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`
`Macugen
`
`Generic Name: pegaptanib sodium
`Dosage Form: injection, solution
`Macugen®
`(pegaptanib sodium injection)
`
`DESCRIPTION
`
`Macugen® (pegaptanib sodium injection) is a sterile, aqueous solution containing pegaptanib sodium for
`intravitreous injection. Macugen is supplied in a single-dose, pre-filled syringe and is formulated as a
`3.47 mg/mL solution, measuredas the free acid form of the oligonucleotide. The active ingredient is 0.3 mg of
`the free acid form of the oligonucleotide without polyethylene glycol, in a nominal volume of 90 uL. This dose
`is equivalent to 1.6 mg of pegaptanib sodium (pegylated oligonucleotide) or 0.32 mg when expressed as the
`sodium salt form of the oligonucleotide moiety. The productis a sterile, clear, preservative-free solution
`containing sodium chloride, monobasic sodium phosphate monohydrate, dibasic sodium phosphate
`heptahydrate, hydrochloric acid, and/or sodium hydroxide to adjust the pH and water for injection.
`
`Pegaptanib sodium is a covalent conjugate of an oligonucleotide of twenty-eight nucleotides in length that
`terminates in a pentylamino linker, to which two 20-kilodalton monomethoxy polyethylene glycol (PEG) units
`are covalently attached via the two amino groupson a lysine residue.
`
`Pegaptanib sodium is represented by the following structural formula:
`
`Dosing line
`
`(Actual air bubble formation may vary)
`WhereR is
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`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.001
`
`
`
`Macugen Official FDA information,side effects and uses.
`
`2 of 11
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`Dosing line and top edge of 3° nib aligned
`
`and n is approximately 450.
`
`The chemical name for pegaptanib sodium is as follows: RNA,((2' - deoxy - 2' - fluoro)C - Gm- Gm-A-A-
`(2' - deoxy - 2' - fluoro)U - (2' - deoxy - 2’ - fluoro)C - Am - Gm - (2' - deoxy - 2' - fluoro)U - Gm - Am - Am - (2'
`- deoxy - 2' - fluoro)U - Gm - (2' - deoxy - 2’ - fluoro)C - (2' - deoxy - 2' - fluoro)U - (2' - deoxy - 2' - fluoro)U -
`Am - (2' - deoxy - 2’ - fluoro)U - Am - (2' - deoxy - 2’ - fluoro)C - Am - (2' - deoxy - 2' - fluoro)U - (2' - deoxy - 2'
`- fluoro)C - (2' - deoxy - 2' - fluoro)C - Gm - (3'-3') - dT), 5'-ester with a,a’ - [4,12 - dioxo - 6 - [[[5 -
`(phosphoonoxy)pentyl]jamino]carbonyl] - 3,13 - dioxa - 5,11 - diaza - 1,15 - pentadecanediyl]bis[w -
`methoxypoly(oxy - 1,2 - ethanediyl)], sodium salt.
`
`The molecular formula for pegaptanib sodium is C294H342F13N107Na280188P28[C2H40]n (wherenis
`approximately 900) and the molecular weight is approximately 50 kilodaltons.
`
`Macugen is formulated to have an osmolality of 280-360 mOsm/Kg, and a pH of6-7.
`
`CLINICAL PHARMACOLOGY
`
`Mechanism of Action
`
`Pegaptanib is a selective vascular endothelial growth factor (VEGF) antagonist. VEGF is a secreted protein
`that selectively binds and activates its receptors located primarily on the surface of vascular endothelial cells.
`VEGF induces angiogenesis, and increases vascular permeability and inflammation, all of which are thought
`to contribute to the progression of the neovascular (wet) form of age-related macular degeneration (AMD), a
`leading cause of blindness. VEGF has been implicated in blood retinal barrier breakdown and pathological
`ocular neovascularization.
`
`Pegaptanib is an aptamer, a pegylated modified oligonucleotide, which adopts a three-dimensional
`conformation that enablesit to bind to extracellular VEGF. Under in vitro testing conditions, pegaptanib binds
`to the major pathological VEGF isoform, extracellular VEGF165, thereby inhibiting VEGF165 binding to its
`VEGF receptors. The inhibition of VEGF164, the rodent counterpart of human VEGF 165, waseffective at
`suppressing pathological neovascularization.
