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Allergan Comments on FDA Requested Class Labeling for Botulinum Toxin Treatments in Connection with Approval of DYSPORT[R].


Proper Education on Toxin Non-Interchangeability Critical to Mitigate Patient Risks

IRVINE, Calif. -- Allergan, Inc. (NYSE NYSE

See: New York Stock Exchange
: AGN AGN Again (Amateur Radio)
AGN Active Galactic Nucleus
AGN Acute Glomerulonephritis
AGN Accountants Global Network
AGN Air Gabon (ICAO code) 
) commented today on Ipsen's and Medicis's joint announcement that the U.S. Food and Drug Administration (FDA FDA
abbr.
Food and Drug Administration


FDA,
n.pr See Food and Drug Administration.

FDA,
n.pr the abbreviation for the Food and Drug Administration.
) has conditioned its approval of DYSPORT([R]) (abobotulinumtoxinA) for the treatment of cervical dystonia cervical dystonia Spasmodic torticollis, see there  and glabellar lines on their commitment to adopt a Risk Evaluation and Mitigation Strategies (REMS) program. The companies report in their news release that one of the purposes of the FDA-mandated REMS is to mitigate the significant risks such as medication errors and overdosing that may result from treating different botulinum toxins as interchangeable. For instance, DYSPORT([R]) is not interchangeable or substitutable for BOTOX([R]) or BOTOX([R]) Cosmetic (collectively, BOTOX([R])). Additionally Ipsen has announced that the FDA has required that the DYSPORT([R]) package insert contain a "boxed warning" regarding the potential spread of DYSPORT([R]) distant from the site of injection, and to address this in their REMS program.

Concurrently with the approval of DYSPORT([R]), the FDA yesterday requested that Allergan consider certain class labeling that we assume is found in the DYSPORT([R]) package insert, including a REMS program.

The proposed boxed warning section provides information regarding reports of spread of botulinum toxins distant from the site of injection, particularly in children treated for spasticity spasticity /spas·tic·i·ty/ (spas-tis´i-te) the state of being spastic; see spastic (2).

spas·tic·i·ty
n.
1. A spastic state or condition.

2. Spastic paralysis.
, an unapproved un·ap·proved  
adj.
Not approved or sanctioned: an unapproved vaccine; an unapproved protest march. 
 indication, who have underlying conditions that would predispose pre·dis·pose
v.
To make susceptible, as to a disease.
 them to these symptoms. The class labeling also notes that the risk exists for adults treated for spasticity or other conditions who have an underlying disease that would predispose them to these symptoms. The proposed label update specifically notes that individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis amyotrophic lateral sclerosis (ALS) (ā'mīətrōf`ik, sklĭrō`sĭs) or motor neuron disease, , or neuromuscular junction disorders such as myasthenia gravis myasthenia gravis (mīəsthē`nēə grä`vĭs), chronic disorder of the muscles characterized by weakness and a tendency to tire easily.  or Lambert-Eaton syndrome should be monitored particularly closely when treated with a botulinum toxin product.

Additionally, the FDA has proposed language to address the safety risks associated with interchanging different botulinum toxins. BOTOX([R]), for instance, is a trademark for a unique biologic product manufactured and distributed by Allergan. Its molecular weight, formulation, safety margin and efficacy profile are specific to BOTOX([R]) and no other product. In its communication to Allergan, the FDA suggested that it has received reports of overdosing associated with inappropriate interchanging of botulinum toxins. Accordingly, the FDA has proposed new language about the lack of interchangeability between botulinum toxin products and specifically that "units of biological activity of BOTOX/BOTOX Cosmetic cannot be compared to or converted into units of any other botulinum toxin products...." In connection with this, the FDA has requested a communication plan regarding "information pertaining to the lack of interchangeability of BOTOX/BOTOX Cosmetic (botulinum toxin type A botulinum toxin type A

Botox, Botox Cosmetic, Dysport (UK), Vistabel (UK)

Pharmacologic class: Neurotoxin

Therapeutic class: Neuromuscular blocker

Pregnancy risk category C

Action

) with other licensed botulinum toxins."

The FDA has also requested that Allergan accept the same boxed warning required of the DYSPORT([R]) label. BOTOX([R]) has been marketed in the United States for nearly 20 years, its safety and efficacy profile are well understood, and reports of suspected distant spread have been rare. Allergan, however, recognizes the increased prevalence of boxed warnings in recent years as a method of highlighting safety information. For instance, in the past 12 months the FDA required more than 50 new or revised black box warnings for marketed pharmaceuticals. Likewise, Allergan recognizes that this boxed warning is proposed as a class labeling requirement and understands that incident rates for other botulinum toxins must be considered in determining the appropriateness of a boxed warning section.

