SOTROVIMAB injection, solution, concentrate

Sotrovimab by

Drug Labeling and Warnings

Sotrovimab by is a Prescription medication manufactured, distributed, or labeled by GlaxoSmithKline LLC. Drug facts, warnings, and ingredients follow.

Drug Details [pdf]

  • CONTACT INFORMATION

    For additional information visit www.sotrovimabinfo.com

    If you have questions, please call the GSK COVID Contact Center at 1-866-GSK-COVID (866-475-2684).


    END SHORT VERSION FACT SHEET

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  • FULL EUA PRESCRIBING INFORMATION

    FULL EUA PRESCRIBING INFORMATION: CONTENTS*

    1      AUTHORIZED USE

    10      DRUG INTERACTIONS

    2      DOSAGE AND ADMINISTRATION

    11      USE IN SPECIFIC POPULATIONS

            2.1      Patient Selection

              11.1      Pregnancy

            2.2      Dosage

              11.2      Lactation

            2.3      Dosage Adjustment in Specific Populations

              11.3      Pediatric Use

            2.4      Dose Preparation and Administration

              11.4      Geriatric Use

    3      DOSAGE FORMS AND STRENGTHS

              11.5      Renal Impairment

    4      CONTRAINDICATIONS

              11.6      Hepatic Impairment

    5      WARNINGS AND PRECAUTIONS

    12      OVERDOSAGE

            5.1      Hypersensitivity Including Anaphylaxis and Infusion-Related Reactions

    13      PRODUCT DESCRIPTION

            5.2      Clinical Worsening After SARS-CoV-2 Monoclonal Antibody Administration

    14      CLINICAL PHARMACOLOGY

            5.3      Limitations of Benefit and Potential for Risk in Patients with Severe COVID‑19

              14.1      Mechanism of Action

    6      OVERALL SAFETY SUMMARY

              14.2      Pharmacokinetics

            6.1      Clinical Trials Experience

    15      MICROBIOLOGY/RESISTANCE INFORMATION

    7      PATIENT MONITORING RECOMMENDATIONS

    16      NONCLINICAL TOXICOLOGY

    8      ADVERSE REACTIONS AND MEDICATION ERRORS REPORTING REQUIREMENTS AND INSTRUCTIONS

    17      ANIMAL PHARMACOLOGIC AND EFFICACY DATA

    9      OTHER REPORTING REQUIREMENTS

    18      CLINICAL TRIAL RESULTS AND SUPPORTING DATA FOR EUA

    19      HOW SUPPLIED/STORAGE AND HANDLING

    20      PATIENT COUNSELING INFORMATION

    21      CONTACT INFORMATION

    *Sections or subsections omitted from the full prescribing information are not listed.

  • 1 AUTHORIZED USE

    Sotrovimab is authorized for use under an Emergency Use Authorization (EUA) for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death [see Clinical Trial Results and Supporting Data for EUA (18)].

    LIMITATIONS OF AUTHORIZED USE

    • Sotrovimab is not authorized for use in patients:
      • o who are hospitalized due to COVID-19, OR
      • o who require oxygen therapy due to COVID-19, OR
      • o who require an increase in baseline oxygen flow rate due to COVID-19 (in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity).
    • Benefit of treatment with sotrovimab has not been observed in patients hospitalized due to COVID‑19. SARS-CoV-2 monoclonal antibodies may be associated with worse clinical outcomes when administered to hospitalized patients with COVID‑19 requiring high flow oxygen or mechanical ventilation [see Warnings and Precautions (5.2)].
  • 2 DOSAGE AND ADMINISTRATION

    2.1 Patient Selection

    Sotrovimab should be administered as soon as possible after a positive viral test for SARS-CoV-2 and within 10 days of symptom onset in adults and pediatric patients (12 years of age and older weighing at least 40 kg) who are at high risk for progression to severe COVID-19, including hospitalization or death [see Authorized Use (1) and Clinical Trial Results and Supporting Data for EUA (18)].

    The following medical conditions or other factors may place adults and pediatric patients (12 to 17 years of age weighing at least 40 kg) at higher risk for progression to severe COVID-19:

    • Older age (for example, ≥65 years of age)
    • Obesity or being overweight (for example, adults with BMI >25 kg/m2, or if 12 to 17, have BMI ≥85th percentile for their age and gender based on CDC growth charts, https://www.cdc.gov/growthcharts/clinical_charts.htm)
    • Pregnancy
    • Chronic kidney disease
    • Diabetes
    • Immunosuppressive disease or immunosuppressive treatment
    • Cardiovascular disease (including congenital heart disease) or hypertension
    • Chronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis, and pulmonary hypertension)
    • Sickle cell disease
    • Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies)
    • Having a medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation [not related to COVID 19])

    Other medical conditions or factors (for example, race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19, and authorization of sotrovimab under the EUA is not limited to the medical conditions or factors listed above. For additional information on medical conditions and factors associated with increased risk for progression to severe COVID-19, see the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Healthcare providers should consider the benefit-risk for an individual patient.

    2.2 Dosage

    The dosage of sotrovimab in adults and pediatric patients (12 years of age and older weighing at least 40 kg) is a single IV infusion of 500 mg. Sotrovimab should be given as soon as possible after positive results of direct SARS-CoV-2 viral testing and within 10 days of symptom onset. Sotrovimab must be diluted and administered as a single intravenous infusion over 30 minutes.

