MACI by is a Other medication manufactured, distributed, or labeled by Vericel Corporation. Drug facts, warnings, and ingredients follow.
MACI® is an autologous cellularized scaffold product indicated for the repair of symptomatic, single or multiple full-thickness cartilage defects of the knee with or without bone involvement in adults. (1)
Limitations of Use
For autologous implantation only.
Each 3 x 5 cm cellular sheet (MACI implant) consists of autologous cultured chondrocytes on a resorbable porcine Type I/III collagen membrane, at a density of at least 500,000 cells per cm2. (3)
The most frequently occurring adverse reactions (≥5%) reported for MACI were arthralgia, tendonitis, back pain, joint swelling, and joint effusion. (6)
Serious adverse reactions reported for MACI were arthralgia, cartilage injury, meniscus injury, treatment failure, and osteoarthritis. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Vericel at 1-800-453-6948 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch for voluntary reporting of adverse reactions.
Pregnancy: Because MACI implantation requires invasive surgical procedures, use in pregnancy is not recommended. (8.1)
See 17 for PATIENT COUNSELING INFORMATION.
Revised: 6/2019
MACI® (autologous cultured chondrocytes on porcine collagen membrane) is an autologous cellularized scaffold product indicated for the repair of single or multiple symptomatic, full-thickness cartilage defects of the knee with or without bone involvement in adults.
Limitations of Use
For Autologous Implantation Only.
Contact Vericel at 1-800-453-6948 or www.MACI.com regarding training materials for surgical implantation of MACI.
Pre-Operative Preparation
Implantation Procedure
Preparing Defect
Figure 1: Preparing Defect Bed
Creating Defect Template
Figure 2: Creating Defect Template
Preparing MACI Implant
Figure 3: Covered Dish in Self-Sealed Pouch
Figure 4: Unpacking MACI Implant
Placing MACI Implant
A physician-prescribed rehabilitation program that includes early mobilization, joint range of motion, and weight bearing is recommended to promote graft maturation and reduce the risk of graft delamination, postoperative thromboembolic events, and joint stiffness. Stage this program to promote a progressive return to full joint range of motion and weight-bearing as well as muscle strengthening and conditioning. Return to recreational and sporting activity should be in consultation with healthcare professionals.
MACI is contraindicated in patients with the following conditions:
The safety of MACI used in patients with malignancy in the area of cartilage biopsy or implant is unknown. The potential exists for expansion of malignant or dysplastic cells present in biopsy tissue during manufacture and subsequent implantation. In addition, implantation of normal autologous chondrocytes could theoretically stimulate growth of malignant cells in the area of the implant, although there have been no such incidents reported in humans or animals.
MACI is intended solely for autologous use. Patients undergoing the surgical procedures associated with MACI are not routinely tested for transmissible infectious diseases. Therefore, the cartilage biopsy and the MACI implant may carry the risk of transmitting infectious diseases to personnel handling these tissues. Accordingly, healthcare providers should employ universal precautions in handling the biopsy samples and the MACI product.
Product manufacture includes reagents derived from animal materials. All animal-derived reagents are tested for viruses, retroviruses, bacteria, fungi, yeast, and mycoplasma before use. Bovine materials are sourced to minimize the risk of transmitting a prion protein that causes bovine spongiform encephalopathy and may cause a rare fatal condition in humans called variant Creutzfeldt-Jakob disease.
These measures do not totally eliminate the risk of transmitting these or other transmissible infectious diseases and disease agents. Report the occurrence of a transmitted infection to Vericel Corporation at 1-800-453-6948.
To create a favorable environment for healing, assess and treat the following conditions prior to or concurrent with implantation with MACI:
MACI is shipped after passing preliminary test results from in-process microbial tests. A final sterility test is initiated prior to shipping, but the result will not be available prior to implantation. If microbial contamination is detected after the product has been shipped, Vericel will notify the healthcare provider(s) and recommend appropriate actions.
