Active Substance: human papillomavirus type 6 L1 protein / human papillomavirus type 11 L1 protein / human papillomavirus type 16 L1 protein / human papillomavirus type 18 L1 protein
Common Name: human papillomavirus vaccine [types 6, 11, 16, 18] (recombinant, adsorbed)
ATC Code: J07BM01
Marketing Authorisation Holder: Sanofi Pasteur MSD, SNC
Active Substance: human papillomavirus type 6 L1 protein / human papillomavirus type 11 L1 protein / human papillomavirus type 16 L1 protein / human papillomavirus type 18 L1 protein
Status: Authorised
Authorisation Date: 2006-09-20
Therapeutic Area: Condylomata Acuminata Papillomavirus Infections Uterine Cervical Dysplasia Immunization
Pharmacotherapeutic Group: Vaccines

Therapeutic Indication

Gardasil is a vaccine for use from the age of 9 years for the prevention of:

  • premalignant genital lesions (cervical, vulvar and vaginal) and cervical cancer causally related to certain oncogenic human papillomavirus (HPV) types;
  • genital warts (condyloma acuminata) causally related to specific HPV types.

See sections 4.4 and 5.1 for important information on the data that support this indication.

The use of Gardasil should be in accordance with official recommendations.

What is Gardasil?

Gardasil is a vaccine. It is a suspension for injection that contains purified proteins for four types of the human papillomavirus (types 6, 11, 16 and 18). It is available in vials or prefilled syringes.

What is Gardasil used for?

Gardasil is used in patients from the age of nine years to protect against:

  • precancerous lesions (abnormal cell growth) in the genital area (cervix, vulva or vagina) and cancer of the cervix that are caused by certain cancer-causing types of the human papillomavirus (HPV);
  • external genital warts that are caused by specific HPV types.

Gardasil is given according to official recommendations.

The vaccine can only be obtained with a prescription.

How is Gardasil used?

Gardasil is given to individuals aged nine years or older, as three doses, with two months between the first and second doses, and four months between the second and third doses. If a different schedule is needed, there should be at least one month between the first and the second doses, and at least three months between the second and the third, and all doses should be given within a year. It is recommended that individuals who receive the first dose of Gardasil should complete all three doses with Gardasil. The vaccine is given as an injection into a muscle, preferably in the shoulder or the thigh.

How does Gardasil work?

Papillomaviruses are viruses that cause warts and abnormal tissue growth. There are more than 100 types of papillomavirus, some of which are associated with genital cancers. HPV types 16 and 18 cause approximately 70% of cervical cancers and HPV types 6 and 11 cause approximately 90% of genital warts.

All papillomaviruses have a shell, or ‘capsid’, that is made up of proteins called ‘L1 proteins’. Gardasil contains the purified L1 proteins for HPV types 6, 11, 16 and 18, which are produced by a method known as ‘recombinant DNA technology’: they are made by a yeast that has received a gene (DNA) that makes it able to produce the L1 proteins. The proteins are assembled in ‘virus-like particles’ (structures that look like HPV, so that the body can recognise them easily). These virus-like particles are not capable of causing infection.

When a patient is given the vaccine, the immune system makes antibodies against the L1 proteins. After vaccination, the immune system is able to produce antibodies more quickly when it is exposed to the real viruses. This will help to protect against the diseases caused by these viruses.

The vaccine also contains an ‘adjuvant’ (a compound containing aluminium) to stimulate a better response.

How has Gardasil been studied?

There were four main studies of Gardasil, involving a total of almost 21,000 women aged between 16 and 26 years. Gardasil was compared with placebo (a dummy vaccine). The studies looked at how many women developed genital lesions or warts that were due to HPV infection. The women were followed up for around three years after the third dose of the vaccine.

Additional studies looked at the ability of Gardasil to prevent infection with HPV types 6, 11, 16 and 18 and genital lesions caused by these HPV types in almost 4,000 women aged between 24 and 45 years, and at the development of antibodies against these HPV types in around 1,700 girls and boys aged between nine and 15 years.

What benefit has Gardasil shown during the studies?

Gardasil was effective against precancerous genital lesions of the cervix, vulva and vagina, cervical cancer, and warts related to HPV types 6, 11, 16 and 18.

Looking at the results of all four studies together, out of the more than 8,000 women vaccinated with Gardasil who had never been infected by HPV types 6, 11, 16 or 18 before, one woman developed a precancerous lesion in the cervix that might have been due to HPV type 16 or 18. In contrast, 85 of the more than 8,000 women who received the placebo vaccine developed lesions that were due to these two HPV types. A similar effect of Gardasil was seen when the analysis also included lesions of the cervix due to the other two HPV types (types 6 and 11).

For external genital lesions due to HPV types 6, 11, 16 or 18 (including warts and precancerous lesions of the vulva or the vagina), the results of three of the studies were looked at together. Two women out of almost 8,000 in the Gardasil group developed genital warts, and there were no cases of precancerous lesions of the vulva or the vagina. In contrast, there was a total of 189 cases of external genital lesions out of almost 8,000 women in the placebo group.

The studies also showed that Gardasil provided some protection against lesions in the cervix linked to other cancer-causing types of HPV, including type 31.

The additional studies confirmed the ability of Gardasil to protect against lesions and HPV infection in 24- to 45-year-old women. The studies also showed that the vaccine stimulates the production of sufficient amounts of antibodies against HPV in girls and boys aged between nine and 15 years.

What is the risk associated with Gardasil?

In studies, the most common side effects with Gardasil (seen in more than 1 patient in 10) were pyrexia (fever) and reactions at the site of the injection (redness, pain and swelling). For the full list of all side effects reported with Gardasil, see the package leaflet.

Gardasil should not be used in people who may be hypersensitive (allergic) to the active substance or any of the other ingredients. Patients who show signs of an allergy after a dose of Gardasil should not receive further doses of the vaccine. Vaccination should be postponed in patients who are ill with a high fever.

Why has Gardasil been approved?

The CHMP decided that Gardasil’s benefits are greater than its risks and recommended that it be given marketing authorisation.

Other information about Gardasil

The European Commission granted a marketing authorisation valid throughout the European Union for Gardasil to Sanofi Pasteur MSD SNC on 20 September 2006. The marketing authorisation is valid for five years, after which it can be renewed.

For more information about treatment with Gardasil, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

Source: European Medicines Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.