    2.3 Dosage Adjustment in Specific Populations

    Pregnancy or Lactation

    No dosage adjustment is recommended in pregnant or lactating women [see Use in Specific Populations (11.1, 11.2)].

    Pediatric Use

    No dosage adjustment is recommended in pediatric patients who weigh at least 40 kg and are 12 years of age and older. Sotrovimab is not authorized for patients under 12 years of age or pediatric patients weighing less than 40 kg [see Use in Specific Populations (11.3)].

    Geriatric Use

    No dosage adjustment is recommended in geriatric patients [see Use in Specific Populations (11.4)].

    Renal Impairment

    No dosage adjustment is recommended in patients with renal impairment [see Use in Specific Populations (11.5)].

    2.4 Dose Preparation and Administration

    Preparation

    Sotrovimab is supplied in a single-dose vial and must be diluted prior to administration.

    Sotrovimab injection should be prepared by a qualified healthcare professional using aseptic technique:

    • Gather the materials for preparation:
      • o Polyvinyl chloride (PVC) or polyolefin (PO), sterile prefilled infusion bag. Choose one of the following sizes: prefilled 50-mL or 100-mL infusion bag containing 0.9% Sodium Chloride Injection, and
      • o One vial of sotrovimab (500 mg/8 mL).
    • Remove one vial of sotrovimab from refrigerated storage and allow to equilibrate to room temperature, protected from light, for approximately 15 minutes.
    • Inspect the vial of sotrovimab visually for particulate matter and discoloration prior to administration. Should either be observed, the solution must be discarded and fresh solution prepared. Sotrovimab is a clear, colorless or yellow to brown solution.
    • Gently swirl the vial several times before use without creating air bubbles. Do not shake the vial.
    • Withdraw 8 mL of sotrovimab from one vial and inject into the prefilled infusion bag containing 0.9% Sodium Chloride Injection.
    • Discard any product remaining in the vial.
    • Prior to the infusion, gently rock the infusion bag back and forth by hand 3 to 5 times. Do not invert the infusion bag. Avoid forming air bubbles.
    • This product is preservative-free; therefore, the diluted infusion solution should be administered immediately. If immediate administration is not possible, store the diluted solution of sotrovimab up to 4 hours at room temperature (20°C to 25°C [68°F to 77°F]) or refrigerated up to 24 hours (2°C to 8°C [36°F to 46°F]).

    Administration

    Sotrovimab infusion solution should be administered by a qualified healthcare professional.

    • Gather the materials for infusion:
      • o Polyvinyl chloride (PVC) or polyolefin (PO) infusion set, and
      • o Use of a 0.2 micron polyethersulfone (PES) filter is strongly recommended.
    • Attach the infusion set to the IV bag using standard bore tubing.
    • Prime the infusion set.
    • Administer the entire infusion solution in the bag over 30 minutes. Due to potential overfill of prefilled saline bags, the entire infusion solution in the bag should be administered to avoid underdosage.
    • Do not administer as an IV push or bolus.
    • The prepared infusion solution should not be administered simultaneously with any other medication. The compatibility of sotrovimab with IV solutions and medications other than 0.9% Sodium Chloride Injection is not known.
    • Once infusion is complete, flush the tubing with 0.9% Sodium Chloride to ensure delivery of the required dose.
    • If the infusion must be discontinued due to an infusion reaction, discard unused product.
    • Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.

    Storage

    This product is preservative-free; therefore, the diluted infusion solution should be administered immediately. If immediate administration is not possible, store the diluted infusion solution for up to 24 hours at refrigerated temperature (2°C to 8°C [36°F to 46°F]) or up to 4 hours at room temperature (20°C to 25°C [68°F to 77°F]) including transportation and infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 15 minutes prior to administration.

  • 3 DOSAGE FORMS AND STRENGTHS

    Sotrovimab is a sterile, preservative-free, clear, colorless or yellow to brown solution available as:

    • Injection: 500-mg/8-mL (62.5-mg/mL) solution in a single-dose vial for intravenous infusion after dilution.
  • 4 CONTRAINDICATIONS

    None.

  • 5 WARNINGS AND PRECAUTIONS

    There are limited clinical data available for sotrovimab. Serious and unexpected adverse events may occur that have not been previously reported with sotrovimab use.

    5.1 Hypersensitivity Including Anaphylaxis and Infusion-Related Reactions

    Serious hypersensitivity reactions, including anaphylaxis, have been observed with administration of sotrovimab [see Overall Safety Summary (6.1)]. If signs and symptoms of a clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue administration and initiate appropriate medications and/or supportive care.

    Infusion-related reactions, occurring during the infusion and up to 24 hours after the infusion, have been observed with administration of sotrovimab. These reactions may be severe or life threatening.

    Signs and symptoms of infusion‑related reactions may include [see Overall Safety Summary (6.1)]:

    • fever, difficulty breathing, reduced oxygen saturation, chills, fatigue, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), chest pain or discomfort, weakness, altered mental status, nausea, headache, bronchospasm, hypotension, hypertension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, vaso-vagal reactions (e.g., pre-syncope, syncope), dizziness, and diaphoresis.

    Consider slowing or stopping the infusion and administer appropriate medications and/or supportive care if an infusion related reaction occurs.

    Hypersensitivity reactions occurring more than 24 hours after the infusion have also been reported with the use of SARS-CoV-2 monoclonal antibodies under Emergency Use Authorization.

