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` NDA 209803/S-002
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` NDA 209805/S-006
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`NDA 209806/S-002
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`SUPPLEMENT APPROVAL
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` Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
` Attention: Wendy L. Carofano, PharmD, RPh, PMP
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` Director, Global Regulatory Affairs
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` 126 E. Lincoln Avenue, P.O. Box 2000
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` Mail Drop: RY34-B188
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` Rahway, NJ 07065
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` Dear Dr. Carofano:
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`Please refer to your supplemental new drug applications (sNDAs) dated and received
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`November 18, 2019, and your amendments, submitted under section 505(b) and
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`pursuant to section 505(b)(2) of the Federal Food, Drug, and Cosmetic Act (FDCA) for
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`Steglatro (ertugliflozin) tablets, Steglujan (ertugliflozin and sitagliptin) tablets, and
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`Segluromet (ertugliflozin and metformin hydrochloride) tablets.
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`We also refer to our letter dated October 21, 2019, notifying you, under Section
`505(o)(4) of the FDCA, of new safety information that we believe should be included in
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`the labeling for sodium-glucose co-transporter 2 (SGLT2) inhibitors. This information
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`pertains to the risk of peri-/post-operative diabetic ketoacidosis.
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`These sNDAs provide for revisions to the labeling for Steglatro, Steglujan, and
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`Segluromet, consistent with our October 21, 2019, letter and the comments sent to you
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`in our December 19, 2019, correspondence.
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`APPROVAL & LABELING
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`We have completed our review of these applications, as amended. They are approved,
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`effective on the date of this letter, for use as recommended in the enclosed agreed-
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`upon labeling with minor editorial revision to the Steglatro Prescribing Information listed
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`below and reflected in the enclosed labeling.
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`•
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`Inserted a page break between the Table of Contents and Full Prescribing
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`Information
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`We note that your January 15, 2020, submissions include final printed labeling (FPL) for
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`your: Prescribing Information and Medication Guide. We have not reviewed this FPL.
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`You are responsible for assuring that the wording in this FPL is identical to that of the
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`approved content of labeling in the structured product labeling (SPL) format.
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`Reference ID: 4547668
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`

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` NDA 209803/S-002
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` NDA 209805/S-006
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` NDA 209806/S-002
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` Page 2
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` WAIVER OF ½ PAGE LENGTH REQUIREMENT FOR HIGHLIGHTS
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`Please note that we have previously granted a waiver of the requirements of 21 CFR
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`201.57(d)(8) regarding the length of Highlights of Prescribing Information.
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` CONTENT OF LABELING
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`As soon as possible, but no later than 14 days from the date of this letter, submit the
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`content of labeling [21 CFR 314.50(l)] in structured product labeling (SPL) format using
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`the FDA automated drug registration and listing system (eLIST), as described at
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`FDA.gov.1 Content of labeling must be identical to the enclosed labeling (text for the
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`Prescribing Information and Medication Guide), with the addition of any labeling
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`changes in pending “Changes Being Effected” (CBE) supplements, as well as annual
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`reportable changes not included in the enclosed labeling.
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`Information on submitting SPL files using eList may be found in the guidance for
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`industry SPL Standard for Content of Labeling Technical Qs and As.2
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`The SPL will be accessible from publicly available labeling repositories.
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`Also within 14 days, amend all pending supplemental applications that include labeling
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`changes for this NDA, including CBE supplements for which FDA has not yet issued an
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`action letter, with the content of labeling [21 CFR 314.50(l)(1)(i)] in Microsoft Word
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`format, that includes the changes approved in this supplemental application, as well as
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`annual reportable changes. To facilitate review of your submission(s), provide a
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`highlighted or marked-up copy that shows all changes, as well as a clean Microsoft
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`Word version. The marked-up copy should provide appropriate annotations, including
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`supplement number(s) and annual report date(s).
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`REQUIRED PEDIATRIC ASSESSMENTS
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`Under the Pediatric Research Equity Act (PREA) (21 U.S.C. 355c), all applications for
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`new active ingredients (which includes new salts and new fixed combinations), new
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`indications, new dosage forms, new dosing regimens, or new routes of administration
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`are required to contain an assessment of the safety and effectiveness of the product for
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`the claimed indication in pediatric patients unless this requirement is waived, deferred,
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`or inapplicable.
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` 1 http://www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/default.htm
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` 2 We update guidances periodically. For the most recent version of a guidance, check the FDA Guidance
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` Documents Database https://www.fda.gov/RegulatoryInformation/Guidances/default.htm.
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`U.S. Food and Drug Administration
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`Silver Spring, MD 20993
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`www.fda.gov
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`Reference ID: 4547668
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`

