TYSABRI 300 mg CONCENTRATE FOR INFUSION SOLUTION

2. What you need to know before you receive Tysabri

Before starting treatment with this medicine, it is important that you and your doctor have discussed the benefits you can expect from this treatment and the risks associated with it.

Tysabri must not be administered to you

• If you are allergic to natalizumab or to any of the other ingredients of this medicine (listed in section 6).

• If you have been diagnosed with progressive multifocal leukoencephalopathy (PML). PML is a rare brain disease.

• If your immune systemhas a serious problem. This can be due to a disease (such as HIV infection) or medicines you are taking or have taken in the past (see below).

• If you are taking medicines that affect the immune system, including certain medicines used to treat MS. These medicines must not be used with Tysabri.

• If you have cancer(unless it is a type of skin cancer called basal cell carcinoma).

Warnings and precautions

Consult your doctorif Tysabri is the right treatment for you. Do this before starting to use Tysabri and when you have been receiving it for more than two years.

Possible brain infection (PML)

Some people who receive this medicine (less than 1 in 100) have had a rare brain infection called PML (progressive multifocal leukoencephalopathy). PML can cause severe disability or death.

• Before starting treatment, your doctor will perform a blood test on all patientsto detect JC virus infection. The JC virus is a common virus that usually does not make you sick. However, PML is associated with an increase in JC virus in the brain. The reason for this increase in some patients treated with Tysabri is not clear. Before and during treatment, your doctor will perform a blood test to check if you have antibodies against the JC virus (anti-JCV antibodies), which are a sign that you have been infected with the JC virus.

• Your doctor will perform an MRI scan, which will be repeated during treatment to rule out PML.

• Symptoms of PMLcan be similar to those of an MS relapse (see section 4, Possible side effects). You can also develop PML up to 6 months after stopping treatment with Tysabri.

Tell your doctor as soon as possibleif you notice that your MS is getting worse or if you notice any new symptoms while you are being treated with Tysabri or up to 6 months after.

• Tell your partner or caregiverswhat to look out for (see also section 4, Possible side effects). Some symptoms can be difficult to detect by yourself, such as mood or behavior changes, confusion, speech and communication difficulties. If you experience any of these, you may need to have more tests. Be aware of symptoms during the 6 months after stopping Tysabri.

• Keep the patient information card that your doctor has given you. It includes this information. Show it to your partner or caregivers.

Three things can increase the risk of PMLwith Tysabri. If you have two or more of these risk factors, the risk increases even more:

• If you have anti-JCV antibodiesin your blood. They are a sign that the virus is in your body. You will have tests before and during treatment with Tysabri.

• If you are receiving long-term treatmentwith Tysabri, especially if it is for more than two years.

• If you have taken a medicine known as animmunosuppressant, which reduces the activity of your immune system.

The JC virus also causes another condition, called JCV granule cell neuronopathy (JCV GCN), which has occurred in some patients receiving treatment with Tysabri. The symptoms of JCV GCN are similar to those of PML.

In the case of patients with a lower risk of PML, your doctor may repeat tests periodically to check:

• If you still do not have anti-JCV antibodies in your blood.

• If you have received treatment for more than 2 years, if you still have a lower level of anti-JCV antibodies in your blood.

If someone develops PML

PML can be treated and treatment with Tysabri will be stopped. However, some people develop a reaction when Tysabri is removed from the body. This reaction (known as IRIS or immune reconstitution inflammatory syndrome) can make your condition worse, including worsening of brain function.

Be aware of other infections

Some infections other than PML can also be serious and can be caused by viruses, bacteria, and other causes.

Tell your doctor or nurse immediatelyif you think you have an infection (see also section 4, Possible side effects).

Changes in platelet count in the blood

Natalizumab may reduce the number of platelets in the blood, which are responsible for blood clotting. This can lead to a disorder called thrombocytopenia (see section 4) by which your blood may not clot quickly enough to stop bleeding. This can cause bruising, as well as more serious problems such as excessive bleeding. Tell your doctor immediately if you have unexplained bruising, red or purple spots on the skin (called petechiae), bleeding from cuts in the skin that do not stop, prolonged bleeding from the gums or nose, blood in the urine or stool, or bleeding in the white part of the eyes.

Children and adolescents

Do not give this medicine to children or adolescents under 18 years of age.

Other medicines and Tysabri

Tell your doctor if you are using, have recently used, or might use any other medicines.

