INDICATION
                        
                        
 
                    MEPSEVII is a recombinant human lysosomal beta glucuronidase indicated
                        in pediatric and adult patients
                        for the treatment of
                        Mucopolysaccharidosis VII (MPS VII, Sly
                        syndrome).
                
                
                    
                        Limitations of Use
                         
                    
                    
                    The effect of MEPSEVII on the central nervous system manifestations of
                        MPS VII has not been determined.
                
                
                    
                        
                            Boxed warning and additional Important Safety Information
                        
                    
                
                
                    
                        
                            
                                
                                     WARNING: ANAPHYLAXIS
                                
                            
                        
                    
                    
                        - 
                            
                                Anaphylaxis has occurred with MEPSEVII administration, as early as the first dose,
                                    therefore
                                    appropriate medical support should be readily available when MEPSEVII is
                                    administered.
                                
                            
                        
- 
                            
                                Closely observe patients during and for 60 minutes after MEPSEVII infusion.
                            
                        
- 
                            
                                Immediately discontinue the MEPSEVII infusion if the patient experiences
                                    anaphylaxis.
                            
                        
 
                
                
                    - 
                        Anaphylaxis to MEPSEVII was reported in 2 of 20 patients in the
                            clinical program. The two patients
                            with anaphylaxis to MEPSEVII during the clinical trials had one occurrence each and
                            tolerated
                            subsequent infusions of MEPSEVII, without recurrence. 
                    
- 
                        Consider the risks and benefits of re-administering MEPSEVII
                            following anaphylaxis.
                    
- 
                        Manifestations included respiratory distress, cyanosis, decreased
                            oxygen saturation, and hypotension.
                        
                    
- 
                        Prior to discharge, inform patients of the signs and symptoms of
                            anaphylaxis and instruct them to
                            seek immediate medical care if symptoms occur. 
                    
                    
                        Adverse Reactions
                    
                
                
                    - 
                        In a clinical trial, the most common adverse reactions occurring
                            with MEPSEVII treatment included
                            infusion site extravasation, diarrhea, rash, anaphylaxis, infusion site swelling, peripheral
                            swelling, and pruritus.
                    
- 
                        One patient experienced a febrile convulsion during MEPSEVII
                            treatment. The patient subsequently
                            was re-challenged without recurrence and continued on treatment. 
                    
                    
                        Use in Specific Populations
                    
                
                
                    - 
                        There are no available data on MEPSEVII use in pregnant women to
                            determine a drug-associated risk
                            of adverse developmental outcomes. 
                    
- 
                        There are no data on the presence of MEPSEVII in either human or
                            animal milk, the effects on the
                            breastfed infant, or the effects on milk production. The developmental and health benefits
                            of
                            breastfeeding should be considered along with the mother’s clinical need for MEPSEVII and
                            any
                            potential adverse effects on the breastfed infant from MEPSEVII or from the underlying
                            maternal
                            condition.
                    
You may report side effects to the FDA at (800) FDA-1088
                            or www.fda.gov/medwatch.
                    
                    You may also report side effects to Ultragenyx at 1-888-756-8657.
                    Please see full Prescribing
                                Information,
                    including the BOXED WARNING, for a complete
                        discussion of the risks associated with MEPSEVII.