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Bylvay (odevixibat) 200, 400, 600, 1200 mcg capsules logo

Understanding the Limitation of Use

Bylvay Is FDA-Approved for All PFIC Patient Types

Indication and Usage

Bylvay is an ileal bile acid transporter (IBAT) inhibitor indicated for the treatment of pruritus in patients 3 months of age and older, with progressive familial intrahepatic cholestasis (PFIC).

Limitation of Use

Bylvay may not be effective in PFIC type 2 patients with ABCB11 variants resulting in non-functional or complete absence of bile salt export pump protein (BSEP-3).

About PFIC2

  • PFIC is a spectrum of autosomal recessive disorders
  • In PFIC2, the ABCB11 (ATP-binding cassette subfamily B member 11) gene has mutations that lead to functional deficiency of the bile salt export pump (BSEP) protein1
  • Targeted sequencing panels can be used by clinicians to support a PFIC diagnosis. These tests have a 27%-62% clinical sensitivity in detecting causal mutations leading to PFIC22

PFIC2 Can Be Subcategorized Based on a Patient’s Mildest Genetic Mutation3

Only 21% of PFIC2 Patients Have the BSEP-3 Subtype

~27% BSEP-1
Mildest predicted form, associated with residual BSEP functionality

~52% BSEP-2
Moderate predicted form

~21% BSEP-3
Severest form, with no residual BSEP functionality

Bylvay MOA

  • Minimal BSEP function (~5%) is required for therapeutic efficacy of Bylvay.4 The mechanism of action requires that the enterohepatic circulation of BAs is preserved. Patients with PFIC2 who have a complete absence or lack of function of BSEP protein (i.e. patients with BSEP-3 subtype of PFIC2) may not respond to Bylvay5

For more about PFIC2

Healthcare providers with questions about a patient’s PFIC2 subcategorization can reach out to medinfo@albireopharma.com or refer to van Wessel et al. J Hepatol. 2020;73(1):84-93.

1. Evason K et al. Am J Surg Pathol. 2011;35(5):687-696.
2. Prevention Genetics Cholestasis Panel. https://www.preventiongenetics.com/testInfo?val=Cholestasis+Panel.
3. van Wessel DBE et al. J Hepatol. 2020;73(1):84-93.
4. Ellinger et al. World J Gastroenterol. 2017;23(29):5295–5303.
5. Bylvay Prescribing Information. Albireo Pharma, Inc.

IMPORTANT SAFETY INFORMATION AND INDICATIONS

Warnings and Precautions:

Liver Test Abnormalities
Patients enrolled in PFIC and ALGS clinical trials had abnormal liver tests at baseline. In clinical trials, treatment-emergent elevations of liver tests or worsening of liver tests relative to baseline values were observed during the clinical trials.

In a clinical trial with PFIC patients, treatment-emergent elevations of liver tests or worsening of liver tests relative to baseline values were observed during the clinical trial. Most abnormalities included elevations in AST, ALT, or total and direct bilirubin. Treatment interruption days ranged from 3 days to 124 days; no PFIC patients permanently discontinued treatment due to liver test abnormalities.

In a clinical trial with ALGS patients, treatment-emergent elevations or worsening in liver tests relative to baseline values were observed during the trial. Most abnormalities included elevations in ALT or AST. One ALGS patient interrupted treatment for 40 days; no ALGS patients permanently discontinued treatment due to liver test abnormalities.

Obtain baseline liver tests and monitor during treatment. Dose reduction or treatment interruption may be required if abnormalities occur. For persistent or recurrent liver test abnormalities, consider treatment discontinuation.

Bylvay was not evaluated in PFIC or ALGS patients with cirrhosis. Closely monitor for liver test abnormalities; permanently discontinue Bylvay if a patient progresses to portal hypertension or experiences a hepatic decompensation event.