• You must notbe given this medicine if you are currently being treated with medicines that affect your immune system, including certain medicines for the treatment of MS.

• You may not be able to use this medicine if you have everreceived a medicine that affects the immune system.

Pregnancy and breastfeeding

• Do not use this medicine if you are pregnant, unless you have discussed it with your doctor. If you are pregnant, think you may be pregnant, or plan to become pregnant, tell your doctor immediately.

• Do not breastfeed while using Tysabri. Your doctor will help you decide whether to stop breastfeeding or stop using the medicine.

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor before using this medicine. Your doctor will consider the risk to the baby and the benefit to the mother.

Driving and using machines

Dizziness is a very common side effect. If you experience this symptom, do not drive or use machines.

Tysabri contains sodium

Each vial of this medicine contains 2.3 mmol (52 mg) of sodium. After dilution before use, the medicine contains 17.7 mmol (406 mg) of sodium per dose. You should take this into account if you are on a low-sodium diet.

3. How Tysabri is administered

Tysabri i.v. infusion should be administered to you by a doctor who has experience in the treatment of MS. Your doctor may switch you directly to Tysabri if no problems are seen with your previous treatment.

• Your doctor will request blood teststo detect anti-JCV antibodies and other possible problems.

• Your doctor will perform an MRI scan, which will be repeated during treatment.

• To switch from some MS medicines, your doctor may recommend that you wait for a certain time to make sure that most of the previous medicine has been removed from your body.

• The recommended dose for adults is 300 mg every four weeks.

• Tysabri must be diluted before it is administered to you. It is given through a drip into a vein (by intravenous infusion), usually in the arm. Administration takes about 1 hour.

• At the end of the leaflet, information is provided on how to prepare and administer the medicine intended for healthcare professionals.

If you stop treatment with Tysabri

It is important to continue administering Tysabri, especially during the first months of treatment. It is important that you continue treatment while you and your doctor decide that it is helping you. Patients who received one or two doses of Tysabri and then took a break in treatment of three months or more had a higher chance of having an allergic reaction when treatment was restarted.

Checking for allergic reactions

Some patients have had an allergic reaction to this medicine. Your doctor may check for allergic reactions during and 1 hour after the infusion. See also section 4, Possible side effects.

If you miss a dose of Tysabri

If you did not receive your usual dose of Tysabri, talk to your doctor to have it administered as soon as possible. After that, you can continue receiving Tysabri every four weeks.

Will Tysabri always work?

In some patients who receive Tysabri, the body's natural defenses can prevent the medicine from working properly over time as the body produces antibodies against the medicine. Your doctor may decide if this medicine is not working properly for you based on your blood tests and stop treatment if necessary.

If you have any other questions about the use of Tysabri, ask your doctor. Follow the instructions for administration of the medicine contained in this leaflet or given by your doctor. If you are unsure, ask your doctor.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Tell your doctor or nurse immediatelyif you notice any of the following symptoms.

Signs of brain infection

• Changes in personality and behavior such as confusion, delirium, or loss of consciousness
• Seizures (epileptic fits)
• Headache
• Nausea/vomiting
• Stiff neck
• Extreme sensitivity to light
• Fever
• Rash (on any part of the body)

These symptoms can be due to a brain infection (encephalitis or PML) or the lining that surrounds it (meningitis).

Signs of other serious infections

• Unexplained fever
• Severe diarrhea
• Shortness of breath
• Prolonged dizziness
• Headache
• Weight loss
• Lack of energy
• Changes in vision
• Pain or redness of the eye(s)

Signs of allergic reaction

• Hives (itchy rash)
• Swelling of the face, lips, or tongue
• Difficulty breathing
• Chest pain or discomfort
• Increased or decreased blood pressure (your doctor or nurse will notice if they are checking your blood pressure)

These are more likely to occur during or soon after the infusion.

Signs of possible liver problems

• Yellowing of the skin or the whites of the eyes
• Unusual darkening of the urine
• Abnormal liver function test

If you experience any of the side effects described above or if you think you have an infection, consult your doctor or nurse immediately. Show your patient information cardand this leaflet to any doctor or nurse who treats you, not just your neurologist.