`
`Pharmacokinetics
`
`Absorption
`
`In animals, pegaptanib is slowly absorbedinto the systemic circulation from the eye after intravitreous
`administration. The rate of absorption from the eyeis the rate limiting step in the disposition of pegaptanib in
`animals and is likely to be the rate limiting step in humans.
`
`In humans, a mean maximum plasma concentration of about 80 ng/mL occurs within 1 to 4 days after a 3 mg
`monocular dose (10 times the recommended dose). The mean area under the plasma concentration-time
`curve (AUC)is about 25 ugehr/mL at this dose.
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.002
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`
`
`Macugen Official FDA information,side effects and uses.
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`3 of 11
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`Distribution/Metabolism/Excretion
`
`Twenty-four hoursafter intravitreous administration of a radiolabeled dose of pegaptanib to both eyes of
`rabbits, radioactivity was mainly distributed in vitreous fluid, retina, and aqueous fluid. After intravitreous and
`intravenous administrations of radiolabeled pegaptanib to rabbits, the highest concentrations of radioactivity
`(excluding the eye for the intravitreous dose) were obtained in the kidney. In rabbits, the component
`nucleotide, 2'-fluorouridine is found in plasma and urine after single radiolabeled pegaptanib intravenous and
`intravitreous doses. In rabbits, pegaptanib is eliminated as parent drug and metabolites primarily in the urine.
`
`Based on preclinical data, pegaptanib is metabolized by endo- and exonucleases.
`
`In humans, after a 3 mg monocular dose (10 times the recommended dose), the average (+ standard
`deviation) apparent plasmahalf-life of pegaptanib is 10 (44) days.
`
`Special Populations
`
`Plasma concentrations do not appear to be affected by age or gender, but have not been studied in patients
`under the age of 50.
`
`Renal Insufficiency
`
`Dose adjustment for patients with renal impairment is not needed when administering the 0.3 mg dose.
`
`Following a single 3 mg dose (10 times the recommendeddose), in patients with severe (N=7), moderate
`(N=18), and mild (N=10) renal impairment, the mean (CV%) pegaptanib AUC values were 37.8 (17%), 26.7
`(31%), and 23.6 (21%) ugehr/mL, respectively. The corresponding Cmax values were 96.8 (23%), 81.6
`(29.2%), and 66.5 (47%) ng/mL, respectively.
`
`In patients with renal impairment, following administration of 3 mg pegaptanib doses every 6 weeks, the last
`detectable pegaptanib concentrations in plasma after the fourth dose were highly variable (ranging from
`8 ng/mL to 66 ng/mL) and the variability was more pronounced in patients with severe renal impairment.
`
`Hemodialysis
`
`Macugen has not been studied in patients requiring hemodialysis.
`
`Hepatic Impairment
`
`Macugen has not been studied in patients with hepatic impairment.
`
`Clinical Studies
`
`Macugen was studied in two controlled, double-masked, and identically designed randomized studiesin
`patients with neovascular AMD. Patients were randomizedto receive control (sham treatment) or 0.3 mg,
`1 mg or 3 mg Macugen administered asintravitreous injections every 6 weeks for 48 weeks. A total of
`approximately 1200 patients were enrolled with 892 patients receiving Macugen and 298 receiving a sham
`injection. The median age of the patients was 77 years. Patients received a mean 8.5 treatments out of a
`possible 9 total treatments acrossall treatment arms. Patients were re-randomized between treatment and no
`treatment during the second year. Patients who continued treatment in year 2 received a mean of
`16 treatments out of a possible total 17 overall.
`
`The twotrials enrolled patients with neovascular AMD characteristics including classic, occult, and mixed
`lesions of up to 12 disc areas and baseline visual acuity in the study eye between 20/40 and 20/320. The
`primary efficacy endpoint wasthe proportion of patients losing less than 15 letters of visual acuity, from
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.003
`
`
`
`Macugen Official FDA information,side effects and uses.