Diarrhea
In a PFIC clinical trial, diarrhea was reported in 2 (10%) placebo-treated patients, 9 (39%) Bylvay-treated 40 mcg/kg/day patients, and 4 (21%) Bylvay-treated 120 mcg/kg/day patients. Treatment interruption due to diarrhea occurred in 2 patients with 3 events during treatment with Bylvay 120 mcg/kg/day. Treatment interruption due to diarrhea ranged between 3 to 7 days. One patient treated with Bylvay 120 mcg/kg/day withdrew from the pivotal clinical trial due to persistent diarrhea.

In an ALGS clinical trial, diarrhea in ALGS patients was reported in 1 (6%) placebo-treated patient and in 10 (29%) Bylvay-treated patients. No patients interrupted or permanently discontinued Bylvay due to diarrhea.

If diarrhea occurs, monitor for dehydration and treat promptly. Interrupt Bylvay dosing if a patient experiences persistent diarrhea. Restart Bylvay at 40 mcg/kg/day when diarrhea resolves and increase the dose as tolerated if appropriate. If diarrhea persists and no alternate etiology is identified, stop Bylvay treatment.

Fat-Soluble Vitamin (FSV) Deficiency
Fat-soluble vitamins (FSV) include vitamin A, D, E, and K (measured using INR levels). PFIC patients can have FSV deficiency at baseline. Bylvay may affect absorption of fat-soluble vitamins. In a clinical trial, new onset or worsening of existing FSV deficiency was reported in 1 (5%) placebo-treated patient and 3 (16%) Bylvay-treated 120 mcg/kg/day patients; none of the Bylvay-treated 40 mcg/kg/day patients had new onset or worsening of existing FSV deficiency. In an ALGS clinical trial, new or worsening of existing FSV deficiency was reported in 3 (17.6%) placebo-treated patients and 3 (8.6%) Bylvay-treated patients.

Obtain serum FSV levels at baseline and monitor during treatment, along with any clinical manifestations. If FSV deficiency is diagnosed, supplement with FSV. Discontinue Bylvay if FSV deficiency persists or worsens despite adequate FSV supplementation.

Adverse Reactions
The most common adverse reactions for Bylvay in patients with PFIC are diarrhea, liver test abnormalities, vomiting, abdominal pain, and fat-soluble vitamin deficiency.

The most common adverse reactions for Bylvay patients with ALGS are diarrhea, abdominal pain, hematoma, and decreased weight.

Drug Interactions
For patients taking bile acid binding resins, take Bylvay at least 4 hours before or 4 hours after taking a bile acid binding resin.

Use in Specific Populations
There are no human data on Bylvay use in pregnant persons to establish a drug-associated risk of major birth defects, miscarriage, or adverse developmental outcomes. Based on findings from animal reproduction studies, Bylvay may cause cardiac malformations when a fetus is exposed during pregnancy. There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Bylvay during pregnancy. For more information, please call 1-855-252-4736.

Indications and Usage

Bylvay is an ileal bile acid transporter (IBAT) inhibitor indicated for the treatment of cholestatic pruritus in:

  • Patients 12 months of age and older with Alagille syndrome (ALGS)
  • Patients 3 months of age and older with progressive familial intrahepatic cholestasis (PFIC)
  • Limitation of Use:
    Bylvay may not be effective in a subgroup of PFIC type 2 patients with specific ABCB11 variants resulting in non-functional or complete absence of the bile salt export pump protein

Please see full Prescribing Information.

IMPORTANT SAFETY INFORMATION AND INDICATIONS

Warnings and Precautions:

Liver Test Abnormalities
Patients enrolled in PFIC and ALGS clinical trials had abnormal liver tests at baseline. In clinical trials, treatment-emergent elevations of liver tests or worsening of liver tests relative to baseline values were observed during the clinical trials.

In a clinical trial with PFIC patients, treatment-emergent elevations of liver tests or worsening of liver tests relative to baseline values were observed during the clinical trial. Most abnormalities included elevations in AST, ALT, or total and direct bilirubin. Treatment interruption days ranged from 3 days to 124 days; no PFIC patients permanently discontinued treatment due to liver test abnormalities.