Other side effects

Very common(may affect more than 1 in 10 people)

• Urinary tract infection
• Sore throat and congested or runny nose
• Headache
• Dizziness
• Feeling sick (nausea)
• Joint pain
• Fatigue
• Dizziness, feeling sick (nausea), itching, and chills during or soon after the infusion

Common(may affect up to 1 in 10 people)

• Anemia (reduced number of red blood cells that can make your skin pale and make you feel short of breath or lacking in energy)
• Allergic reaction (hypersensitivity)
• Chills
• Hives (itchy rash)
• Vomiting
• Fever
• Difficulty breathing (dyspnea)
• Redness of the face or body (flushing)
• Herpes virus infections
• Discomfort around the infusion site. You may have bruising, redness, pain, itching, or swelling

Uncommon(may affect up to 1 in 100 people)

• Severe allergic reaction (anaphylactic reaction)
• Progressive multifocal leukoencephalopathy (PML)
• Inflammatory disorder after stopping the medicine
• Swelling of the face
• Increased number of white blood cells (eosinophilia)
• Reduced number of platelets
• Easy bruising (purpura)

Rare(may affect up to 1 in 1,000 people)

• Herpes virus infection in the eye
• Severe anemia (reduced number of red blood cells that can make your skin pale and make you feel short of breath or lacking in energy)
• Severe swelling under the skin
• High levels of bilirubin in the blood (hyperbilirubinemia)that can cause symptoms such as yellowing of the eyes or skin, fever, and fatigue

Frequency not known(cannot be estimated from the available data)

• Rare infections (so-called "opportunistic infections")
• Liver damage

Tell your doctor as soon as possibleif you think you have an infection.

You will also find this information on the patient information card that your doctor has given you.

Reporting of side effects

If you experience any side effects, consult your doctor, even if they are not listed in this leaflet. You can also report side effects directly through the national reporting system listed in Appendix V. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Tysabri

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label and carton. The expiry date is the last day of the month stated.

Unopened vial:

Store in a refrigerator.

Do not freeze.

Keep the vial in the outer packaging to protect it from light.

Diluted solution:

It is recommended to use the product immediately after dilution. If not, the diluted solution should be stored between 2°C and 8°C and infused within 24 hours after dilution.

Do not use this medicine if you notice particles or color changes in the liquid.

6. Package contents and additional information

Composition of Tysabri

The active substance is natalizumab. Each 15 ml vial of concentrate contains 300 mg of natalizumab (20 mg/ml). When diluted, the solution for infusion contains approximately 2.6 mg per ml of natalizumab.

The other ingredients are:

Sodium monobasic phosphate monohydrate

Sodium dibasic phosphate heptahydrate

Sodium chloride (see section 2 “Tysabri contains sodium”)

Polysorbate 80 (E 433)

Water for injections

Appearance and package contents of the product

Tysabri is a clear or slightly turbid, colorless liquid.

Each carton contains one glass vial.

Marketing authorisation holder and manufacturer

Biogen Netherlands B.V.

Prins Mauritslaan 13

1171 LP Badhoevedorp

Netherlands

For further information about this medicine, please contact the local representative of the marketing authorisation holder:

Date of last revision of this leaflet:09/2024

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency website: https://www.ema.europa.eu.

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This information is intended only for healthcare professionals:

1. Inspect the Tysabri vial for the absence of particles before dilution and administration. If particles are observed or if the liquid is not colorless and transparent or slightly opalescent, the vial should not be used.

1. Use an aseptic technique to prepare the medicine. Remove the flip-off cap from the vial. Insert the needle of the syringe into the vial, through the center of the stopper, and aspirate 15 ml of concentrate for solution for infusion.

1. Add the 15 ml of concentrate for solution for infusion to 100 ml of sodium chloride 9 mg/ml (0.9%) injection solution. Gently invert the solution to mix completely. Do not shake.

1. Tysabri should not be mixed with other medicines or diluents.

1. Visually inspect the diluted medicine for the absence of particles or color changes before administration. The diluted product should not be used if particles or color changes are observed.

1. The diluted medicine should be used as soon as possible and within 24 hours after dilution. If the diluted medicine is stored between 2°C and 8°C (do not freeze), it should be allowed to reach room temperature before infusion.

1. The diluted solution is intended for intravenous infusion over 1 hour, at an approximate rate of 2 ml per minute.

1. After completion of the infusion, the intravenous infusion sets are flushed with sodium chloride 9 mg/ml (0.9%) injection solution.

1. The vials are for single use.

1. In order to improve the traceability of biological medicinal products, the name (Tysabri) and batch number of the administered product should be clearly recorded.

1. Disposal of unused medicine and all materials that have come into contact with it should be done in accordance with local regulations.