FORM DA-1/88

APLICATION FORM FOR THE REGISTRATION OF DRUGS (WHICH ARE INCLUDED AS

MONOGRAPH IN GP/BPC/USP-MF/INT.PH. OR ALREADY INTORDUCED IN BANGLADESH)
________________________________________________________________________

1. NAME OF THE MANUFACTURER : Incepta Pharmaceuticals Ltd.

AND PLACE OF MANUFACTURING : Savar, Dhaka.
________________________________________________________________________

2. MANUFACTURING LICENCE NOS. : a) Biological 108

b) Non-Biological 193
________________________________________________________________________

3. NAME OF THE PREPARATION :

a) Generic Name : Omalizumab

b) Trade/Brand Name : To be submitted during inclusion
________________________________________________________________________

4. PRODUCT DATA SHEET

a) Presentation and Packaging Quantities:

Box contains one vial of lyophilized powder of Omalizumab for injection. Each vial contains
150mg of Omalizumab INN

b) Description:
Asthma
Omalizumab inhibits the binding of IgE to the high-affinity IgE receptor (FcεRI) on the surface
of mast cells and basophils. Reduction in surface-bound IgE on FcεRI-bearing cells limits the
degree of release of mediators of the allergic response. Treatment with Omalizumab also
reduces the number of FcεRI receptors on basophils in atopic patients.
Chronic Idiopathic Urticaria
Omalizumab binds to IgE and lowers free IgE levels. Subsequently, IgE receptors (FcεRI) on
cells down-regulate. The mechanism by which these effects of omalizumab result in an
improvement of CIU symptoms is unknown.

c) Indications and Uses:

Asthma
Omalizumab is indicated for adults and adolescents (12 years of age and above) with
moderate to severe persistent asthma who have a positive skin test or in vitro reactivity to a
perennial aeroallergen and whose symptoms are inadequately controlled with inhaled
corticosteroids.
Omalizumab has been shown to decrease the incidence of asthma exacerbations in these
patients.
Limitations of Use
 Omalizumab is not indicated for the relief of acute bronchospasm or status
asthmaticus.
 Omalizumab is not indicated for treatment of other allergic conditions.
Chronic Idiopathic Urticaria (CIU)
Omalizumab is indicated for the treatment of adults and adolescents (12 years of age and
above) with chronic idiopathic urticaria who remain symptomatic despite H1 antihistamine
treatment.
 Limitation of Use
Omalizumab is not indicated for treatment of other forms of urticaria.

d) Dosage and Administration:

Dosage For Asthma
Administer Omalizumab 150 to 375 mg by subcutaneous injection every 2 or 4 weeks.
Determine doses (mg) and dosing frequency by serum total IgE level (IU/mL), measured
before the start of treatment, and body weight (kg) (see Table 1 and 2).
Adjust doses for significant changes in body weight (see Table 1 and 2).
Total IgE levels are elevated during treatment and remain elevated for up to one year after
the discontinuation of treatment. Therefore, re-testing of IgE levels during Omalizumab
treatment cannot be used as a guide for dose determination.
 Interruptions lasting less than one year: Dose based on serum IgE levels obtained at
the initial dose determination.
 Interruptions lasting one year or more: Re-test total serum IgE levels for dose
determination.
Periodically reassess the need for continued therapy based upon the patient's disease
severity and level of asthma control.
Table 1: Subcutaneous Omalizumab Doses Every 4 Weeks for Patients 12 Years of
Age and Older with Asthma
Pre-treatment Body Weight
Serum IgE 30-60 kg > 60-70 kg > 70-90 kg > 90-150 kg
> 30-100 IU/mL 150 mg 150 mg 150 mg 300 mg
> 100-200 300 mg 300 mg 300 mg  
IU/mL
> 200-300 300 mg  
IU/mL
> 300-400   SEE TABLE 2  
IU/mL
> 400-500  
IU/mL
> 500-600
IU/mL

Table 2: Subcutaneous Omalizumab Doses Every 2 Weeks for Patients 12 Years

of Age and Older with Asthma
Pre-treatment Body Weight
Serum IgE 30-60 kg > 60-70 kg > 70-90 kg > 90-150 kg
> 30-100 IU/mL   SEE TABLE 1  
> 100-200   225 mg
IU/mL
> 200-300   225 mg 225 mg 300 mg
IU/mL
> 300-400 225 mg 225 mg 300 mg
IU/mL
> 400-500 300 mg 300 mg 375mg
IU/mL
> 500-600 300 mg 375 mg DO NOT DOSE
IU/mL
> 600-700 375 mg  
IU/mL
Dosage For Chronic Idiopathic Urticaria
Administer Omalizumab 150 or 300 mg by subcutaneous injection every 4 weeks.
Dosing of Omalizumab in CIU patients is not dependent on serum IgE (free or total) level or
body weight.