    5.2 Clinical Worsening After SARS-CoV-2 Monoclonal Antibody Administration

    Clinical worsening of COVID‑19 after administration of SARS-CoV-2 monoclonal antibody treatment has been reported and may include signs or symptoms of fever, hypoxia or increased respiratory difficulty, arrythmia (e.g., atrial fibrillation, tachycardia, bradycardia), fatigue, and altered mental status. Some of these events required hospitalization. It is not known if these events were related to SARS-CoV-2 monoclonal antibody use or were due to progression of COVID‑19.

    5.3 Limitations of Benefit and Potential for Risk in Patients with Severe COVID19

    Benefit of treatment with sotrovimab has not been observed in patients hospitalized due to COVID‑19. SARS-CoV-2 monoclonal antibodies may be associated with worse clinical outcomes when administered to hospitalized patients with COVID‑19 requiring high flow oxygen or mechanical ventilation. Therefore, sotrovimab is not authorized for use in patients [see Limitations of Authorized Use]:

    • who are hospitalized due to COVID‑19, OR
    • who require oxygen therapy due to COVID‑19, OR
    • who require an increase in baseline oxygen flow rate due to COVID‑19 in those on chronic oxygen therapy due to underlying non‑COVID‑19 related comorbidity.
  • 6 OVERALL SAFETY SUMMARY

    6.1 Clinical Trials Experience

    The ongoing Phase 1/2/3 double-blind, placebo-controlled, randomized study enrolled 1,057 non-hospitalized patients with COVID-19 (COMET-ICE). The safety of sotrovimab is primarily based on an interim analysis from 868 patients through Day 15 [see Clinical Trial Results and Supporting Data for EUA (18)].

    All patients received a single 500-mg infusion of sotrovimab (n = 430) or placebo (n = 438). Two patients experienced treatment interruptions due to infusion site extravasation; infusion was completed for each.

    Infusion-related reactions, including immediate hypersensitivity reactions, have been observed in 1% of patients treated with sotrovimab and 1% of patients treated with placebo in COMET-ICE. Reported events that started within 24 hours of study treatment were pyrexia, chills, dizziness, dyspnea, pruritus, rash, and infusion-related reactions; all events were Grade 1 (mild) or Grade 2 (moderate).

    One case of anaphylaxis was reported following sotrovimab infusion in a study in hospitalized patients; the infusion was immediately discontinued, and the patient received epinephrine. The event resolved but recurred within 2 hours; the patient received another dose of epinephrine and improved with no additional reactions. Other serious infusion-related reactions (including immediate hypersensitivity reactions) reported following sotrovimab infusion in the hospitalized study included Grade 3 (serious) or Grade 4 (life-threatening) bronchospasm and shortness of breath. These events were also reported following infusion of placebo. Sotrovimab is not authorized for use in patients hospitalized due to COVID-19 [see Warnings and Precautions (5.1, 5.3)].

    The most common treatment-emergent adverse events observed in the sotrovimab treatment group in COMET-ICE were rash (2%) and diarrhea (1%), all of which were Grade 1 (mild) or Grade 2 (moderate). No other treatment-emergent adverse events were reported at a higher rate with sotrovimab compared to placebo.

  • 7 PATIENT MONITORING RECOMMENDATIONS

    Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.

  • 8 ADVERSE REACTIONS AND MEDICATION ERRORS REPORTING REQUIREMENTS AND INSTRUCTIONS

    Clinical trials evaluating the safety of sotrovimab are ongoing [see Overall Safety Summary (6)].

    Completion of an FDA MedWatch Form to report all medication errors and serious adverse events* occurring during sotrovimab use and considered to be potentially related to sotrovimab is mandatory and must be done by the prescribing healthcare provider and/or the provider’s designee. These adverse events must be reported within 7 calendar days from the onset of the event:

    *Serious adverse events are defined as:

    • death;
    • a life-threatening adverse event;
    • inpatient hospitalization or prolongation of existing hospitalization;
    • a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions;
    • a congenital anomaly/birth defect;
    • a medical or surgical intervention to prevent death, a life-threatening event, hospitalization, disability, or congenital anomaly.

    If a serious and unexpected adverse event occurs and appears to be associated with the use of sotrovimab, the prescribing healthcare provider and/or the provider’s designee should complete and submit a MedWatch form to FDA using one of the following methods:

    IMPORTANT: When reporting adverse events or medication errors to MedWatch, please complete the entire form with detailed information. It is important that the information reported to FDA be as detailed and complete as possible. Information should include:

    • Patient demographics (e.g., patient initials, date of birth),
    • Pertinent medical history,
    • Pertinent details regarding admission and course of illness,
    • Concomitant medications,
    • Timing of adverse event(s) in relationship to administration of sotrovimab,
    • Pertinent laboratory and virology information,
    • Outcome of the event and any additional follow-up information if it is available at the time of the MedWatch report. Subsequent reporting of follow-up information should be completed if additional details become available.