The most frequently occurring adverse reactions (≥5%) reported for MACI were arthralgia, tendonitis, back pain, joint swelling, and joint effusion.
Serious adverse reactions reported for MACI were arthralgia, cartilage injury, meniscus injury, treatment failure, and osteoarthritis.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a product cannot be directly compared to rates in the clinical trials of another product and may not reflect the rates observed in practice.
In a 2-year prospective, multicenter, randomized, open-label, parallel-group clinical trial1, 144 patients, ages 18 to 54 years, were randomized to receive a 1-time treatment with MACI or microfracture (1:1, 72 patients in each treatment group). Demographic characteristics of patients in the trial were similar in both treatment groups. The majority of patients were male (62.5% MACI, 66.7% microfracture), and the mean ages were 34.8 (MACI) and 32.9 (microfracture) years. Overall, 70 patients in the MACI group and 67 patients in the microfracture group completed 2 years of follow-up.
In addition, all 144 subjects from the 2-year clinical trial had the option to enroll in a 3-year follow-up study (extension study). Safety and efficacy assessments were performed at yearly scheduled visits. The demographic characteristics of patients (N = 128) enrolled in the extension study were similar in both treatment groups and consistent with the overall population of the 2-year clinical trial.
The proportion of patients with at least 1 subsequent surgical procedure (any surgical procedure performed on the treated knee joint, including arthroscopy, arthrotomy, or manipulation under anesthesia) in the 2 years following study treatment was comparable between treatment groups (8.3% in the MACI group and 9.7% in the microfracture group).
Adverse reactions reported in ≥5% of patients in either treatment group in the 2-year clinical trial are provided in Table 1.
System Organ Class | MACI n = 72 n (%) | Microfracture n = 72 n (%) |
Musculoskeletal and Connective Tissue Disorders | ||
Arthralgia | 37 (51.4) | 46 (63.9) |
Back pain | 8 (11.1) | 7 (9.7) |
Joint swelling | 7 (9.7) | 4 (5.6) |
Joint effusion | 5 (6.9) | 4 (5.6) |
Injury, Poisoning and Procedural Complications | ||
Cartilage injury | 3 (4.2) | 9 (12.5) |
Ligament sprain | 3 (4.2) | 5 (6.9) |
Procedural pain | 3 (4.2) | 4 (5.6) |
General Disorders and Administration Site Conditions | ||
Treatment failure | 1 (1.4) | 4 (5.6) |
In the 3-year extension study, adverse reactions reported in ≥5% of patients were (MACI vs microfracture): arthralgia (46.2% vs 50.8%), tendonitis (6.2% vs 1.6%), back pain (4.6% vs 6.3%), osteoarthritis (4.6% vs 7.9%), joint effusion (3.1% vs 7.9%), cartilage injury (6.2% vs 15.9%), procedural pain (3.1% vs 7.9%), ligament sprain (1.5% vs 7.9%), and treatment failure (4.6% vs 7.9%).
Serious adverse reactions reported in patients in either treatment group for integrated data across the 2-year clinical trial and the 3-year extension study are provided in Table 2.
System Organ Class | MACI n = 72 n (%) | Microfracture n = 72 n (%) |
Musculoskeletal and Connective Tissue Disorders | ||
Arthralgia | 1 (1.4) | 7 (9.7) |
Joint Lock | 0 | 3 (4.2) |
Meniscus Injury | 3 (4.2) | 0 |
Osteoarthritis | 3 (4.2) | 0 |
Injury, Poisoning and Procedural Complications | ||
Cartilage injury | 3 (4.2) | 8 (11.1) |
General Disorders and Administration Site Conditions | ||
Treatment failure | 3 (4.2) | 7 (9.7) |
Graft complication (e.g., abnormalities to the repair graft that become symptomatic; this could include graft overgrowth [tissue hypertrophy], under-fill or damage to the repair tissue that has elicited a painful response, or mechanical symptoms), graft delamination (i.e., a dislodging of the repair graft from the underlying subchondral bone that has become symptomatic; this can be measured as marginal, partial, or a complete delaminated graft), and tendonitis have been reported during use of MACI outside the United States. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to MACI exposure.