`
`4 of 11
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`baseline up to 54 week assessment. Verteporfin photodynamic therapy (PDT) usage was permitted at the
`discretion of the investigators in patients with predominantly classic lesions.
`
`The groups treated with Macugen 0.3 mg exhibited a statistically significant result in both trials for the primary
`efficacy endpoint at 1 year: Study EOP1003, Macugen 73% vs. Sham 60%; Study EOP1004, Macugen 67%
`vs. Sham 53%. Concomitant use of PDT overall was low. More sham treated patients (75/296) received PDT
`than Macugen 0.3 mg treated patients (58/294).
`
`On average, Macugen 0.3 mg treated patients and sham treated patients continued to experiencevision loss.
`However, the rate of vision decline in the Macugen treated group was slower than the rate in the patients who
`received sham treatment. See Figure 1.
`
`Figure 1
`
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`At the end ofthe first year (week 54), approximately 1050 of the original 1200 patients were re-randomizedto
`either continue the same treatment or to discontinue treatment through week 102. See Figure 2.
`
`Macugen was less effective during the second year than during the first year. The percentage of patients
`losing less than 15 letters from baseline to week 102 was: Study EOP1003, Macugen 38/67 (57%); Sham
`30/54 (56%); Study EOP1004, Macugen 40/66 (61%); Sham 18/53 (34%).
`
`Figure 2
`
`oO
`
`sey
`
`ON
`
`Doselevels above 0.3 mg did not demonstrate any additional benefit.
`
`The safety or efficacy of Macugen beyond 2 years has not been demonstrated.
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
`
`Regeneron Exhibit 1009.004
`
`
`
`Macugen Official FDA information,side effects and uses.
`
`S5of 11
`
`INDICATIONS AND USAGE
`
`Macugen is indicated for the treatment of neovascular (wet) age-related macular degeneration.
`
`CONTRAINDICATIONS
`
`Macugen is contraindicated in patients with ocular or periocular infections.
`
`Macugen is contraindicated in patients with known hypersensitivity to pegaptanib sodium or any other
`excipient in this product.
`
`WARNINGS
`
`Intravitreous injections including those with Macugen have been associated with endophthalmitis. Proper
`aseptic injection technique should always beutilized when administering Macugen. In addition, patients
`should be monitored during the week following the injection to permit early treatment, should an infection
`occur (see DOSAGE AND ADMINISTRATION).
`
`Increasesin intraocular pressure have been seen within 30 minutes of injection with Macugen. Therefore,
`intraocular pressure as well as the perfusion of the optic nerve head should be monitored and managed
`appropriately.
`
`PRECAUTIONS
`
`General
`
`FOR OPHTHALMIC INTRAVITREAL INJECTION ONLY.
`
`Rare cases of anaphylaxis/anaphylactoid reactions, including angioedema, have been reported in the post-
`marketing experience following the Macugen intravitreal administration procedure (see ADVERSE EVENTS
`and DOSAGE AND ADMINISTRATION).
`
`Information for Patients
`
`In the days following Macugen administration, patients are at risk for the development of endophthalmitis. If
`the eye becomesred, sensitive to light, painful or develops a change in vision, the patient should seek the
`immediate care with their ophthalmologist.
`
`Drug Interactions
`
`Drug interaction studies have not been conducted with Macugen. Pegaptanib is metabolized by nucleases
`and is generally not affected by the cytochrome P450 system.
`
`Two early clinical studies conducted in patients who received Macugen alone and in combination with PDT
`revealed no apparentdifference in the plasma pharmacokinetics of pegaptanib.
`
`Carcinogenesis, Mutagenesis, Impairment of Fertility
`
`Carcinogenicity studies with pegaptanib have not been conducted.
`
`Pegaptanib and its monomer component nucleotides (2'-MA, 2'-MG, 2'-FU, 2'-FC) were evaluated for
`genotoxicity in a battery of in vitro and in vivo assay systems. Pegaptanib, 2'-O-methyladenosine (2'-MA), and
`2'-O-methylguanosine (2'-MG) were negative in all assay systems evaluated. 2'-fluorouridine (2'-FU) and 2'-
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.005
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`
`
`Macugen Official FDA information,side effects and uses.