    The following steps are highlighted to provide the necessary information for safety tracking:

    • 1. In Section A, Box 1, provide the patient’s initials in the Patient Identifier.
    • 2. In Section A, Box 2, provide the patient’s date of birth.
    • 3. In Section B, Box 5, description of the event:
      • a. Write “Sotrovimab use for COVID-19 under Emergency Use Authorization (EUA)” as the first line.
      • b. Provide a detailed report of medication error and/or adverse event. It is important to provide detailed information regarding the patient and adverse event/medication error for ongoing safety evaluation of this unapproved drug. Please see information to include listed above.
    • 4. In Section G, Box 1, name and address:
      • c. Provide the name and contact information of the prescribing healthcare provider or institutional designee who is responsible for the report.
      • d. Provide the address of the treating institution (NOT the healthcare provider’s office address).
  • 9 OTHER REPORTING REQUIREMENTS

    • In addition, please provide a copy of all FDA MedWatch forms to:

      GlaxoSmithKline, Global Safety
      Fax: 919-287-2902
      Email: WW.GSKAEReportingUS@gsk.com
      Or call the GSK COVID Contact Center at 1-866-GSK-COVID (866-475-2684) to report adverse events.
  • 10 DRUG INTERACTIONS

    Clinical drug-drug interaction studies have not been performed with sotrovimab. Sotrovimab is not renally excreted or metabolized by cytochrome P450 (CYP) enzymes; therefore, interactions with concomitant medications that are renally excreted or that are substrates, inducers, or inhibitors of CYP enzymes are unlikely.

  • 11 USE IN SPECIFIC POPULATIONS

    11.1 Pregnancy

    Risk Summary

    There are insufficient data to evaluate a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcome. Sotrovimab should be used during pregnancy only if the potential benefit justifies the potential risk for the mother and the fetus.

    Nonclinical reproductive toxicity studies have not been conducted with sotrovimab. In a cross-reactive binding assay using a protein array enriched for human embryofetal proteins, no off-target binding was detected for sotrovimab. Since sotrovimab is an Fc‑enhanced human immunoglobulin G (IgG), it has the potential for placental transfer from the mother to the developing fetus. The potential treatment benefit or risk of placental transfer of sotrovimab to the developing fetus is not known.

    The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

    11.2 Lactation

    Risk Summary

    There are no available data on the presence of sotrovimab in human or animal 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 sotrovimab and any potential adverse effects on the breastfed infant from sotrovimab or from the underlying maternal condition. Individuals with COVID-19 who are breastfeeding should follow practices according to clinical guidelines to avoid exposing the infant to COVID-19.

    11.3 Pediatric Use

    Sotrovimab is not authorized for use in pediatric patients under 12 years of age or weighing less than 40 kg. The safety and effectiveness of sotrovimab have not been assessed in pediatric patients. The recommended dosing regimen in patients 12 years to less than 18 years of age, weighing at least 40 kg, is expected to result in comparable serum exposures of sotrovimab as those observed in adults based on an allometric scaling approach (which accounted for effect of body weight changes associated with age on clearance and volume of distribution).

    11.4 Geriatric Use

    Of the 430 patients receiving sotrovimab in COMET-ICE, 20% were 65 years of age and older and 10% were over 70 years of age. The difference in pharmacokinetics (PK) of sotrovimab in geriatric patients compared to younger patients has not been quantified.

    11.5 Renal Impairment

    No clinical trials have been conducted to evaluate the effects of renal impairment on the PK of sotrovimab. Sotrovimab is not eliminated intact in the urine, thus renal impairment is not expected to affect the exposure of sotrovimab.

    11.6 Hepatic Impairment

    No clinical trials have been conducted to evaluate the effects of hepatic impairment on the PK of sotrovimab. The impact of hepatic impairment on the PK of sotrovimab is unknown.

  • 12 OVERDOSAGE

    There is no human experience of acute overdosage with sotrovimab.

    There is no specific treatment for an overdose with sotrovimab. If overdose occurs, the patient should be treated supportively with appropriate monitoring as necessary.

  • 13 PRODUCT DESCRIPTION

    Sotrovimab is a human immunoglobulin G-1 (IgG1-kappa) monoclonal antibody consisting of 2 identical light chain (LC) polypeptides composed of 214 amino acids each and 2 identical heavy chain (HC) polypeptides, each composed of 457 amino acids. Sotrovimab is produced by a Chinese Hamster Ovary cell line and has a molecular weight of approximately 149 kDa.

    Sotrovimab injection is a sterile, preservative-free, clear, colorless or yellow to brown solution supplied in a single-dose vial for intravenous infusion after dilution.

    Each mL contains sotrovimab (62.5 mg), L-histidine (1.51 mg), L-histidine monohydrochloride (2.15 mg), L-methionine (0.75 mg), polysorbate 80 (0.4 mg), and sucrose (70 mg). The solution of sotrovimab has a pH of 6.0.

  • 14 CLINICAL PHARMACOLOGY

    14.1 Mechanism of Action

    Sotrovimab is a recombinant human IgG1-kappa mAb that binds to a conserved epitope on the spike protein receptor binding domain of SARS-CoV-2 with a dissociation constant KD = 0.21 nM) but does not compete with human ACE2 receptor binding (IC50 value >33.6 nM [5 µg/mL]). Sotrovimab inhibits an undefined step that occurs after virus attachment and prior to fusion of the viral and cell membranes. The Fc domain of sotrovimab includes M428L and N434S amino acid substitutions (LS modification) that extend antibody half-life, but do not impact wild-type Fc-mediated effector functions in cell culture.

    14.2 Pharmacokinetics

    It is expected that the half-life of sotrovimab is longer than Fc-unmodified IgG due to the LS modification, but data are not available. Based on noncompartmental analysis, the mean (geomean) Cmax following a 1 hour IV infusion was 137 µg/mL (N = 129, CV% 40), and the mean (geomean) Day 29 concentration was 34 µg/mL (N = 78, CV% 23) from all subjects with an available Day 29 sample.

