golodirsen
General
Genetic Implications:
Pronunciation:
goe-loe-dir-sen
Trade Name(s)
- Vyondys 53
Ther. Class.
none assigned
Pharm. Class.
antisense oligonucleotides
Indications
Duchenne muscular dystrophy (DMD) in patients who have a confirmed mutation of the DMD gene that is amenable to exon 53 skipping.
Action
Binds to exon 51 of dystrophin pre-messenger RNA (mRNA), resulting in exclusion of this exon during mRNA processing. Exon skipping allows for production of an internally truncated dystrophin protein.
Therapeutic Effect(s):
Increased dystrophin production.
Pharmacokinetics
Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed to extravascular tissues.
Metabolism and Excretion: Not hepatically metabolized. Primarily excreted unchanged in urine.
Half-life: 3.4 hr.
TIME/ACTION PROFILE (plasma concentrations)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | unknown | unknown | unknown |
Contraindication/Precautions
Contraindicated in:
- Hypersensitivity.
Use Cautiously in:
- Renal impairment;
- OB: Safety not established in pregnancy;
- Lactation: Safety not established in breastfeeding.
Adverse Reactions/Side Effects
CV: tachycardia
EENT: nasopharyngitis
GI: abdominal pain, nausea, vomiting, constipation, diarrhea
GU: nephrotoxicity
Local: injection site pain
MS: back pain
Neuro: headache, dizziness
Resp: cough
Misc: falls, fever, HYPERSENSITIVITY REACTIONS (including anaphylaxis)
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
Interactions
Drug-Drug
None reported.
Route/Dosage
IV (Adults and Children): 30 mg/kg once weekly.
Availability
Solution for injection: 50 mg/mL
Assessment
- Monitor for signs and symptoms of hypersensitivity reactions (rash, fever, pruritus, urticaria, dermatitis, skin exfoliation) during infusion. If hypersensitivity reaction occurs, consider slowing infusion rate or interrupting therapy. Treat symptomatically.
Lab Test Considerations:
Assess serum cystatin C, urine dipstick, and urine protein-to-creatinine ratio before starting therapy. Monitor GFR by 24-hr urine collection before starting and periodically during therapy; serum creatinine may not be a reliable measure due to ↓ muscle mass. Monitor for proteinuria by dipstick urinalysis monthly. Monitor serum cystatin C and urine protein-to-creatinine ratio every 3 mo. Use urine obtained on the day of infusion prior to infusion or urine obtained at least 48 hr after most recent infusion. If proteinuria or persistent elevated serum cystatin C occurs, refer to pediatric nephrologist for further evaluation.
Implementation
- May apply topical anesthetic cream to infusion site before infusion.
- Intermittent Infusion: Allow vials to warm to room temperature. Mix contents of each vial by inverting gently 2–3 times; do not shake. Solution is clear to slightly opalescent, colorless, and may contain trace amounts of small, white to off-white amorphous particles; do not administer solutions that are cloudy, discolored, or contain additional particulate matter. Withdraw volume required from each vial with 21-gauge or smaller needle. Dilution: 0.9% NaCl for total volume of 100–150 mL. Gently invert 2–3 times to mix; do not shake. Solution is stable for 4 hr at room temperature including infusion time or 24 hr if refrigerated. Do not freeze. Discard unused solution.
- Rate: Infuse over 35–60 min via an in-line 0.2-micron filter. Flush line with 0.9% NaCl before and after infusion.
- Y-Site Incompatibility: Do not administer with or mix with other medications.
Patient/Family Teaching
- Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
- Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests will be needed. Emphasize importance of regular lab tests to monitor for renal toxicity.
- Advise patient to notify health care professional immediately if signs and symptoms of hypersensitivity reactions occur (rash, hives, fever, itchiness, skin peeling).
- Rep: Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Evaluation/Desired Outcomes
Increased dystrophin production.