Risk Summary
MACI implantation requires invasive surgical procedures; therefore use during pregnancy is not recommended. Limited clinical data on patients exposed to MACI during pregnancy are available. There are insufficient data with MACI use in pregnant women to inform a product-associated risk. Animal reproduction studies have not been conducted with MACI. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.
Risk Summary
There is no information regarding the presence of MACI in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for MACI and any potential adverse effects on the breastfed infant from MACI or from the underlying maternal condition.
MACI, autologous cultured chondrocytes on porcine collagen membrane, is a cellular sheet that consists of autologous chondrocytes seeded on a 3 x 5 cm, resorbable porcine Type I/III collagen membrane, for implantation into cartilage defects of the knee. The active ingredients of MACI are the autologous cultured chondrocytes and porcine Type I/III collagen. The autologous chondrocytes are propagated in cell culture and are seeded on the collagen at a density of 500,000 to 1,000,000 cells per cm2. The final MACI implant contains at least 500,000 cells per cm2 and does not contain any preservative.
The product manufacture also uses reagents derived from animal materials. The resorbable, Type I/III, collagen membrane, which is a component of MACI, is porcine-derived. Fetal bovine serum is a component in the culture medium used to propagate the autologous chondrocytes; therefore, trace quantities of bovine-derived proteins may be present in MACI. These animal-derived reagents are tested for viruses, retroviruses, bacteria, fungi, yeast, and mycoplasma before use.
MACI may contain residual gentamicin because it is included during manufacture. Gentamicin is not included in the transport medium used to maintain product stability. Studies determined an average of 9.2 μg residual gentamicin per MACI implant.
A final sterility test is initiated prior to shipping, but the result will not be available prior to implantation. Passing results from preliminary in-process microbial tests are required for release of MACI for shipping.
Studies to evaluate the carcinogenicity or impairment of fertility potential of MACI have not been performed. In vitro studies have shown that the expansion process for chondrocytes does not induce changes to the cellular karyotype.
Four studies (in vitro and in vivo) were conducted to assess the genotoxic potential of the collagen membrane. The results from these studies demonstrated that the collagen membrane was non-mutagenic.
Implantation of analogous products in critical-size defects in the hind limbs of rabbits and horses did not reveal any serious safety concerns. The products consisted of the same membrane as MACI with rabbit or horse cells, respectively. Non-clinical testing has shown that the collagen membrane is not toxic and is compatible with biological tissue.
The effectiveness of MACI implant was evaluated in a 2-year prospective, multicenter, randomized, open-label, parallel-group study, SUMMIT (Superiority of MACI implant versus Microfracture Treatment in patients with symptomatic articular cartilage defects in the knee),1 which enrolled a total of 144 subjects, ages 18 to 54 years, with at least one symptomatic Outerbridge Grade III or IV focal cartilage defect on the medial femoral condyle, lateral femoral condyle, and/or the trochlea. Failure of a prior cartilage surgery was not required for study entry. The subjects were randomized to receive either a 1-time treatment with MACI or microfracture. The co-primary efficacy endpoint was change from baseline to Week 104 for the subject’s Knee injury and Osteoarthritis Outcome Score (KOOS) in two subscales: Pain and Function (Sports and Recreational Activities [SRA])2. Safety also was evaluated through Week 104 [see Adverse Reactions (6.1)].
Of the 72 subjects randomized to MACI, 70 completed the study and 2 discontinued prematurely (1 due to an adverse event [AE] and 1 wished to withdraw). Of the 72 subjects randomized to microfracture, 67 completed the study and 5 discontinued prematurely (1 due to an AE, 1 wished to withdraw, and 3 due to lack of clinical benefit).
At Week 104, KOOS pain and function (SRA) had improved from baseline in both treatment groups, but the improvement was statistically significantly (p = 0.001) greater in the MACI group compared with the microfracture group (Table 3).