    Specific Populations

    The effect of different covariates (e.g., age, sex, race, body weight, disease severity, hepatic impairment) on the PK of sotrovimab is unknown. Renal impairment is not expected to impact the PK of sotrovimab since mAbs with molecular weight >69 kDa do not undergo renal elimination. Similarly, dialysis is not expected to impact the PK of sotrovimab.

  • 15 MICROBIOLOGY/RESISTANCE INFORMATION

    Antiviral Activity

    The neutralization activity of sotrovimab against SARS-CoV-2 (isolate USA WA1/2020) was measured in a concentration response model using cultured Vero E6 cells. Sotrovimab neutralized SARS‑CoV-2 with an average EC50 value of 0.67 nM (100.1 ng/mL) and an average EC90 value of 1.2 nM (186.3 ng/mL).

    Sotrovimab demonstrated cell culture FcγR activation using Jurkat reporter cells expressing FcγRIIa (low-affinity R131 and high affinity H131 alleles), FcγRIIIa (low-affinity F158 and high-affinity V158 alleles) and FcγRIIb. Sotrovimab exhibited antibody-dependent cell-mediated cytotoxicity (ADCC) in cell culture using isolated human natural killer (NK) cells following engagement with target cells expressing spike protein. Sotrovimab also elicited antibody-dependent cellular phagocytosis (ADCP) in cell-based assays using CD14+ monocytes targeting cells expressing spike protein.

    Antibody Dependent Enhancement (ADE) of Infection

    The risk that sotrovimab could mediate viral uptake and replication by immune cells was studied in U937 cells, primary human monocytic dendritic cells, and peripheral blood mononuclear cells. This experiment did not demonstrate productive viral infection in immune cells exposed to SARS CoV-2 in the presence of concentrations of sotrovimab from 1-fold down to 1000-fold below the EC50 value.

    The potential for ADE was also evaluated in a hamster model of SARS-CoV-2 using sotrovimab. Intraperitoneal administration prior to inoculation resulted in a dose-dependent improvement in all measured outcomes (body weight, lung weight, total viral RNA in the lungs, or infectious virus levels based on TCID50 measurements). No evidence of enhancement of disease was observed at any dose evaluated, including sub-neutralizing doses down to 0.05 mg/kg.

    Antiviral Resistance

    There is a potential risk of treatment failure due to the development of viral variants that are resistant to sotrovimab. Prescribing healthcare providers should consider the prevalence of SARS-CoV-2 variants in their area, where data are available, when considering treatment options.

    An E340A amino acid substitution in the spike protein emerged in cell culture selection of resistant virus and had a >100-fold reduction in activity in a pseudotyped virus-like particle (VLP) assay. This substitution is in the conserved epitope of sotrovimab, which is comprised of 23 amino acids. A pseudotyped VLP assessment in cell culture showed that epitope amino acid sequence polymorphisms P337H/L/R/T and E340A/K/G conferred reduced susceptibility to sotrovimab based on observed fold-increase in EC50 value shown in parentheses: E340K (>297), P337R (>276), P337L (180), E340A (>100), E340G (27), P337H (7.5), and P337T (5.4). The presence of the highly prevalent D614G variant, either alone or in combination, did not alter neutralization of sotrovimab. Pseudotyped VLP assessments indicate that sotrovimab retains activity against the UK (2.3-fold change in EC50 value; B.1.1.7: H69-, V70-, Y144‑, N501Y, A570D, D614G, P681H, T716I, S982A, D1118H), South Africa (0.6-fold change in EC50 value; B.1.351: L18F, D80A, D215G, R246I, K417N, E484K, N501Y, D614G, A701V), Brazil (0.35-fold change in EC50 value; P.1: L18F, T20N, P26S, D138Y, R190S, K417T, E484K, N501Y, D614G, H655Y, T1027I, V1176F), California (0.7‑fold change in EC50 value; CAL.20C: S13I, W152C, L452R, D614G), New York (0.6-fold change in EC50 value; B.1.526: L5F, T95I, D253G, E484K, D614G, A701V), and India (0.7-fold change in EC50 value; B.1.617; T95I, G142D, E154K, L452R, E484Q, D614G, P681R, and Q1071H) variant spike proteins (Table 1). Microneutralization data using authentic SARS-CoV-2 variant virus indicate that sotrovimab retains activity against the UK (3-fold change in EC50 value), South Africa (1.2-fold change in EC50 value) and Brazil (1.6‑fold change in EC50 value) variants (Table 1).

    Table 1: Authentic SARS-CoV-2 and Pseudotyped Virus-Like Particle Neutralization Data for SARS-CoV-2 Variant Substitutions with Sotrovimab
    a  For variants with more than one substitution of concern, only the one(s) with the greatest impact on activity is (are) listed.
    b  No change: <5-fold reduction in susceptibility
    c  Not all isolates of the New York lineage harbor the E484K substitution (as of February 2021).
    d  Not determined.