"With the approval of another botulinum toxin, the FDA's request for updated class safety labeling and the reinforcement of non-interchangeability is timely and responsible," said Dr. Sef Kurstjens, Allergan's Chief Medical Officer. "Our patients are our first priority and as the world's leader in the development of botulinum toxin we support efforts to responsibly educate patients and healthcare practitioners about important safety considerations when evaluating such treatments as no two botulinum toxins are alike. Better education enhances the risk/benefit profile of products and enhances patient outcomes and satisfaction. Accordingly, we will work with the FDA to update the safety labeling for BOTOX([R]) and develop an appropriate REMS program."

For nearly 20 years, physicians and patients have come to rely on the well understood and trusted risk-benefit profile of BOTOX([R]), which has been established in approximately 50 randomized ran·dom·ize  
tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es
To make random in arrangement, especially in order to control the variables in an experiment.
, placebo-controlled clinical trials(i) and in approximately 11,000 patients treated with BOTOX([R]) and BOTOX([R]) Cosmetic in Allergan's clinical trials.(ii) BOTOX([R]) is the only neurotoxin neurotoxin /neu·ro·tox·in/ (noor´o-tok?sin) a substance that is poisonous or destructive to nerve tissue.

neu·ro·tox·in
n.
See neurolysin.
 worldwide approved for 21 different indications across approximately 80 countries. BOTOX([R]) Cosmetic, first approved in the United States in 2002, has been the most popular physician-administered aesthetic injectable treatment for the past seven years and has since received approvals in more than 60 countries worldwide, marketed under different trade names. Approximately 22 million vials of BOTOX([R]) and BOTOX([R]) Cosmetic have been distributed worldwide since the product was first approved and nearly 17 million treatment sessions have been recorded with BOTOX([R]) and BOTOX([R]) Cosmetic in the United States alone over the past 14 years (1994-2008).(iii)With approximately 2,000 articles on BOTOX([R]) and BOTOX([R]) Cosmetic in peer-reviewed publications,(iv) the product is one of the most widely researched medicines in the world.

Important BOTOX([R]) and BOTOX([R]) Cosmetic (Botulinum Toxin Type A) Information

BOTOX([R]) is indicated for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and neck pain associated with cervical dystonia.

BOTOX([R]) is also indicated for the treatment of strabismus strabismus (strəbĭz`məs), inability of the eyes to focus together because of an imbalance in the muscles that control eye movement; also called squint.  and blepharospasm bleph·a·ro·spasm
n.
Spasmodic winking caused by the involuntary contraction of an eyelid muscle.



blepharospasm

spasm of the orbicularis oculi muscle of the eyelid.
 associated with dystonia dystonia /dys·to·nia/ (-to´ne-ah) dyskinetic movements due to disordered tonicity of muscle.dyston´ic

dystonia musculo´rum defor´mans
, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and above.

The efficacy of BOTOX([R]) treatment in deviations over 50 prism diopters, in restrictive strabismus, in Duane's syndrome with lateral rectus rectus /rec·tus/ (rek´tus) [L.] straight.

rectus

[L.] straight.


rectus abdominis muscle
see Table 13.2.

ocular rectus muscle
see Table 13.1F.
 weakness, and in secondary strabismus caused by prior surgical over-recession of the antagonist has not been established. BOTOX([R]) is ineffective in chronic paralytic paralytic /par·a·lyt·ic/ (par?ah-lit´ik)
1. affected with or pertaining to paralysis.

2. a person affected with paralysis.


par·a·lyt·ic
adj.
1.
 strabismus except when used in conjunction with surgical repair to reduce antagonist contracture contracture /con·trac·ture/ (-cher) abnormal shortening of muscle tissue, rendering the muscle highly resistant to passive stretching. .

And BOTOX([R]) is indicated for the treatment of severe primary axillary ax·il·lar·y
n.
Relating to the axilla.


Axillary
Located in or near the armpit.

Mentioned in: Mastectomy


axillary

of or pertaining to the armpit.
 hyperhidrosis that is inadequately managed with topical agents.

BOTOX([R]) Cosmetic is approved for the temporary treatment of moderate to severe frown lines between the brows in people ages 18-65.

Important BOTOX([R]) and BOTOX([R]) Cosmetic (Botulinum Toxin Type A) Safety Information

BOTOX([R])and BOTOX([R]) Cosmetic treatment should not be injected in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity hypersensitivity, heightened response in a body tissue to an antigen or foreign substance. The body normally responds to an antigen by producing specific antibodies against it. The antibodies impart immunity for any later exposure to that antigen.  to any ingredient in the formulation.

Serious heart problems and serious allergic reactions have been reported rarely. If you think you're having an allergic reaction or other unusual symptoms, such as difficulty swallowing, speaking or breathing, call your doctor immediately. Individuals with peripheral motor neuropathic diseases (e.g., amyotrophic lateral sclerosis, or motor neuropathy) or neuromuscular junctional disorders (e.g., myasthenia gravis or Lambert-Eaton syndrome) should only receive BOTOX([R])or BOTOX([R])Cosmetic with caution. Patients with neuromuscular disorders may be at increased risk of clinically significant systemic side effects with BOTOX([R])or BOTOX([R])Cosmetic. For full prescribing information, please visit www.botox.com and www.botoxcosmetic.com.

