMOBI | 34 | 37.2 | – 11.1 | – 7.6 (p=0.0002) |
Figure 2 describes the least-square mean change from predose in MDS-UPDRS Part III Motor Scores after administration of KYNMOBI versus placebo at week 12.
Figure 2: Estimated Least-Square Mean Change in MDS-UPDRS Part III Motor Score After Administration of KYNMOBI vs Placebo (at Week 12) in Study 1
16 HOW SUPPLIED/STORAGE AND HANDLING
16.1 How Supplied
KYNMOBI sublingual film is a blue to green rectangular film with a white printed number identifying the strength (e.g., “10” is 10 mg). Each sublingual film is individually packaged in a sealed foil pouch. Films are supplied in the following strengths and package configurations (Table 3):
Single Film Strength (NDC Code) | Package Configuration | NDC Code |
---|---|---|
Trade Titration Kit | ||
10 mg (63402-010-01)15 mg (63402-015-01)20 mg (63402-020-01)25 mg (63402-025-01)30 mg (63402-030-01) | Each titration kit carton will contain a total of 10 individually packaged films of:2 – single 10 mg films2 – single 15 mg films2 – single 20 mg films2 – single 25 mg films2 – single 30 mg films | 63402-088-10 |
Trade Product | ||
10 mg (63402-010-01) | 30 films per carton | 63402-010-30 |
15 mg (63402-015-01) | 30 films per carton | 63402-015-30 |
20 mg (63402-020-01) | 30 films per carton | 63402-020-30 |
25 mg (63402-025-01) | 30 films per carton | 63402-025-30 |
30 mg (63402-030-01) | 30 films per carton | 63402-030-30 |
16.2 Storage and Handling
Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP controlled room temperature].
Keep KYNMOBI in the foil pouch until ready to use.
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use).
Administration of KYNMOBI
Advise patients that KYNMOBI is for sublingual use only [see Dosage and Administration (2.1)].
KYNMOBI must be administered whole. Advise patients not to cut, chew, or swallow KYNMOBI.
Nausea and Vomiting
Advise patients that KYNMOBI may cause nausea and vomiting when it is administered at recommended doses. Treatment with an antiemetic (e.g., trimethobenzamide) may be used, as needed, if nausea or vomiting occurs. Inform patients that they should discuss with their healthcare provider when the antiemetic can be discontinued [see Warnings and Precautions (5.1)].
Falling Asleep During Activities of Daily Living and Somnolence
Alert patients to the potential sedating effects of KYNMOBI, including somnolence and falling asleep while engaged in activities of daily living. Instruct patients not to drive a car or engage in other potentially dangerous activities until they have gained sufficient experience with KYNMOBI to gauge whether or not it affects their mental and/or motor performance adversely. Advise patients that if increased somnolence or episodes of falling asleep during activities of daily living (e.g., watching television, passenger in a car, etc.) occur, they should not drive or participate in potentially dangerous activities until they have discussed this with their healthcare provider. Because of possible additive effects of alcohol use, advise patients to limit their alcohol intake [see Warnings and Precautions (5.2)].
Hypersensitivity/Allergic Reactions
Advise patients that hypersensitivity/allergic reaction (e.g., swelling of the lips, tongue and mouth, flushing, and, infrequently, urticaria and throat tightness) may occur because of apomorphine, sodium metabisulfite, or any KYNMOBI excipients. Inform patients with a sulfite sensitivity that KYNMOBI contains sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes [see Warnings and Precautions (5.3)]. Advise patients who experience any hypersensitivity/allergic reaction to KYNMOBI that they should avoid taking KYNMOBI again [see Contraindications (4)].
Hypotension/Orthostatic Hypotension
Advise patients that they may develop postural (orthostatic) hypotension with or without symptoms, such as dizziness, nausea, syncope, and sweating. Instruct patients to rise slowly after sitting or lying down after taking KYNMOBI. Instruct patients to limit their alcohol intake because it may potentiate the hypotensive effect of KYNMOBI. Instruct patients to lie down before and after taking sublingual nitroglycerin because it may potentiate the hypotensive effect of KYNMOBI [see Warnings and Precautions (5.4)].
Oral Mucosal Irritation
Inform patients that KYNMOBI may result in oral mucosal adverse reactions such as irritation, erythema, lip swelling, mouth ulceration, dry mouth, stomatitis, glossodynia, oropharyngeal pain, swollen tongue, ageusia, oral pain, lip ulceration, oral disorder and hypoaesthesia oral [see Warnings and Precautions (5.5) and Adverse Reactions (6.1)].
