• Clinical Development
  Program Overview
• Study C08-003
• Study C08-002
• Study C09-001
  (Age <18 y)
• Soliris Safety
• Dosing and
  Administration
• Access for Soliris

For patients with atypical Hemolytic Uremic Syndrome:
(aHUS) Soliris^® aHUS Dosing Guide

All patients must be vaccinated against Neisseria meningitidis at least 2 weeks prior to the first dose of Soliris therapy. Do not initiate Soliris therapy in patients with unresolved serious Neisseria meningitidis infection or who are not currently vaccinated, unless the risks of delaying Soliris treatment outweigh the risk of developing a meningococcal infection.¹

Soliris is a therapy for aHUS—a chronic disease needing chronic treatment¹

Supplemental dosing of Soliris is required for patients undergoing concomitant plasma therapy¹

^*PE/PI = plasmapheresis or plasma exchange; or fresh frozen plasma infusion.

Monitoring After Discontinuation

Thrombotic Microangiopathy (TMA) complications after discontinuation were observed in the aHUS clinical studies.²

aHUS patients who discontinue treatment with Soliris should be monitored closely for at least 12 weeks for signs and symptoms of TMA complications. If TMA complications occur after Soliris discontinuation, consider reinstitution of Soliris treatment, plasma therapy,^† or appropriate organ-specific supportive measures.¹

^†Plasma therapy = plasmapheresis, plasma exchange, or fresh frozen plasma infusion (PE/PI).

DO NOT ADMINISTER AS AN IV PUSH OR BOLUS INJECTION.

• If diluted solution is refrigerated, warm to room temperature (18°C-25°C [64°F-77°F]) only by exposure to ambient air¹
• Administer as an IV infusion over 35 minutes via gravity feed, a syringe-type pump, or an infusion pump¹
• It is not necessary to protect diluted solution from light during administration

Preparation of Soliris for Administration

All patients must be vaccinated against Neisseria meningitidis at least 2 weeks prior to the first dose of Soliris therapy. Do not initiate Soliris therapy in patients with unresolved serious Neisseria meningitidis infection or who are not currently vaccinated, unless the risks of delaying Soliris treatment outweigh the risk of developing a meningococcal infection.¹

1. Withdraw the required amount of Soliris from the vial into a sterile syringe and transfer the recommended dose to an infusion bag¹

2. Dilute Soliris to a final concentration of 5 mg/mL using the above table as a guideline. The volume of diluent should be equivalent to the drug volume¹

• Discard any unused portion left in the vial, as the product contains no preservatives¹
• One of the following may be used to prepare the final admixed solution: 0.9% Sodium Chloride Injection, USP; 0.45% Sodium Chloride Injection, USP; 5% Dextrose in Water Injection, USP; or Ringer's Injection, USP

3. Gently invert the infusion bag containing the diluted solution to ensure thorough mixture of the product and the diluent¹

4. Inspect visually for particulate matter and discoloration prior to administration¹

• The diluted solution is a clear colorless liquid and should be practically free of any particles¹

5. Allow the admixture to adjust to room temperature prior to administration (18°C-25°C, 64°F-77°F). It must not be heated in a microwave or with any heat source other than ambient air temperature¹

6. Admixed solution of Soliris is stable for 24 hours at 2°C-8°C (36°F-46°F) and at room temperature¹

J code: J1300

Contact Soliris OneSource at 1.888.SOLIRIS (1.888.765.4747)

• All Alexion Nurse Case Managers are registered nurses and have extensive insurance and clinical experience. An Alexion Nurse Case Manager will partner with each patient and his or her healthcare team
• Fast and convenient same-day shipping that meets the needs of PNH and aHUS patients

IMPORTANT SAFETY INFORMATION

Indications and Usage

Paroxysmal Nocturnal Hemoglobinuria (PNH)
Soliris is indicated for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis.

Atypical Hemolytic Uremic Syndrome (aHUS)
Soliris is indicated for the treatment of patients with atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy.

The effectiveness of Soliris in aHUS is based on the effects on thrombotic microangiopathy (TMA) and renal function. Prospective clinical trials in additional patients are ongoing to confirm the benefit of Soliris in patients with aHUS.