The appropriate duration of therapy for CIU has not been evaluated. Periodically reassess the
need for continued therapy.

Reconstitution
The supplied Omalizumab lyophilized powder must be reconstituted with Sterile Water for
Injection (SWFI) USP, using the following instructions:
 Before reconstitution, determine the number of vials that will need to be reconstituted
(each vial delivers 150 mg of Omalizumab) [see above].
 Draw 1.4 mL of SWFI, USP, into a 3 mL syringe equipped with a 1 inch, 18-gauge
needle.
 Place the vial upright on a flat surface and using standard aseptic technique, insert
the needle and inject the SWFI, USP, directly onto the product.
 Keeping the vial upright, gently swirl the upright vial for approximately 1 minute to
evenly wet the powder. Do not shake.
 Gently swirl the vial for 5 to 10 seconds approximately every 5 minutes in order to
dissolve any remaining solids. The lyophilized product takes 15 to 20 minutes to
dissolve. If it takes longer than 20 minutes to dissolve completely, gently swirl the vial
for 5 to 10 seconds approximately every 5 minutes until there are no visible gel-like
particles in the solution. Do not use if the contents of the vial do not dissolve
completely by 40 minutes.
 After reconstitution, Omalizumab solution is somewhat viscous and will appear clear
or slightly opalescent. It is acceptable if there are a few small bubbles or foam around
the edge of the vial; there should be no visible gel-like particles in the reconstituted
solution. Do not use if foreign particles are present.
 Invert the vial for 15 seconds in order to allow the solution to drain toward the
stopper.
 Use the Omalizumab solution within 8 hours following reconstitution when stored in
the vial at 2 to 8°C (36 to 46°F), or within 4 hours of reconstitution when stored at
room temperature. Reconstituted Omalizumab vials should be protected from
sunlight.
 Using a new 3 mL syringe equipped with a 1-inch, 18-gauge needle, insert the needle
into the inverted vial. Position the needle tip at the very bottom of the solution in the
vial stopper when drawing the solution into the syringe. The reconstituted product is
somewhat viscous; in order to obtain the full 1.2 mL dose, all of the product must be
withdrawn from the vial before expelling any air or excess solution from the syringe.
Before removing the needle from the vial, pull the plunger all the way back to the end
of the syringe barrel in order to remove all of the solution from the inverted vial.
 Replace the 18-gauge needle with a 25-gauge needle for subcutaneous injection.
 Expel air, large bubbles, and any excess solution in order to obtain the required 1.2
mL dose. A thin layer of small bubbles may remain at the top of the solution in the
syringe.

Administration
Administer Omalizumab by subcutaneous injection. The injection may take 5-10 seconds to
administer because the solution is slightly viscous. Do not administer more than 150 mg
 (contents of one vial) per injection site. Divide doses of more than 150 mg among two or
more injection sites (Table 3).

Table 3: Number of Injections and Total Injection Volumes

Omalizumab Dose* Number of Injections Total Volume Injected

150 mg 1 1.2 mL
225 mg 2 1.8 mL
300 mg 2 2.4 mL
375 mg 3 3.0 mL
*All doses in the table are approved for use in asthma patients. The 150 mg and 300 mg
Omalizumab doses are intended for use in CIU patients.

e) Contraindications:
The use of Omalizumab is contraindicated in the following: Severe hypersensitivity reaction to
Omalizumab or any ingredient of Omalizumab.

f) Pregnancy and lactation:

Pregnancy

Pregnancy Category B

Pregnancy Exposure Registry

There is a pregnancy exposure registry that monitors pregnancy outcomes in women
exposed to Omalizumab during pregnancy. Encourage patients to call 1-866-4OMALIZUMAB
(1-866-496-5247) or visit www.Omalizumabpregnancyregistry.com for information about the
pregnancy exposure registry and the enrollment procedure.

Risk Summary
Adequate and well-controlled studies with Omalizumab have not been conducted in pregnant
women. All pregnancies, regardless of drug exposure, have a background rate of 2 to 4% for
major malformations, and 15 to 20% for pregnancy loss. In animal reproduction studies, no
evidence of fetal harm was observed in Cynomolgus monkeys with subcutaneous doses of
omalizumab up to 10 times the maximum recommended human dose (MRHD). Because
animal reproduction studies are not always predictive of human response, Omalizumab
should be used during pregnancy only if clearly needed.

Clinical Considerations
In general, monoclonal antibodies are transported across the placenta in a linear fashion as
pregnancy progresses, with the largest amount transferred during the third trimester.