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`6 of 11
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`fluorocytidine (2'-FC) were nonclastogenic and were negativein all S. typhimurium tester strains, but
`produced a non-doserelated increase in revertant frequencyin a single E. coli tester strain. Pegaptanib, 2'-
`FU, and 2'-FC tested negative in cell transformation assays.
`
`No data are available to evaluate male or female mating or fertility indices.
`
`Pregnancy
`
`Teratogenic Effects: Pregnancy Category B.
`
`Pegaptanib produced no maternal toxicity and no evidence of teratogenicity or fetal mortality in mice at
`intravenous doses of up to 40 mg/kg/day (about 7,000 times the recommended human monocular ophthalmic
`dose of 0.3 mg/eye). Pegaptanib crosses the placenta in mice.
`
`There are no studies in pregnant women. The potential risk to humans is unknown. Macugen should be used
`during pregnancyonlyif the potential benefit to the mother justifies the potential risk to the fetus.
`
`Nursing Mothers
`
`It is not known whether pegaptanib is excreted in human milk. Because many drugs are excreted in human
`milk, caution should be exercised when Macugen is administered to a nursing woman.
`
`Pediatric Use
`
`Safety and effectiveness of Macugen in pediatric patients have not been studied.
`
`Geriatric Use
`
`Approximately 94% (834/892) of the patients treated with Macugen were 2 65 years of age and
`approximately 62% (553/892) were 2 75 years of age. No difference in treatment effect or systemic exposure
`was seen with increasing age.
`
`ADVERSE EVENTS
`
`Serious adverse events related to the injection procedure occurring in < 1% ofintravitreous injections
`included endophthalmitis (see WARNINGS), retinal detachment, and iatrogenic traumatic cataract.
`
`The most frequently reported adverse events in patients treated with Macugen 0.3 mg for up to two years
`were anterior chamber inflammation, blurred vision, cataract, conjunctival hemorrhage, corneal edema, eye
`discharge, eyeirritation, eye pain, hypertension, increasedintraocular pressure (IOP), ocular discomfort,
`punctate keratitis, reduced visual acuity, visual disturbance, vitreous floaters, and vitreous opacities. These
`events occurred in approximately 10-40% of patients.
`
`The following events were reported in 6-10% of patients receiving Macugen 0.3 mg therapy:
`
`Ocular: blepharitis, conjunctivitis, photopsia, vitreous disorder.
`
`Non-Ocular: bronchitis, diarrhea, dizziness, headache, nausea, urinary tract infection.
`
`The following events were reported in 1-5% of patients receiving Macugen 0.3 mg therapy:
`
`Ocular: allergic conjunctivitis, conjunctival edema, corneal abrasion, corneal deposits, corneal epithelium
`disorder, endophthalmitis, eye inflammation, eye swelling, eyelid irritation, meibomianitis, mydriasis,
`periorbital hematoma, retinal edema, vitreous hemorrhage.
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.006
`
`
`
`Macugen Official FDA information,side effects and uses.
`
`7 of 11
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`Non-Ocular: arthritis, bone spur, carotid artery occlusion, cerebrovascular accident, chest pain, contact
`dermatitis, contusion, diabetes mellitus, dyspepsia, hearing loss, pleural effusion, transient ischemic attack,
`urinary retention, vertigo, vomiting.
`
`Post-Marketing Experience: Anaphylaxis/anaphylactoid reactions, including angioedema, have been
`identified during postapproval use of Macugen. Becausethese 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 drug exposure (see PRECAUTIONS and DOSAGE AND ADMINISTRATION).
`
`OVERDOSAGE
`
`Doses of Macugen up to 10 times the recommended dosage of 0.3 mg have been studied. No additional
`adverse events have been noted but there is decreasedefficacy with doses above 1 mg.
`
`DOSAGE AND ADMINISTRATION
`
`Macugen 0.3 mg should be administered once every six weeksby intravitreous injection into the eye to be
`treated.
`
`Macugen should beinspected visually for particulate matter and discoloration prior to administration.