BOTOX([R])for Blepharospasm in Patients 12 Years of Age: Reduced blinking from BOTOX([R])injection of the orbicularis muscle can lead to corneal corneal

pertaining to the cornea. See also keratitis, keratopathy.


corneal anomaly
includes microcornea, coloboma, megalocornea, dermoid, congenital opacity.

corneal black body
see corneal sequestrum (below).
 exposure, persistent epithelial defect and corneal perforation per·fo·ra·tion
n.
1. The act of perforating or the state of being perforated.

2. An abnormal opening in a hollow organ or viscus, as one made by rupture or injury.


Perforation
A hole.
. The most frequently reported treatment-related adverse reactions in these patients are ptosis Ptosis Definition

Ptosis is the term used for a drooping upper eyelid. Ptosis, also called blepharoptosis, can affect one or both eyes.
Description

The eyelids serve to protect and lubricate the outer eye.
 (20.8%), superficial punctate keratitis (6.3%) and eye dryness (6.3%).

BOTOX([R])for Strabismus in Patients 12 Years of Age: Inducing paralysis in one or more extraocular muscles may produce spatial disorientation, double vision or past pointing. The most commonly reported adverse effects are ptosis (16%) and vertical deviation (17%).

BOTOX([R])for Cervical Dystonia in Adults: There have been rare cases of dysphagia dysphagia /dys·pha·gia/ (-fa´jah) difficulty in swallowing.

dys·pha·gia or dys·pha·gy
n.
Difficulty in swallowing or inability to swallow.
 severe enough to warrant the insertion of a gastric feeding tube. The most frequently reported adverse reactions in patients with cervical dystonia are dysphagia (19%), upper respiratory infection Noun 1. upper respiratory infection - infection of the upper respiratory tract
respiratory infection, respiratory tract infection - any infection of the respiratory tract
 (12%), neck pain (11%), and headache (11%).

BOTOX([R])for Severe Primary Axillary Hyperhidrosis Inadequately Managed with Topical Agents: The most frequently reported adverse events (3 - 10%) are injection site pain and hemorrhage, non-axillary sweating, infection, pharyngitis pharyngitis

Inflammation and infection (usually bacterial or viral) of the pharynx. Symptoms include pain (sore throat, worse on swallowing), redness, swollen lymph nodes, and fever.
, flu syndrome, headache, fever, neck or back pain, pruritus pruritus /pru·ri·tus/ (proo-ri´tus) itching.prurit´ic

pruritus a´ni  intense chronic itching in the anal region.

pruritus hiema´lis  xerotic eczema.
, and anxiety.

BOTOX([R])Cosmetic for Temporary Improvement in the Appearance of Moderate to Severe Frown Lines Between the Brows in Adults 18-65: The most common side effects following injection include temporary eyelid eyelid /eye·lid/ (-lid) either of two movable folds (upper and lower) protecting the anterior surface of the eyeball.

eye·lid or eye-lid
n.
 droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness and/or bleeding/bruising may be associated with the injection.

Forward-Looking Statements

This press release contains "forward-looking statements," including statements regarding the safety, effectiveness and adverse events associated with BOTOX([R]). These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or unknown risks or uncertainties materialize, actual results could vary materially from Allergan's expectations and projections. Risks and uncertainties include, among other things, general industry, biologic and pharmaceutical market conditions; technological advances and patents attained by competitors; challenges inherent in the research and development and regulatory processes; inconsistency of treatment results among patients; potential difficulties in manufacturing; and governmental laws and regulations affecting domestic and foreign operations. Additional information concerning these and other risk factors can be found in press releases issued by Allergan, as well as Allergan's public periodic filings with the Securities and Exchange Commission, including the discussion under the heading "Risk Factors" in Allergan's 2008 Form 10-K. Copies of Allergan's press releases and additional information about Allergan is available on the World Wide Web at www.allergan.com or you can contact the Allergan Investor Relations Department by calling 1-714-246-4636.

About Allergan, Inc.

Founded in 1950, Allergan, Inc., with headquarters in Irvine, California, is a multi-specialty health care company that discovers, develops and commercializes innovative pharmaceuticals, biologics and medical devices that enable people to live life to its greatest potential - to see more clearly, move more freely, express themselves more fully. The Company employs approximately 8,000 people worldwide and operates state-of-the-art R&D facilities and world-class manufacturing plants. In addition to its discovery-to-development research organization, Allergan has global marketing and sales capabilities with a presence in more than 100 countries.

([c]) 2009 Allergan, Inc. Irvine, CA 92612. ([R]) and [TM] marks owned by Allergan, Inc.

(i) Allergan data on file, Medical Affairs (ii) Allergan data on file, Medical Affairs (iii) Allergan data on file; global Regulatory Affairs (iv) Allergan data on file; global Literature & Information Services
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Date:Apr 30, 2009
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