LS = least squares; KOOS = Knee injury and Osteoarthritis Outcome Score; SD = standard deviation; SRA = Sports and Recreational Activities.
* Difference in least squares mean values at Week 104 [MACI – Microfracture]. **p-value for difference in co-primary endpoints assessed jointly at Week 104 based on multivariate analysis of variance. |
||||||
MACI Mean (SD) | Microfracture Mean (SD) |
|||||
N | Pain | Function | N | Pain | Function | |
Baseline | 72 | 37.0 (13.5) | 14.9 (14.7) | 71 | 35.4 (12.1) | 12.6 (16.7) |
Week 104 | 72 | 82.4 (16.2) | 60.9 (27.8) | 70 | 70.9 (24.2) | 48.7 (30.3) |
Change From Baseline to Week 104 | 72 | 45.4 (21.1) | 46.0 (28.4) | 69 | 35.2 (23.9) | 35.8 (31.6) |
LS Means (Week 104) | 44.1 | 46.1 | 32.4 | 34.6 | ||
Difference * [MACI – Microfracture] | 11.8 | 11.4 | ||||
p-value ** | 0.001 |
In a responder analysis, the proportion of subjects with at least a 10-point improvement in both KOOS pain and function (SRA) was greater in the MACI group (63/72=87.5%; 95% CI [77.6%, 94.1%]) compared with the microfracture group (49/72=68.1%; 95% CI [56.0%, 78.6%]).
All subjects from the 2-year study had the option to enroll in a 3 year follow-up study (extension study), in which 128 subjects participated. All 65 subjects (100%, 65/65) in the MACI group and 59 subjects (93.7%, 59/63) in the microfracture group completed the extension study. The mean 2-year KOOS pain and function scores remained stable for the additional 3-year period in both treatment groups (Table 4).
Visit | MACI | Microfracture | ||||
N | Pain mean (SD) | Function mean (SD) | N | Pain mean (SD) | Function mean (SD) |
|
Baseline | 65/65 | 37.1 (13.1) | 15.4 (14.8) | 63/63 | 35.2 (12.3) | 11.9 (16.2) |
2 Years | 63/63 | 82.2 (15.8) | 60.5 (26.5) | 60/60 | 71.8 (23.9) | 48.9 (30.6) |
5 Years | 65/64 | 82.2 (20.1) | 61.9 (30.9) | 59/59 | 74.8 (21.7) | 50.3 (32.3) |
How Supplied
Storage and Handling
Manufactured by: Vericel Corporation, 64 Sidney Street, Cambridge, MA 02139
MACI® is a registered trademark of Vericel Corporation.
Patents: www.vcel.com/research-and-development
© 2018 Vericel Corporation.
65617.D
MACI
autologous cultured chondrocytes implant |
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Labeler - Vericel Corporation (079745570) |
Mark Image Registration | Serial | Company Trademark Application Date |
---|---|
MACI 87035415 5108912 Live/Registered |
Southern States LLC 2016-05-12 |
MACI 86855486 5770006 Live/Registered |
VERICEL CORPORATION 2015-12-21 |
MACI 86640793 not registered Dead/Abandoned |
Scott M. Schlesinger, MD, FACS 2015-05-26 |
MACI 85843354 not registered Dead/Abandoned |
VERICEL CORPORATION 2013-02-07 |
MACI 85611711 4261148 Live/Registered |
Dicandrien, Inc. 2012-04-30 |
MACI 85512439 4927713 Live/Registered |
VERICEL CORPORATION 2012-01-10 |
MACI 77739920 not registered Dead/Abandoned |
GENZYME CORPORATION 2009-05-19 |
MACI 75854103 2535450 Dead/Cancelled |
Verigen Transplantation Service International (VTSI) AG 1999-11-19 |
MACI 74041633 1631438 Dead/Cancelled |
Regulatory Resources Inc. 1990-03-22 |