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  • 7 Westferry Circus Canary Wharf London E14 4HB United Kingdom

    An agency of the European Union Telephone +44 (0)20 7418 8400 Facsimile +44 (0)20 7523 7455 E-mail info@ema.europa.eu Website www.ema.europa.eu

    15 November 2012

    EMA/790069/2012 Committee for Medicinal Products for Human Use (CHMP)

    Assessment report

    Bexsero

    Common name: Meningococcal group B Vaccine (rDNA, component, adsorbed)

    Procedure No. EMEA/H/C/002333

    Assessment Report as adopted by the CHMP with all information of a commercially confidential nature deleted.

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    Product information

    Name of the medicinal product:

    Bexsero

    Applicant:

    Novartis Vaccines and Diagnostics S.r.l. Via Fiorentina, 1 IT-53100 Siena Italy

    Active substance:

    -Recombinant Neisseria meningitidis group B NHBA fusion protein -Recombinant Neisseria meningitidis group B NadA protein -Recombinant Neisseria meningitidis group B fHbp fusion protein

    -Outer membrane vesicles (OMV) from Neisseria meningitidis group B strain NZ98/254 measured as amount of total protein containing the PorA P1.4

    Common Name:

    Meningococcal group B Vaccine (rDNA, component, adsorbed)

    Pharmaco-therapeutic group (ATC Code):

    Meningococcal vaccines (J07AH09)

    Therapeutic indication:

    Bexsero is indicated for active immunisation of individuals from 2 months of age and older against invasive meningococcal disease caused by Neisseria meningitidis group B. The impact of invasive disease in different age groups as well as the variability of antigen epidemiology for group B strains in different geographical areas should be considered when vaccinating. See section 5.1 for information on protection against specific group B strains. The use of this vaccine should be in accordance with official recommendations.

    Pharmaceutical form:

    Suspension for injection

    Strengths:

    One dose (0.5 ml) contains:

    -Recombinant Neisseria meningitidis group B NHBA fusion protein 50 micrograms

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    -Recombinant Neisseria meningitidis group B NadA protein 50 micrograms -Recombinant Neisseria meningitidis group B fHbp fusion protein 50 micrograms -Outer membrane vesicles (OMV) from Neisseria meningitidis group B strain NZ98/254 measured as amount of total protein containing the PorA P1.4 25 micrograms

    Route of administration:

    Intramuscular use

    Packaging:

    pre-filled syringe (glass)

    Package sizes:

    1 pre-filled syringe with needle, 1 pre-filled syringe without needle, 10 pre-filled syringes with needle, 10 pre-filled syringes without needle

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    Table of contents

    1. Background information on the procedure .............................................. 6 1.1. Submission of the dossier ...................................................................................... 6 1.2. Steps taken for the assessment of the product ......................................................... 7

    2. Scientific discussion ................................................................................ 8 2.1. Introduction......................................................................................................... 8 2.2. Quality aspects .................................................................................................... 9 2.3. Non-clinical aspects ............................................................................................ 19 2.4. Clinical aspects .................................................................................................. 23 2.5. Clinical efficacy .................................................................................................. 26 2.6. Clinical safety .................................................................................................... 85 2.7. Pharmacovigilance .............................................................................................. 94

    3. Benefit-Risk Balance ........................................................................... 98

    4. Recommendations ............................................................................. 100

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    List of abbreviations CI Confidence Interval

    CSR Clinical Study Report

    DTPa-HBV-IPV/Hib Infanrix Hexa (combined diphtheria and tetanus toxoids, acellular pertussis adsorbed, hepatitis B (recombinant), inactivated poliovirus, Haemophilus influenzae type b vaccine)