Falls
Alert patients that they may have increased risk for falling when using KYNMOBI [see Warnings and Precautions (5.6)].
Hallucinations and/or Psychotic-Like Behavior
Inform patients that KYNMOBI may cause hallucinations or other manifestations of psychotic-like behavior. Advise patients to inform their healthcare provider if they have a major psychotic disorder or are taking any treatments for psychosis [see Warnings and Precautions (5.7)].
Hemolytic Anemia
Inform patients and caregivers that hemolytic anemia may occur and to contact their healthcare provider if they develop any signs or symptoms [see Warnings and Precautions (5.8)].
Impulse Control/Compulsive Behaviors
Patients and their caregivers should be alerted to the possibility that they may experience intense urges to spend money uncontrollably, intense urges to gamble, increased sexual urges, binge eating and/or other intense urges and the inability to control these urges while taking KYNMOBI [see Warnings and Precautions (5.9)].
Withdrawal-Emergent Hyperpyrexia and Confusion
Advise patients to contact their healthcare provider if they wish to discontinue KYNMOBI or decrease the dose of KYNMOBI [see Warnings and Precautions (5.10)].
QTc Prolongation and Potential for Proarrhythmic Effects
Alert patients that KYNMOBI may cause QTc prolongation and might produce proarrhythmic effects that could cause torsades de pointes and sudden death. Palpitations and syncope may signal the occurrence of an episode of torsades de pointes [see Warnings and Precautions (5.11)].
Priapism
Advise patients that KYNMOBI may cause prolonged painful erections and that if this occurs that they should seek medical attention immediately [ see Warnings and Precautions (5.13)].
Manufactured for:
Sunovion Pharmaceuticals Inc.
Marlborough, Massachusetts 01752 USA
KYNMOBI and are registered trademarks of Sunovion Pharmaceuticals Inc.
SUNOVION and are registered trademarks of Sumitomo Pharma Co., Ltd.
Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Pharma Co., Ltd.
© 2022 Sunovion Pharmaceuticals Inc. All rights reserved.For more information, go to www.KYNMOBI.com or call Sunovion Customer Service at 1-888-394-7377.
10413-03
INSTRUCTIONS FOR USE KYNMOBI TM (kin-moe′-bee) (apomorphine hydrochloride)Sublingual Film | |
Read this Instructions for Use before you start taking KYNMOBI and each time you get a refill. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or treatment. | |
Important
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How to store KYNMOBI | |
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How KYNMOBI is packaged Inside each child-resistant carton is a plastic tray with a pull-out handle that holds the sealed pouches of KYNMOBI sublingual film (see Figure A). Each KYNMOBI sublingual film comes in a sealed foil pouch (see Figure B). | |
Figure B | ![]() |
ATTENTION: Read the Instructions for Use on the other side of this leaflet. | |
INSTRUCTIONS FOR USE | |||||||
Instructions on How to Use the Child-Resistant Carton | |||||||
STEP 1 Open CartonOpen carton from the end with the arrow. Push in both tabs to unlock. Hold tabs in. (See Figure C.)Lift up tray handle. Pull out tray (see Figure D). | STEP 2 Remove PouchPush finger up through the hole in the bottom of tray. (See Figure E.)Firmly pull one (1) pouch from the tray (see Figure F). | STEP 3 Close CartonTo close, slide tray in until it clicks. (See Figure G.)This ensures the carton remains child resistant (see Figure H). | |||||
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Figure C | Figure E | Figure G | |||||
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Figure D | Figure F | Figure H | |||||
Instructions for Taking KYNMOBI | |||||||
Step 4
| Step 5 Drink water. Before taking each KYNMOBI, drink water to moisten your mouth. This helps the film dissolve more easily (see Figure I). | Step 6 Open the KYNMOBI foil pouch. Hold the wing tabs on the pouch between your thumb and pointer finger of each hand. Make sure to place your fingers directly on the raised dots on each wing tab.Gently pull the wing tabs apart to open the pouch (see Figure J). | Step 7 Take KYNMOBI out of the pouch. Hold KYNMOBI between your fingers by the outside edges and remove the entire KYNMOBI from the pouch (see Figure K).KYNMOBI must be taken whole. Throw away KYNMOBI if it is broken or missing pieces. Use a new KYNMOBI for your dose. | ||||
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Step 8 Place entire KYNMOBI under your tongue. Place KYNMOBI as far back under your tongue as you can (see Figure L).Close your mouth. | Step 9 Keep KYNMOBI in place until it has completely dissolved (see Figure M).