Data
Animal Data
Reproductive studies have been performed in Cynomolgus monkeys at subcutaneous doses
of omalizumab up to 75 mg/kg (approximately 10 times the MRHD on a mg/kg basis). No
evidence of maternal toxicity, embryotoxicity, or teratogenicity was observed when
omalizumab was administered throughout organogenesis. Omalizumab did not elicit adverse
effects on fetal or neonatal growth when administered throughout late gestation, delivery and
nursing. Neonatal serum levels of omalizumab after in utero exposure and 28 days of nursing
 were between 11% and 94% of the maternal serum level. Levels of omalizumab in milk were
0.15% of maternal serum concentration.

Lactation

It is not known whether Omalizumab is present in human breast milk; however, IgG is present
in human milk in small amounts. In Cynomolgus monkeys, milk levels of omalizumab were
measured at 0.15% of the maternal serum concentration [see Use In Specific Populations].
The developmental and health benefits of breastfeeding should be considered along with the
mother's clinical need for Omalizumab and any potential adverse effects on the breastfed
child from Omalizumab or from the underlying maternal condition. Exercise caution when
administering Omalizumab to a nursing woman

g) Precautions:

Anaphylaxis
Anaphylaxis has been reported to occur after administration of Omalizumab in premarketing
clinical trials and in postmarketing spontaneous reports. Signs and symptoms in these
reported cases have included bronchospasm, hypotension, syncope, urticaria, and/or
angioedema of the throat or tongue. Some of these events have been life-threatening. In
premarketing clinical trials in patients with asthma, anaphylaxis was reported in 3 of 3507
(0.1%) patients. Anaphylaxis occurred with the first dose of Omalizumab in two patients and
with the fourth dose in one patient. The time to onset of anaphylaxis was 90 minutes after
administration in two patients and 2 hours after administration in one patient. In
postmarketing spontaneous reports, the frequency of anaphylaxis attributed to Omalizumab
use was estimated to be at least 0.2% of patients based on an estimated exposure of about
57,300 patients from June 2003 through December 2006. Anaphylaxis has occurred as early
as after the first dose of Omalizumab, but also has occurred beyond one year after beginning
regularly scheduled treatment.

Administer Omalizumab only in a healthcare setting by healthcare providers prepared to

manage anaphylaxis that can be life-threatening. Observe patients closely for an appropriate
period of time after administration of Omalizumab, taking into account the time to onset of
anaphylaxisseen in premarketing clinical trials and postmarketing spontaneous reports.
Inform patients of the signs and symptoms of anaphylaxis, and instruct them to seek
immediate medical care should signs or symptoms occur.
Discontinue Omalizumab in patients who experience a severe hypersensitivity reaction.

Malignancy
Malignant neoplasms were observed in 20 of 4127 (0.5%) Omalizumab-treated patients
compared with 5 of 2236 (0.2%) control patients in clinical studies of adults and adolescents (
≥ 12 years of age) with asthma and other allergic disorders. The observed malignancies in
Omalizumabtreated patients were a variety of types, with breast, non-melanoma skin,
prostate, melanoma, and parotid occurring more than once, and five other types occurring
once each. The majority of patients were observed for less than 1 year. The impact of longer
exposure to Omalizumab or use in patients at higher risk for malignancy (e.g., elderly, current
smokers) is not known.

In a subsequent observational study of 5007 Omalizumab-treated and 2829 non-

Omalizumab-treated patients with moderate to severe persistent asthma and a positive skin
test reaction or in vitro reactivity to a perennial aeroallergen, patients were followed for up to
5 years. In this study, the incidence rates of primary malignancies (per 1000 patient years)
were similar among Omalizumab-treated (12.3) and non-Omalizumab-treated patients (13.0).
However, study limitations preclude definitively ruling out a malignancy risk with Omalizumab.
 Study limitations include: the observational study design, the bias introduced by allowing
enrollment of patients previously exposed to Omalizumab (88%), enrollment of patients (56%)
while a history of cancer or a premalignant condition were study exclusion criteria, and the
high study discontinuation rate (44%).

Acute Asthma Symptoms

Omalizumab has not been shown to alleviate asthma exacerbations acutely. Do not use
Omalizumab to treat acute bronchospasm or status asthmaticus.

Corticosteroid Reduction
Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation of Omalizumab
therapy for asthma. Decrease corticosteroids gradually under the direct supervision of a
physician. In CIU patients, the use of Omalizumab in combination with corticosteroids has not
been evaluated.

Eosinophilic Conditions
In rare cases, patients with asthma on therapy with Omalizumab may present with serious
systemic eosinophilia sometimes presenting with clinical features of vasculitis consistent with
Churg-Strauss syndrome, a condition which is often treated with systemic corticosteroid
therapy. These events usually, but not always, have been associated with the reduction of
oral corticosteroid therapy. Physicians should be alert to eosinophilia, vasculitic rash,
worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their
patients.
A causal association between Omalizumab and these underlying conditions has not been
established.