    ECDC European Centre for Disease Prevention and Control

    ELISA Enzyme Linked Immunosorbent Assay

    EU European Union

    GCP Good Clinical Practice

    GMC Geometric Mean Concentration

    GMR Geometric Mean Ratio

    GMT Geometric Mean Titer

    HHE Hypotonic-hyporesponsive Episode

    hSBA Serum Bactericidal Assay using Human Complement

    KD Kawasaki Disease

    LL Lower Limit

    MATS Meningococcal Antigen Typing System

    MedDRA Medical Dictionary for Regulatory Activities

    MenB serogroup B meningococcus

    MeNZB Outer membrane vesicle vaccine derived from Neisseria meningitidis serogroup B strain NZ98/254. This vaccine was developed to combat the outbreak of group B meningococcal disease in New Zealand

    MITT Modified Intention to Treat

    MMRV Priorix Tetra (measles, mumps, rubella and varicella live-vaccine vaccine)

    OMV Outer Membrane Vesicles

    OMV NZ Outer membrane vesicle derived from Neisseria meningitidis serogroup B strain NZ98/254 (New Zealand strain)

    OMV NW Outer membrane vesicle derived from Neisseria meningitidis serogroup B strain H44/76 (Norwegian strain)

    PCV7 PrevenarTM pneumococcal vaccine (7-valent pneumococcal conjugate vaccine)

    PP Per Protocol

    SBA Serum Bactericidal Assay

    SOC System Organ Class

    WHO World Health Organization

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    1. Background information on the procedure

    1.1. Submission of the dossier

    The applicant Novartis Vaccines and Diagnostics S.r.l. submitted on 7 January 2011 an application for Marketing Authorisation to the European Medicines Agency (EMA) for Bexsero, through the centralised procedure falling within the Article 3(1) and point 1 of Annex of Regulation (EC) No 726/2004.

    The applicant applied for the following indication, active immunisation of individuals from 2 months of age and older against invasive meningococcal disease caused by Neisseria meningitidis group B. The impact of invasive disease in different age groups as well as the variability of antigen epidemiology for group B strains in different geographical areas should be considered when vaccinating. See section 5.1 for information on protection against specific group B strains. The use of this vaccine should be in accordance with official recommendations.

    The legal basis for this application refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application.

    The application submitted is composed of administrative information, complete quality data, non-clinical and clinical data based on applicants own tests and studies and/or bibliographic literature substituting/supporting certain test(s) or study(ies).

    Information on Paediatric requirements

    Pursuant to Article 7 of Regulation (EC) No 1901/2006, the application included EMA Decision P/038/2011 on the agreement of a paediatric investigation plan (PIP).

    At the time of submission of the application, the PIP EMEA-000139-PIP01-M01 was not yet completed as some measures were deferred.

    Information relating to orphan market exclusivity

    Similarity

    Pursuant to Article 8 of Regulation (EC) No. 141/2000 and Article 3 of Commission Regulation (EC) No 847/2000, the applicant did not submit a critical report addressing the possible similarity with authorised orphan medicinal products because there is no authorised orphan medicinal product for a condition related to the proposed indication.

    New active Substance status

    The applicant requested the active substance Meningococcal group B vaccine contained in the above medicinal product to be considered as a new active substance in itself, as the applicant claims that it is not a constituent of a product previously authorised within the Union.

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    Scientific Advice

    The applicant received Scientific Advice from the CHMP during the development phase (2006, 2007, 2008 and 2009). The Scientific Advices pertained to insert quality, non-clinical and clinical aspects of the dossier.

    Licensing status

    The product was not licensed in any country at the time of submission of the application.

    1.2. Steps taken for the assessment of the product

    The Rapporteur and Co-Rapporteur appointed by the CHMP and the evaluation teams were:

    Rapporteur: Kristina Dunder

    Co-Rapporteur: Karsten Bruins Slot

    The application was received by the EMA on 7 January 2011.

    The procedure started on 19 January 2011.

    The Rapporteur's first Assessment Report was circulated to all CHMP members on 08 April 2011 The Co-Rapporteur's first Assessment Report was circulated to all CHMP members on 08 April 2011.

    During the meeting on 19 May 2011, the CHMP agreed on the consolidated List of Questions to be sent to the applicant. The final cons

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