| Step 10 Open your mouth to check if KYNMOBI has completely dissolved. It can take about 3 minutes for KYNMOBI to dissolve.After the film completely dissolves, you may swallow. | |||||
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For assistance with the KYNMOBI child-resistant carton, please ask your care partner for help.You may also contact your doctor or Sunovion Customer Service at 1-888-394-7377 with questions or for support.This Instructions for Use has been approved by the U.S. Food and Drug Administration. | |||||||
Manufactured for Sunovion Pharmaceuticals Inc. Marlborough, Massachusetts 01752 USA.KYNMOBI and | |||||||
(See reverse side for additional information) |
PRINCIPAL DISPLAY PANEL – TRADE POUCH LABEL – 10 mg
NDC 63402-010-01 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
10 mg
For Sublingual Use Only
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE POUCH LABEL – 15 mg
NDC 63402-015-01 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
15 mg
For Sublingual Use Only
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE POUCH LABEL – 20 mg
NDC 63402-020-01 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
20 mg
For Sublingual Use Only
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE POUCH LABEL – 25 mg
NDC 63402-025-01 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
25 mg
For Sublingual Use Only
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE POUCH LABEL – 30 mg
NDC 63402-030-01 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
30 mg
For Sublingual Use Only
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE CARTON – 10 mg
NDC 63402-010-30 30 pouches each containing 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
10 mg
For Sublingual Use Only
ATTENTION DISPENSER:
Each time KYNMOBI is dispensed give the patient the Instructions for Use, also provided at www.kynmobi.com/cr-ifu.pdf
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE CARTON – 15 mg
NDC 63402-015-30 30 pouches each containing 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
15 mg
For Sublingual Use Only
ATTENTION DISPENSER:
Each time KYNMOBI is dispensed give the patient the Instructions for Use, also provided at www.kynmobi.com/cr-ifu.pdf
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE CARTON – 20 mg
NDC 63402-020-30 30 pouches each containing 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
20 mg
For Sublingual Use Only
ATTENTION DISPENSER:
Each time KYNMOBI is dispensed give the patient the Instructions for Use, also provided at www.kynmobi.com/cr-ifu.pdf
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE CARTON – 25 mg
NDC 63402-025-30 30 pouches each containing 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
25 mg
For Sublingual Use Only
ATTENTION DISPENSER:
Each time KYNMOBI is dispensed give the patient the Instructions for Use, also provided at www.kynmobi.com/cr-ifu.pdf
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE CARTON – 30 mg
NDC 63402-030-30 30 pouches each containing 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
30 mg
For Sublingual Use Only
ATTENTION DISPENSER:
Each time KYNMOBI is dispensed give the patient the Instructions for Use, also provided at www.kynmobi.com/cr-ifu.pdf
Rx only
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE OUTER TITRATION CARTON – 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
NDC 63402-088-10 10 pouches each containing 1 sublingual film
KYNMOBI™
(apomorphine HCl) sublingual film
10 mg 15 mg 20 mg 25 mg 30 mg
For Sublingual Use Only
Rx only
READ THE INSTRUCTIONS INSIDE THE TOP PANEL AND READ THE COMPLETE INSTRUCTIONS FOR USE BEFORE TAKING KYNMOBITM
SUNOVION
PRINCIPAL DISPLAY PANEL – TRADE OUTER TITRATION CARTON – 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
NDC 63402-188-10 10 pouches each containing 1 sublingual film
PROFESSIONAL SAMPLE – NOT FOR SALE OR REIMBURSEMENT
KYNMOBI™
(apomorphine HCl) sublingual film
10 mg 15 mg 20 mg 25 mg 30 mg
For Sublingual Use Only
Rx only
READ THE INSTRUCTIONS INSIDE THE TOP PANEL AND READ THE COMPLETE INSTRUCTIONS FOR USE BEFORE TAKING KYNMOBITM.
CONTENTS OF THIS KIT:
KYNMOBI 10 mg: 2 pouches, each containing 1 sublingual film
KYNMOBI 15 mg: 2 pouches, each containing 1 sublingual film
KYNMOBI 20 mg: 2 pouches, each containing 1 sublingual film
KYNMOBI 25 mg: 2 pouches, each containing 1 sublingual filmKYNMOBI 30 mg: 2 pouches, each containing 1 sublingual film
SUNOVION
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Labeler — Sunovion Pharmaceuticals Inc. (131661746) |
Revised: 05/2022 Sunovion Pharmaceuticals Inc.
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