    Lineage with Spike Protein Substitution

    Key Substitutions Testeda

    Fold Reduction in Susceptibility (Pseudotyped VLP)

    Fold Reduction in Susceptibility (Authentic Virus)

    B.1.1.7 (UK origin)

    N501Y

    No changeb

    No changeb

    B.1.351 (South Africa origin)

    K417N + E484K + N501Y

    No changeb

    No changeb

    P.1 (Brazil origin)

    K417T + E484K + N501Y

    No changeb

    No changeb

    B.1.427/B.1.429 (California origin)

    L452R

    No changeb

    ndd

    B.1.526 (New York origin)c

    E484K

    No changeb

    ndd

    B.1.617 (India origin)

    L452R + E484Q

    No changeb

    ndd

    Limited nucleotide sequencing data from a total of 218 participants, at the time of authorization, indicated that 9 participants (5 placebo and 4 treated with sotrovimab) enrolled in COMET-ICE were infected with the CAL.20C variant (S13I, W152C, L452R), and one subject treated with sotrovimab progressed to require hospitalization. Two additional participants in the placebo group carried the L452R variant only. None of the participants were infected with SARS-CoV-2 that contained the full complement of spike substitutions characteristic of the UK (B.1.1.7), South African (B.1.351), or Brazilian (P.1) variants. One participant in the placebo group carried the N501Y variant at baseline.

    In COMET-ICE, post-baseline epitope variants were detected in eight participants in the cohort receiving sotrovimab (spike protein substitutions E340K [4 subjects: ≥99.7% allele frequency]; A344V [6.2%]; K356R [7.5%]; S359G [2 subjects: 12.2% and 8.3%]). Of the variants detected at baseline and post-baseline, L335F, G339C, E340A, E340K, R346I, K356N, K356R, R357I, I358V and S359G substitutions have been assessed phenotypically using a pseudotyped VLP system. E340A and E340K substitutions confer reduced susceptibility to sotrovimab (>100-fold and >297-fold changes in EC50 value, respectively). Sotrovimab retains susceptibility against L335F (0.8-fold change in EC50 value), G339C (1.2-fold change in EC50 value), R346I (1.7-fold change in EC50 value), K356N (1.1-fold change in EC50 value), K356R (0.8-fold change in EC50 value), R357I (1-fold change in EC50 value), I358V (0.7-fold change in EC50 value), and S359G (0.8-fold change in EC50 value) substitutions. The clinical impact of these variants is not yet known. Data collection and analysis is still ongoing.

    Immune Response Attenuation

    There is a theoretical risk that antibody administration may attenuate the endogenous immune response to SARS-CoV-2 and make patients more susceptible to re-infection.

  • 16 NONCLINICAL TOXICOLOGY

    Carcinogenesis, mutagenesis, and reproductive toxicology studies with sotrovimab have not been conducted.

    In a toxicology study in monkeys, sotrovimab had no adverse effects when administered intravenously.

    In tissue cross reactivity studies using human and monkey adult tissues, no binding of clinical concern was detected for sotrovimab.

    In a cross-reactive binding assay using a protein array enriched for human embryofetal proteins, no off-target binding was detected for sotrovimab.

  • 17 ANIMAL PHARMACOLOGIC AND EFFICACY DATA

    In a Syrian Golden hamster model of SARS-CoV-2 infection, antiviral activity was demonstrated using a single dose of sotrovimab which was administered intraperitoneally at 24- or 48-hours prior to infection. Animals receiving 5 mg/kg or more of the antibody showed a significant improvement in body weight loss and significantly decreased total lung SARS-CoV-2 viral RNA compared to vehicle only and control antibody-treated animals. Levels of virus in the lung (as measured by TCID50) were significantly decreased versus controls in hamsters receiving 0.5 mg/kg or more of the antibody.

  • 18 CLINICAL TRIAL RESULTS AND SUPPORTING DATA FOR EUA

    Clinical data supporting this EUA are based on an interim analysis from the Phase 1/2/3 COMET-ICE trial (NCT #04545060) that occurred after 583 randomized subjects had the opportunity to complete at least Day 29 of the trial. COMET-ICE is an ongoing, randomized, double-blind, placebo-controlled trial studying sotrovimab for the treatment of subjects with mild-to-moderate COVID-19 (subjects with COVID-19 symptoms who are not hospitalized). Eligible subjects were 18 years of age and older with at least one of the following comorbidities: diabetes, obesity (BMI >30), chronic kidney disease, congestive heart failure, chronic obstructive pulmonary disease, or moderate to severe asthma, or were 55 years of age and older regardless of comorbidities. The study included symptomatic patients with SARS-CoV-2 infection as confirmed by local laboratory tests and/or point of care tests and symptom onset within 5 days of enrollment. Subjects with severe COVID-19 requiring supplemental oxygen or hospitalization and severely immunocompromised patients were excluded from the trial. Subjects were treated with a single 500-mg infusion of sotrovimab (n = 291) or placebo (n = 292) over 1 hour (Intent to Treat [ITT] population at interim analysis 1).

    At baseline, the median age was 53 years (range:18 to 96); 22% of subjects were 65 years of age or older and 11% were over 70 years of age; 46% of subjects were male; 87% were White, 7% Black or African American, 6% Asian, 63% Hispanic or Latino. Fifty-eight percent of subjects received sotrovimab or placebo within 3 days of COVID-19 symptom onset and 42% within 4 to 5 days. The three most common pre-defined risk factors or comorbidities were obesity (63%), 55 years of age or older (47%), and diabetes requiring medication (23%). Overall, baseline demographic and disease characteristics were well balanced between the treatment arms.

    The primary endpoint, progression of COVID-19 at Day 29, was reduced by 85% (adjusted relative risk reduction) in recipients of sotrovimab versus placebo (p = 0.002). Table 2 provides the results of the primary endpoint and a key secondary endpoint of COMET-ICE.