`
`Administration of the syringe contents involves assembly of the syringe with the administration needle. The
`injection procedure should be carried out under controlled aseptic conditions, which includes the use ofsterile
`gloves, a sterile drape, and a sterile eyelid speculum (or equivalent). When ready to assemble syringe and
`administer injection, carefully peel open pouches, remove contents, and place on sterile field. If upon opening
`the pouch, the plastic clip is missing or not attached to the syringe, the syringe should not be used.
`
`To avoid compromising the sterility of the product, do not pull back on the plunger.
`
`e Removethe syringe from the plastic clip.
`e Twistoff cap.
`e Attach the sterile BD® 30G 1/2" Precision Glide® administration needle (included) to the syringe by
`screwing it into the syringetip.
`-- Another sterile administration needle may be used in lieu of the one included. Removethe plastic
`needle shield from the needle.
`
`e Holding the syringe with the needle pointing up, check the syringe for bubbles. If there are bubbles,
`gently tap the syringe with your finger until the bubbles rise to the top of the syringe. SLOWLY
`depressthe plunger to eliminate all the bubbles and to expel the excess drug so that the top edge
`of the 3rd rib on the plunger stopper aligns with the pre-printed black dosing line (See Fig 2, below).
`e Inject the entire contents of the syringe.
`
`PRIOR to Injection
`Fig 1. Before expelling air bubble and excess drug
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.007
`
`
`
`Figure 2
`
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`Macugen Official FDA information,side effects and uses.
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`8 of 11
`
`Figure 1
`
`Mean Visual Acuity: Year 1
`
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`
`READYfor Injection
`Fig 2. After expelling air bubble and excess drug
`
`Mean Visual Acuity: Year 2
`
`EOP 1003
`
`EOP 1004
`
`PatientTreatment (ve ar 1)-+(Year 2)
`= (0.5 mg) (Orcontnus }
`+ (0.5 mg] 0.3 mg)
`(Siam) > Sham or discontinue
`
`s
`
`&-
`
`a
`
`ao
`
`66
`
`
`
`Patent Trea ment(Year 1) (vear 2)
`+ (0.3mg) > (0.3 mg)
`= (0.5 mg) > (Olcontinus)
`(Sham) > Slam or dacontinue
`
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`
`The patient's medical history for hypersensitivity reactions should be evaluated prior to performing the
`intravitreal procedure (see PRECAUTIONS and ADVERSE EVENTS). Adequate anesthesia and a broad-
`spectrum microbicide should be given prior to the injection.
`
`Following the injection, patients should be monitored for elevation in intraocular pressure and for
`endophthalmitis. Monitoring may consist of a check for perfusion of the optic nerve head immediately after
`the injection, tonometry within 30 minutes following the injection, and biomicroscopy between two and seven
`days following the injection. Patients should be instructed to report any symptoms suggestive of
`endophthalmitis without delay.
`
`No special dosage modification is required for any of the populations that have been studied (i.e. gender,
`elderly).
`
`The safety and efficacy of Macugen therapy administered to both eyes concurrently have not been studied.
`
`HOW SUPPLIED
`
`Macugen (pegaptanib sodium injection) is supplied in a sterile foil pouch as a single-use glass syringe pre-
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.008
`
`
`
`Macugen Official FDA information,side effects and uses.
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`9 of 11
`
`filled with 0.3 mg of Macugen® in a nominal 90 uL deliverable volume pack.A sterile packaged BD® single
`use 30G x 1/2" Precision Glide® Luer Lok® needle is supplied in a separate pouch. The foil pouch and
`needle are packaged together in a carton.
`
`Storage
`
`Store in the refrigerator at 2° to 8°C (36° to 46°F). Do not freeze or shake vigorously.
`
`Rx only.
`
`BD and Precision Glide Luer Lok® are registered trademarks of Becton Dickinson & CO, Franklin Lakes, New
`Jersey 07417
`
`NDC 68782-001-02
`
`Manufactured by:
`Gilead Sciences, Inc
`650 Cliffside Drive
`San Dimas, CA 91773
`
`For.
`EyetechInc.