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` NDA 209803/S-002
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` NDA 209805/S-006
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` NDA 209806/S-002
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` Page 3
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`Because none of these criteria apply to your applications, you are exempt from this
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`requirement.
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` PROMOTIONAL MATERIALS
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`You may request advisory comments on proposed introductory advertising and
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`promotional labeling. To do so, submit the following, in triplicate, (1) a cover letter
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`requesting advisory comments, (2) the proposed materials in draft or mock-up form with
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`annotated references, and (3) the Prescribing Information to:
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` OPDP Regulatory Project Manager
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` Food and Drug Administration
` Center for Drug Evaluation and Research
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` Office of Prescription Drug Promotion (OPDP)
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` 5901-B Ammendale Road
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` Beltsville, MD 20705-1266
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` Alternatively, you may submit a request for advisory comments electronically in eCTD
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` format. For more information about submitting promotional materials in eCTD format,
` see the draft guidance for industry Providing Regulatory Submissions in Electronic and
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`Non-Electronic Format-Promotional Labeling and Advertising Materials for Human
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` Prescription Drugs.3
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`You must submit final promotional materials and Prescribing Information, accompanied
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`by a Form FDA 2253, at the time of initial dissemination or publication
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`[21 CFR 314.81(b)(3)(i)]. Form FDA 2253 is available at FDA.gov.4 Information and
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`Instructions for completing the form can be found at FDA.gov.5 For more information
`about submission of promotional materials to the Office of Prescription Drug Promotion
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`(OPDP), see FDA.gov.6
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`All promotional materials that include representations about your drug product must be
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`promptly revised to be consistent with the labeling changes approved in this
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`supplement, including any new safety information [21 CFR 314.70(a)(4)]. The revisions
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`in your promotional materials should include prominent disclosure of the important new
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`safety information that appears in the revised labeling. Within 7 days of receipt of this
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`letter, submit your statement of intent to comply with 21 CFR 314.70(a)(4) to the
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` 3 When final, this guidance will represent the FDA’s current thinking on this topic. For the most recent
` version of a guidance, check the FDA guidance web page at
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` https://www.fda.gov/RegulatoryInformation/Guidances/default.htm.
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`4 http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/UCM083570.pdf
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` 5 http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/UCM375154.pdf
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` 6 http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm090142.htm
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`U.S. Food and Drug Administration
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`Silver Spring, MD 20993
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`www.fda.gov
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`Reference ID: 4547668
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`

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` NDA 209803/S-002
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` NDA 209805/S-006
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` NDA 209806/S-002
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` Page 4
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`address above, by fax to 301-847-8444, or electronically in eCTD format. For more
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`information about submitting promotional materials in eCTD format, see the draft
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`guidance for industry Providing Regulatory Submissions in Electronic and Non-
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`Electronic Format-Promotional Labeling and Advertising Materials for Human
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`Prescription Drugs.
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` REPORTING REQUIREMENTS
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`We remind you that you must comply with reporting requirements for an approved NDA
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`(21 CFR 314.80 and 314.81).
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`If you have any questions, call Liz Godwin, Senior Regulatory Project Manager, at
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`240-402-3438.
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`Sincerely,
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`{See appended electronic signature page}
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`Anil Rajpal, M.D., M.P.H.
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`Deputy Director for Safety (Acting)
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`Division of Metabolism and Endocrinology Products
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`Office of Drug Evaluation II
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`Center for Drug Evaluation and Research
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`ENCLOSURES:
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`• Content of Labeling
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`o Prescribing Information
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`o Medication Guide
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`U.S. Food and Drug Administration
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`Silver Spring, MD 20993
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`www.fda.gov
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`Reference ID: 4547668
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`

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`Signature Page 1 of 1
`--------------------------------------------------------------------------------------------
`This is a representation of an electronic record that was signed
`electronically. Following this are manifestations of any and all
`electronic signatures for this electronic record.
`--------------------------------------------------------------------------------------------
`/s/
`------------------------------------------------------------
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`ANIL K RAJPAL
`01/24/2020 11:41:26 AM
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`Reference ID: 4547668
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`(
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