    Table 2. Interim Efficacy Results in Adults with Mild-to-Moderate COVID-19

    Sotrovimab

    n = 291

    Placebo

    n = 292

    Progression of COVID-19 (defined as hospitalization for >24 hours for acute management of any illness or death from any cause) (Day 29)

    Proportion (n, %)

    3 (1%)

    21 (7%)

    Adjusted Relative Risk Reduction (97.24% CI)

    85%

    (44%, 96%)

    p-value

    0.002

    All-cause mortality (up to Day 29)

    Proportion (n, %)

    0

    1 (<1%)

    Analysis of change from baseline in viral load in COMET-ICE is not yet possible because data are not available in the majority of trial participants.

  • 19 HOW SUPPLIED/STORAGE AND HANDLING

    How Supplied

    Sotrovimab injection 500 mg (62.5 mg/mL) is a sterile, preservative-free, clear, colorless or yellow to brown solution supplied in a carton containing one single-dose glass vial with a rubber vial stopper (not made with natural rubber latex) and a flip-off cap (NDC: 0173-0901-86).

    Storage and Handling

    Sotrovimab is preservative-free. Discard unused portion.

    Store unopened vials refrigerated at 2°C to 8°C (36°F to 46°F) in original carton. Do not freeze or shake. Protect from light.

    The solution of sotrovimab in the vial is preservative-free and requires dilution prior to administration. The diluted infusion solution of sotrovimab should be administered immediately. If immediate administration is not possible, store the diluted infusion solution for up to 24 hours at refrigerated temperature (2°C to 8°C [36°F to 46°F]) or up to 4 hours at room temperature (20°C to 25°C [68°F to 77°F]) including transportation and infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 15 minutes prior to administration.

  • 20 PATIENT COUNSELING INFORMATION

    Patients treated with sotrovimab should continue to self-isolate and use infection control measures (e.g., wear mask, isolate, social distance, avoid sharing personal items, clean and disinfect “high touch” surfaces, and frequent handwashing) according to CDC guidelines. Also, see “Fact Sheet for Patients, Parents, and Caregivers”.

  • 21 CONTACT INFORMATION

    For additional information visit www.sotrovimabinfo.com

    If you have questions, please call the GSK COVID Contact Center at 1-866-GSK-COVID (866-475-2684).

    Manufactured by GlaxoSmithKline LLC

    Philadelphia, PA 19112, U.S. License No. 1727

    Distributed by GlaxoSmithKline

    Research Triangle Park, NC 27709

    ©2021 GSK group of companies or its licensor.

    STR:2FS-HCP

    Revised: July 2021

    DETACH HERE AND GIVE FACT SHEET TO PATIENT, PARENT OR CAREGIVER.

  • FACT SHEET FOR PATIENTS, PARENTS, AND CAREGIVERS

    Emergency Use Authorization (EUA) of Sotrovimab for the Treatment of Coronavirus Disease 2019 (COVID-19)

    You are being given a medicine called sotrovimab for the treatment of coronavirus disease 2019 (COVID‑19). This Fact Sheet contains information to help you understand the potential risks and potential benefits of taking sotrovimab, which you may receive.

    Receiving sotrovimab may benefit certain people with COVID‑19.

    Read this Fact Sheet for information about sotrovimab. Talk to your healthcare provider if you have any questions. It is your choice to receive sotrovimab or stop it at any time.

    What is COVID-19?

    COVID-19 is caused by a virus called a coronavirus. People can get COVID‑19 through contact with another person who has the virus.

    COVID-19 illnesses have ranged from very mild (including some with no reported symptoms) to severe, including illness resulting in death. While information so far suggests that most COVID-19 illness is mild, serious illness can happen and may cause other medical conditions to become worse. People of all ages with severe, long-lasting (chronic) medical conditions like heart disease, lung disease, diabetes, for example, and other conditions including obesity, seem to be at higher risk of being hospitalized for COVID-19. Older age, with or without other conditions, also places people at higher risk of being hospitalized for COVID-19.

    What are the symptoms of COVID-19?

    The symptoms of COVID‑19 are fever, cough, and shortness of breath, which may appear 2 to 14 days after exposure. Serious illness, including breathing problems, can occur and may cause your other medical conditions to become worse.

    What is sotrovimab?

    Sotrovimab is an investigational medicine used to treat mild-to-moderate symptoms of COVID‑19 in adults and children (12 years of age and older weighing at least 88 pounds [40 kg]) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk of progression to severe COVID-19, including hospitalization or death. Sotrovimab is investigational because it is still being studied. There is limited information about the safety and effectiveness of using sotrovimab to treat people with mild-to-moderate COVID-19.

    The U.S. Food & Drug Administration (FDA) has authorized the emergency use of sotrovimab for the treatment of COVID-19 under an Emergency Use Authorization (EUA). For more information on EUA, see the “What is an Emergency Use Authorization (EUA)?” section at the end of this Fact Sheet.

    What should I tell my healthcare provider before I receive sotrovimab?

    Tell your healthcare provider about all of your medical conditions, including if you:

    • Have any allergies
    • Are pregnant or plan to become pregnant
    • Are breastfeeding or plan to breastfeed
    • Have any serious illnesses
    • Are taking any medicines (prescription, over-the-counter, vitamins, or herbal products)

    How will I receive sotrovimab?

