Gadolinium-based contrast agents: update from Guerbet LLC on U.S. FDA requirements
Gadolinium-based contrast agents: update from Guerbet LLC on U.S. Food and Drug Administration (FDA) requirements Princeton (USA)–Guerbet LLC takes note of the drug safety communication1 issued on December 19, 2017 by the U.S. Food and Drug Administration (FDA), regarding gadolinium-based contrast agents (GBCAs) and the retention of gadolinium in the body.
The FDA is requiring a new class warning and other safety measures for all gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (MRI).
The FDA notes that following administration of all GBCAs, gadolinium retention can be found in patients’ bodies, including the brain, for months to years. However, gadolinium retention has not been directly linked to adverse health effects in patients with normal kidney function, and FDA concluded that the benefit of all approved GBCAs continues to outweigh any potential risks.
As noted in the communication, FDA explains that there are two types of GBCAs based on their chemical structures: linear and macrocyclic. Linear GBCAs result in more retention, and retention for a longer period of time than macrocyclic GBCAs. FDA adds that gadolinium levels in the body are lowest after administration of macrocyclic agents such as Dotarem®(gadoterate meglumine).
“Health care professionals should consider the retention characteristics of each agent when choosing a GBCA for patients who may be at higher risk for gadolinium retention…These patients include those requiring multiple lifetime doses, pregnant women, children, and patients with inflammatory conditions. Minimize repeated GBCA imaging studies when possible, particularly closely spaced MRI studies. However, do not avoid or defer necessary GBCA MRI scans.”1
In addition to labeling changes, the FDA is requiring the development of a new patient Medication Guide to provide educational information that every patient will be asked to read before receiving a GBCA. Guerbet is currently working with the FDA to develop a guide, which is considered part of the product labeling and therefore must go through FDA regulatory review and approval prior to release to the public.
Magnetic resonance imaging (MRI) is a widely used diagnostic procedure which is critical to patient health. Contrast-enhanced MRI exams are necessary to give physicians a sharper, more accurate picture of tissue than would otherwise be available to them.
Guerbet will continue to work with FDA to implement the required labeling changes, including the Medication Guide, and will continue to work with all Health Authorities to further understand the mechanisms and consequences of gadolinium deposition in tissue.