In a clinical trial with ALGS patients, treatment-emergent elevations or worsening in liver tests relative to baseline values were observed during the trial. Most abnormalities included elevations in ALT or AST. One ALGS patient interrupted treatment for 40 days; no ALGS patients permanently discontinued treatment due to liver test abnormalities.

Obtain baseline liver tests and monitor during treatment. Dose reduction or treatment interruption may be required if abnormalities occur. For persistent or recurrent liver test abnormalities, consider treatment discontinuation.

Bylvay was not evaluated in PFIC or ALGS patients with cirrhosis. Closely monitor for liver test abnormalities; permanently discontinue Bylvay if a patient progresses to portal hypertension or experiences a hepatic decompensation event.

Diarrhea
In a PFIC clinical trial, diarrhea was reported in 2 (10%) placebo-treated patients, 9 (39%) Bylvay-treated 40 mcg/kg/day patients, and 4 (21%) Bylvay-treated 120 mcg/kg/day patients. Treatment interruption due to diarrhea occurred in 2 patients with 3 events during treatment with Bylvay 120 mcg/kg/day. Treatment interruption due to diarrhea ranged between 3 to 7 days. One patient treated with Bylvay 120 mcg/kg/day withdrew from the pivotal clinical trial due to persistent diarrhea.

In an ALGS clinical trial, diarrhea in ALGS patients was reported in 1 (6%) placebo-treated patient and in 10 (29%) Bylvay-treated patients. No patients interrupted or permanently discontinued Bylvay due to diarrhea.

If diarrhea occurs, monitor for dehydration and treat promptly. Interrupt Bylvay dosing if a patient experiences persistent diarrhea. Restart Bylvay at 40 mcg/kg/day when diarrhea resolves and increase the dose as tolerated if appropriate. If diarrhea persists and no alternate etiology is identified, stop Bylvay treatment.

Fat-Soluble Vitamin (FSV) Deficiency
Fat-soluble vitamins (FSV) include vitamin A, D, E, and K (measured using INR levels). PFIC patients can have FSV deficiency at baseline. Bylvay may affect absorption of fat-soluble vitamins. In a clinical trial, new onset or worsening of existing FSV deficiency was reported in 1 (5%) placebo-treated patient and 3 (16%) Bylvay-treated 120 mcg/kg/day patients; none of the Bylvay-treated 40 mcg/kg/day patients had new onset or worsening of existing FSV deficiency. In an ALGS clinical trial, new or worsening of existing FSV deficiency was reported in 3 (17.6%) placebo-treated patients and 3 (8.6%) Bylvay-treated patients.

Obtain serum FSV levels at baseline and monitor during treatment, along with any clinical manifestations. If FSV deficiency is diagnosed, supplement with FSV. Discontinue Bylvay if FSV deficiency persists or worsens despite adequate FSV supplementation.

Adverse Reactions
The most common adverse reactions for Bylvay in patients with PFIC are diarrhea, liver test abnormalities, vomiting, abdominal pain, and fat-soluble vitamin deficiency.

The most common adverse reactions for Bylvay patients with ALGS are diarrhea, abdominal pain, hematoma, and decreased weight.

Drug Interactions
For patients taking bile acid binding resins, take Bylvay at least 4 hours before or 4 hours after taking a bile acid binding resin.

Use in Specific Populations
There are no human data on Bylvay use in pregnant persons to establish a drug-associated risk of major birth defects, miscarriage, or adverse developmental outcomes. Based on findings from animal reproduction studies, Bylvay may cause cardiac malformations when a fetus is exposed during pregnancy. There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Bylvay during pregnancy. For more information, please call 1-855-252-4736.

Indications and Usage

Bylvay is an ileal bile acid transporter (IBAT) inhibitor indicated for the treatment of cholestatic pruritus in:

  • Patients 12 months of age and older with Alagille syndrome (ALGS)
  • Patients 3 months of age and older with progressive familial intrahepatic cholestasis (PFIC)
  • Limitation of Use:
    Bylvay may not be effective in a subgroup of PFIC type 2 patients with specific ABCB11 variants resulting in non-functional or complete absence of the bile salt export pump protein

Please see full Prescribing Information.