    • You will receive 1 dose of sotrovimab.
    • Sotrovimab will be given to you through a vein (intravenous or IV infusion) over 30 minutes.
    • You will be observed by your healthcare provider for at least 1 hour after you receive sotrovimab.

    What are the important possible side effects of sotrovimab?

    Possible side effects of sotrovimab are:

    • Allergic reactions. Allergic reactions can happen during and after infusion with sotrovimab. Tell your healthcare provider right away if you get any of the following signs and symptoms of allergic reactions: fever; difficulty breathing; low oxygen level in your blood; chills; tiredness; fast or slow heart rate; chest discomfort or pain; weakness; confusion; nausea; headache; shortness of breath; low or high blood pressure; wheezing; swelling of your lips, face, or throat; rash including hives; itching; muscle aches; dizziness; feeling faint; and sweating.

    The side effects of getting any medicine through a vein may include brief pain, bleeding, bruising of the skin, soreness, swelling, and possible infection at the infusion site.

    These are not all the possible side effects of sotrovimab. Not many people have been given sotrovimab. Serious and unexpected side effects may happen. Sotrovimab is still being studied, so it is possible that all of the risks are not known at this time.

    It is possible that sotrovimab could interfere with your body’s own ability to fight off a future infection of SARS-CoV-2. Similarly, sotrovimab may reduce your body’s immune response to a vaccine for SARS-CoV-2. Specific studies have not been conducted to address these possible risks. Talk to your healthcare provider if you have any questions.

    What other treatment choices are there?

    Like sotrovimab, FDA may allow for the emergency use of other medicines to treat people with COVID-19. Go to https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization for information on the emergency use of other medicines that are not approved by FDA to treat people with COVID-19. Your healthcare provider may talk with you about clinical trials for which you may be eligible.

    It is your choice to be treated or not to be treated with sotrovimab. Should you decide not to receive sotrovimab, or stop it at any time, it will not change your standard medical care.

    What if I am pregnant or breastfeeding?

    There is no experience treating pregnant women or breastfeeding mothers with sotrovimab. For a mother and unborn baby, the benefit of receiving sotrovimab may be greater than the risk from the treatment. If you are pregnant or breastfeeding, discuss your options and specific situation with your healthcare provider.

    How do I report side effects with sotrovimab?

    Tell your healthcare provider right away if you have any side effects that bother you or do not go away.

    Report side effects to FDA MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088, or call the GSK COVID Contact Center at 1-866-GSK-COVID (866-475-2684).

    How can I learn more?

    What is an Emergency Use Authorization (EUA)?

    The FDA has made sotrovimab available under an emergency access mechanism called an EUA. The EUA is supported by a Secretary of Health and Human Service (HHS) declaration that circumstances exist to justify the emergency use of drugs and biological products during the COVID-19 pandemic.

    Sotrovimab has not undergone the same type of review as an FDA-approved medicine. In issuing an EUA under the COVID-19 public health emergency, the FDA must determine, among other things, that based on the totality of scientific evidence available, it is reasonable to believe that the product may be effective for diagnosing, treating, or preventing COVID-19, or a serious or life-threatening disease or condition caused by COVID-19; that the known and potential benefits of the product, when used to diagnose, treat, or prevent such disease or condition, outweigh the known and potential risks of such product; and that there are no adequate, approved and available alternatives. All of these criteria must be met to allow for the medicine to be used in the treatment of patients during the COVID‑19 pandemic.

    The EUA for sotrovimab is in effect for the duration of the COVID-19 declaration justifying emergency use of these medicines, unless terminated or revoked (after which the products may no longer be used).

    Manufactured by GlaxoSmithKline LLC
    Philadelphia, PA 19112, U.S. License No. 1727
    Distributed by GlaxoSmithKline
    Research Triangle Park, NC 27709
    ©2021 GSK group of companies or its licensor.
    STR:1FS-P
    Issued: May 2021

  • PRINCIPAL DISPLAY PANEL

    PRINCIPAL DISPLAY PANEL

    NDC: 0173-0901-86

    Sotrovimab

    Injection

    500 mg/8 mL

    (62.5 mg/mL)

    Rx Only

    For intravenous infusion after further dilution.

    Contains One 8-mL Single-Dose Vial.

    Discard Unused Portion.

    For Use Under Emergency Use Authorization (EUA)

    ©2021 GSK group of companies or its licensor.

    Product of China

    Rev. 4/21

    62000000058567

    Sotrovimab EUA carton
  • INGREDIENTS AND APPEARANCE
    SOTROVIMAB 
    sotrovimab injection, solution, concentrate
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC: 0173-0901
    Route of AdministrationINTRAVENOUS
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    SOTROVIMAB (UNII: 1MTK0BPN8V) (SOTROVIMAB - UNII:1MTK0BPN8V) SOTROVIMAB62.5 mg  in 1 mL
    Inactive Ingredients
    Ingredient NameStrength
    HISTIDINE MONOHYDROCHLORIDE (UNII: 1D5Q932XM6)  
    METHIONINE (UNII: AE28F7PNPL)  
    POLYSORBATE 80 (UNII: 6OZP39ZG8H)  
    SUCROSE (UNII: C151H8M554)  
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC: 0173-0901-861 in 1 CARTON05/26/2021
    18 mL in 1 VIAL; Type 0: Not a Combination Product
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    Unapproved drug other05/26/2021
    Labeler - GlaxoSmithKline LLC (167380711)

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