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Active Substance: human papillomavirus1 type 16 L1 protein / human papillomavirus type 18 L1 protein
Common Name: human papillomavirus vaccine [types 16, 18] (recombinant, adjuvanted, adsorbed)
ATC Code: J07BM02
Marketing Authorisation Holder: GlaxoSmithKline Biologicals S.A.
Active Substance: human papillomavirus1 type 16 L1 protein / human papillomavirus type 18 L1 protein
Status: Authorised
Authorisation Date: 2007-09-20
Therapeutic Area: Papillomavirus Infections Uterine Cervical Dysplasia Immunization
Pharmacotherapeutic Group: Vaccines

Therapeutic Indication

Cervarix is a vaccine for use from the age of nine years for the prevention of premalignant genital (cervical, vulvar and vaginal) lesions and cervical cancer causally related to certain oncogenic human-papillomavirus (HPV) types.

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

What is Cervarix?

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

What is Cervarix used for?

Cervarix is used in women and girls from nine years old to protect against cancer of the cervix (neck of the womb) and precancerous lesions (abnormal cell growth) in the genital area (cervix, vulva or vagina) caused by certain types of the human papillomavirus (HPV).

Cervarix is given according to official recommendations.

The vaccine can only be obtained with a prescription.

How is Cervarix used?

Cervarix is given as two or three doses depending on age.

Girls aged 9 to 14 years can be given two doses, six months apart. If necessary, the second dose can be given between 5 and 13 months after the first dose.

Girls and women aged 15 and above are given three doses. It is recommended that there is one month between the first and second doses, and five months between the second and third doses. However, the second and third doses can be given after longer gaps if necessary.

It is recommended that individuals who receive the first dose of Cervarix should complete the course of vaccination. The vaccine is given as an injection into the shoulder muscle.

How does Cervarix 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.

All papillomaviruses have a shell or ‘capsid’, which is made up of distinctive proteins called ‘L1 proteins’. Cervarix contains purified L1 proteins for HPV types 16 and 18, which are produced by a method known as ‘recombinant DNA technology’: they are made by cells into which a gene (DNA) has been introduced that makes the cells 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).

When a patient is given the vaccine, the immune system makes antibodies against the L1 proteins. The antibodies help to destroy the virus. 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 is made using an ‘adjuvant system’ that contains MPL, a purified lipid (a fat-like substance) extracted from bacteria, which enhances the response of the immune system to the vaccine. The vaccine is ‘adsorbed’, which means that the virus-like particles and the MPL are fixed onto an aluminium compound, to stimulate a better immune response.

How has Cervarix been studied?

One main study of Cervarix involved almost 19,000 women aged between 15 and 25 years. Cervarix was compared with another vaccine that is not active against HPV (in this case, a vaccine against hepatitis A virus). The study looked at how many women, who in the vast majority had no current infection with HPV types 16 or 18 at the start of the study, went on to develop precancerous lesions in the cervix linked to infection with these types of HPV. The women were followed up for up to four years after the first dose of the vaccines.

The effect of two doses of Cervarix in girls aged 9 to 14 years was compared with the effect of three doses in girls and women aged 15 to 25 in a second main study. The main measure of effectiveness was the development of protective antibodies against HPV types 16 and 18 one month after the last dose in previously unvaccinated subjects.

Five additional studies also looked at the development of antibodies in girls and women from 9 to 25 years of age who were given three doses of Cervarix.

The company also presented data on protection against precancerous vulvar and vaginal lesions in patients given Cervarix.

What benefit has Cervarix shown during the studies?

Cervarix was more effective than the comparator vaccine in preventing abnormal cell growth in the cervix. In the first main study, after an average of 39 months, four of the more than 7,000 women who received Cervarix and who had not been infected with HPV types 16 or 18 before, developed precancerous lesions in the cervix linked to these HPV types. This compared with 56 of the more than 7,000 women who received the other vaccine. The study also showed that Cervarix can provide protection against infection or lesions linked to some other HPV types.

The second main study showed that two doses of Cervarix given 5 to 13 months apart were no less effective in girls aged 9 to 14 than a standard three-dose vaccination was in older subjects: all previously unprotected subjects had developed high levels of protective antibodies against virus types 16 and 18 one month after their last dose. The additional five studies also showed that all of those aged nine years and older who were given three doses of Cervarix developed high levels of antibodies against HPV types 16 and 18. Taken together these results suggested that the vaccine would be effective at protecting from infection with these HPV types when given from 9 years of age, and that a two-dose vaccination was suitable in those aged 9 to 14.

Data on protection against precancerous vulvar and vaginal lesions indicated that Cervarix could be effective in protecting against these lesions.

What is the risk associated with Cervarix?

The most common side effects with Cervarix (seen in more than 1 patient in 10) are headache, myalgia (muscle pain), reactions at the site of injection including pain, redness and swelling, and fatigue (tiredness).

Vaccination with Cervarix must be postponed in patients who are ill with a high fever. For the full list of all side effects and restrictions with Cervarix, see the package leaflet.

Why has Cervarix been approved?

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

What measures are being taken to ensure the safe and effective use of Cervarix?

A risk management plan has been developed to ensure that Cervarix is used as safely as possible. Based on this plan, safety information has been included in the summary of product characteristics and the package leaflet for Cervarix, including the appropriate precautions to be followed by healthcare professionals and patients.

Other information about Cervarix

The European Commission granted a marketing authorisation valid throughout the European Union for Cervarix on 20 September 2007.

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

Source: European Medicines Agency

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