Limitation of Use
Soliris is not indicated for the treatment of patients with Shiga toxin E. coli related hemolytic uremic syndrome (STEC-HUS).

Contraindications
Soliris is contraindicated in:

• Patients with unresolved serious Neisseria meningitidis infection
• Patients who are not currently vaccinated against Neisseria meningitidis, unless the risks of delaying Soliris treatment outweigh the risks of developing a meningococcal infection

Warnings and Precautions

Other Infections
Soliris blocks terminal complement activation; therefore patients may have increased susceptibility to infections, especially with encapsulated bacteria. Children treated with Soliris may be at increased risk of developing serious infections due to Streptococcus pneumoniae and Haemophilus influenza type b (Hib). Administer vaccinations for the prevention of Streptococcus pneumoniae and Haemophilus influenza type b (Hib) infections according to ACIP guidelines. Use caution when administering Soliris to patients with any systemic infection.

Monitoring After Soliris Discontinuation
Treatment Discontinuation for PNH
Monitor patients after discontinuing Soliris for at least 8 weeks to detect hemolysis.

Treatment Discontinuation for aHUS
After discontinuing Soliris, monitor patients with aHUS for signs and symptoms of thrombotic microangiopathy (TMA) complications for at least 12 weeks. In aHUS clinical studies, 18 patients (5 in the prospective studies) discontinued Soliris treatment. TMA complications occurred following a missed dose in 5 patients, and Soliris was reinitiated in 4 of these 5 patients.

Clinical signs and symptoms of TMA include changes in mental status, seizures, angina, dyspnea, or thrombosis. In addition, the following changes in laboratory parameters may identify a TMA complication: occurrence of two, or repeated measurement of any one of the following: a decrease in platelet count by 25% or more compared to baseline or the peak platelet count during Soliris treatment; an increase in serum creatinine by 25% or more compared to baseline or nadir during Soliris treatment; or, an increase in serum LDH by 25% or more over baseline or nadir during Soliris treatment.

If TMA complications occur after Soliris discontinuation, consider reinstitution of Soliris treatment, plasma therapy [plasmapheresis, plasma exchange, or fresh frozen plasma infusion (PE/PI)], or appropriate organ-specific supportive measures.

Laboratory Monitoring
PNH
Serum LDH levels increase during hemolysis and may assist in monitoring Soliris effects, including the response to discontinuation of therapy. In clinical studies, six patients achieved a reduction in serum LDH levels only after a decrease in the Soliris dosing interval from 14 to 12 days. All other patients achieved a reduction in serum LDH levels with the 14 day dosing interval [see Clinical Pharmacology and Clinical Studies].

aHUS
Early signs of thrombotic microangiopathy (TMA) include a decrease in platelet count, and increases in serum LDH and creatinine levels. Follow patients for signs of TMA by monitoring serial platelet counts, serum LDH, and creatinine during Soliris therapy and following discontinuation of Soliris.

Infusion Reactions
As with all protein products, administration of Soliris may result in infusion reactions, including anaphylaxis or other hypersensitivity reactions. In clinical trials, no patients experienced an infusion reaction which required discontinuation of Soliris. Interrupt Soliris infusion and institute appropriate supportive measures if signs of cardiovascular instability or respiratory compromise occur.

Adverse Reactions
The most frequently reported adverse reactions in the PNH randomized trial (≥10% overall and greater than placebo) are: headache, nasopharyngitis, back pain, and nausea.

The most frequently reported adverse reactions in aHUS single arm prospective trials (≥15% combined per patient incidence) are: hypertension, upper respiratory tract infection, diarrhea, headache, anemia, vomiting, nausea, urinary tract infection, and leukopenia.

Thrombosis Prevention and Management
The effect of withdrawal of anticoagulant therapy during Soliris treatment has not been established. Therefore, treatment with Soliris should not alter anticoagulant management.

Please see full prescribing information for Soliris^® (eculizumab), including boxed WARNING regarding serious meningococcal infection.

References
1. Soliris^® (eculizumab) [package insert]. Alexion Pharmaceuticals; 2011. 2. Data on file. Alexion Pharmaceuticals, Inc.