Fever, Arthralgia, And Rash

In post-approval use, some patients have experienced a constellation of signs and symptoms
including arthritis/arthralgia, rash, fever and lymphadenopathy with an onset 1 to 5 days after
the first or subsequent injections of Omalizumab. These signs and symptoms have recurred
after additional doses in some patients. Although circulating immune complexes or a skin
biopsy consistent with a Type III reaction were not seen with these cases, these signs and
symptoms are similar to those seen in patients with serum sickness. Physicians should stop
Omalizumab if a patient develops this constellation of signs and symptoms.

Parasitic (Helminth) Infection

Monitor patients at high risk of geohelminth infection while on Omalizumab therapy.
Insufficient data are available to determine the length of monitoring required for geohelminth
infections after stopping Omalizumab treatment.
In a one-year clinical trial conducted in Brazil in patients at high risk for geohelminthic
infections (roundworm, hookworm, whipworm, threadworm), 53% (36/68) of Omalizumab-
treated patients experienced an infection, as diagnosed by standard stool examination,
compared to 42% (29/69) of placebo controls. The point estimate of the odds ratio for
infection was 1.96, with a 95% confidence interval (0.88, 4.36) indicating that in this study a
patient who had an infection was anywhere from 0.88 to 4.36 times as likely to have received
Omalizumab than a patient who did not have an infection. Response to appropriate anti-
geohelminth treatment of infection as measured by stool egg counts was not different
between treatment groups.

h) Side-effects:

Use of Omalizumab has been associated with:

 Anaphylaxis
  Malignancies

i) Overdose:

The maximum tolerated dose of Omalizumab has not been determined. Single intravenous
doses of up to 4,000 mg have been administered to patients without evidence of dose limiting
toxicities. The highest cumulative dose administered to patients was 44,000 mg over a 20
week period, which was not associated with toxicities.

j) Drug interaction:
No formal drug interaction studies have been performed with Omalizumab.
In patients with asthma the concomitant use of Omalizumab and allergen immunotherapy has
not been evaluated.
In patients with CIU the use of Omalizumab in combination with immunosuppressive
therapies has not been studied.

5. TECHNICAL DATA

a) Composition/Formula

I. Name of the Substance Specification Qty./ml

Active Substance (in mg)
Rivaroxaban
INN 10

II. Excipients

Sodium Starch Glycolate BP 3.000

Lactose BP 10.40
Microcrystalline Cellulose BP 122.5
(Avicel PH 101)
Povidone K 30 BP 10.05
Magnesium Stearate BP 2.000
Colloidal Silicone Dioxide USPNF 2.000

b) Manufacturing Instructions:
1. Place Cetostearyl Alcohol, Mineral Oil, Polysorbate 60 and Sorbitan Monostearate in a
jacketed vessel. Heat to 75°C and mix for 15 minutes.
2. Place water, Glycerin and Benzyl Alcohol in a kettle after passing through 60mesh screen.
Heat to boil and cool to 75°C.
3. Mix step 1 and 2 and sieve through 60 mesh screen
4. Add Betamethasone Valerate and Neomycin sulphate to step 3 and homogenize for 20
minutes. Start congealing and then pass through a Colloid mill.
5. Send sample to QC for analysis.
6. After QC approval, fill the tube to seal as per specification.

c) Control Data for the Active material:

As per BP specification

d) Pharmacopoeia References for other constituents:

As that mentioned in the composition/formula
e) Control Data for finished product:
Appearance : Conform
Color : White to off-white
Label claim/gm : Each gm cream contains Betamethasone Valerate BP
1.22mg and Neomycin Sulphate BP 5mg.

f) Stability Data : To be submitted at the time of inclusion

g) Proposed Shelf Life : To be submitted at the time of inclusion

6. a) Number of manufacturers already manufacturing the product in Bangladesh:

None
b) Estimated market size of the product in Bangladesh: Tk. 10 million (approx.)

7. a) Proposed maximum retail price ( MRP) : To be submitted at the time of inclusion

b) Estimated price – per dose; per day treatment, cost for the recommended course of
treatment: To be submitted at the time inclusion.

8. Particulars:

Signature: Signature:

MAHBUBUL KARIM A.K.M. ZAKARIA

Director, Technical Operations Deputy Manager, R & D Formulation

Qualification: Qualification:
B. Pharm. (Hons.) B. Pharm (Hons.)
M. Pharm M. Pharm
.

Registration No. A – 811 Registration No. A – 1617

Date of joining in this company: Date of joining in this company:

1st April. 2004 1st May 2001

Total experience in Pharmaceutical Total experience in Pharmaceutical

Industry: Twenty Five Years Industry: Ten Years

9) In case of imported drugs : Not applicable

10) Date of Submission :

11) Additional Information (if any) : Not applicable