`140 East Hanover Avenue
`Cedar Knolls, NJ 07927
`
`Revised 08/2008
`
`PRINCIPAL DISPLAY PANEL
`
`NDC 68782-001-02
`Rx only
`Macugen®
`(pegaptanib sodium injection)
`For Intravitreous Injection
`0.3 mg / 90 uL*
`
`
`
`
`
`aaSE Store relrigerated, 2 - 8°C (35 - 45°F). Oo aot freeze of shake vigorously.
`
`
` 7160
`
`
`NDC 68782-001-02
`Rx only
`
`{
`QOSAGE ANO USE
`+
`For intravitreaus injection
`
`
`.
`‘See accompanying prescribing iinformationand directions for assembly.
`
`“Each 1 mLsyringe delivers a unit doseof 0.3 mg pepaptantb sodium in 90 wl when administered as directed.
`
`Macugen®
`
`
`Gates saents:
`(pegaptanib sodium injection)
`-Lok* needle.
`.
`single-use BD 30gauge x 2" Lieer-
`‘om foil pouch as a single-vse glass syringe pre-filled with 0.3 mg/90 pl of Macupen.
`a fae insert/ Directionsfor Assembly.
`For latravitvecus Injection
`
` 10-6127-00-7
`
`
`
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.009
`
`
`
`Macugen Official FDA information,side effects and uses.
`
`10 of 11
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`Macugen
`pegaptanib sodium injection, solution
`
`Product Information
`
`Product Type
`
`HUMAN PRESCRIPTION
`DRUG
`
`NDC Product Code
`(Source)
`
`68782-001
`
`Route of Administration
`
`INTRAVITREAL
`
`DEA Schedule
`
`Active Ingredient/Active Moiety
`
`Ingredient Name
`
`Basis of Strength
`
`Strength
`
`PEGAPTANIB
`
`3.47 mg in 1 mL
`
`PEGAPTANIB SODIUM
`(PEGAPTANIB)
`
`Inactive Ingredients
`
`Ingredient Name
`
`SODIUM CHLORIDE
`
`SODIUM PHOSPHATE, MONOBASIC,
`MONOHYDRATE
`
`SODIUM PHOSPHATE, DIBASIC, HEPTAHYDRATE
`
`HYDROCHLORIC ACID
`
`SODIUM HYDROXIDE
`
`WATER
`
`Product Characteristics
`
`Strength
`
`Score
`
`Size
`
`Imprint Code
`
`Color
`
`Shape
`
`Flavor
`
`Contains
`
`Packaging
`
`#
`
`1
`
`NDC
`
`68782-001-02
`
`Package
`Description
`
`1 SYRINGE In 1
`CARTON
`
`Multilevel
`Packaging
`
`contains a SYRINGE
`
`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.010
`
`
`
`Macugen Official FDA information,side effects and uses.
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`11 of 11
`
`1
`
`0.09 mL In 1
`SYRINGE
`
`This package is
`contained within the
`
`CARTON (68782-00
`1-02)
`
`Marketing Information
`Marketing Category Application Number Marketing Start Date Marketing End Date
`or Monograph
`Citation
`
`NDA
`
`NDA021756
`
`12/17/2004
`
`Labeler = Eyetech Inc. (828561485)
`
`Establishment
`
`Name
`
`Address
`
`Gilead Sciences, Inc.
`
`Revised: 08/2008
`
`ID/FEI
`
`941715849
`
`Operations
`
`manufacture
`
`Eyetech Inc.
`
`More Macugen resources
`
`Macugen Side Effects (in More Detail)
`Macugen Usein Pregnancy & Breastfeeding
`Macugen Drug Interactions
`Macugen Support Group
`0 Reviews for Macugen - Add your own review/rating
`
`Macugen Monograph (AHFSDI)
`Macugen Advanced Consumer (Micromedex) - Includes Dosage Information
`Macugen MedFacts Consumer Leaflet (Wolters Kluwer)
`Macugen Consumer Overview
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`Compare Macugenwith other medications
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`e Macular Degeneration
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`http://web.archive.org/web/20110307065238/http://www.drugs.com:80/pro/macugen.html
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`Regeneron Exhibit 1009.011
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