EUCRISA- crisaborole ointment
For Healthcare Providers >

1. Patient Information
2. Hypersensitivity Reactions:
3. Who Should Not Use Eucrisa?
4. What Are The Possible Side Effects Of Eucrisa?
5. How Should I Store Eucrisa?
6. Active Ingredient:
7. Inactive Ingredients:

Patient Information ⮝

Advise the patient or caregivers to read the FDA-approved patient labeling (Patient Information).

Hypersensitivity Reactions: ⮝

Advise patients to discontinue EUCRISA and

EUCRISA is a prescription medicine used on the skin (topical) to treat mild to moderate eczema (atopic dermatitis) in adults and children 2 years of age and older.

It is not known if EUCRISA is safe and effective in children under 2 years of age.

Who Should Not Use Eucrisa? ⮝

Do not use EUCRISA if you are allergic to crisaborole or any of the ingredients in EUCRISA.

• Use EUCRISA exactly as your healthcare provider tells you to use it.
• Apply a thin layer of EUCRISA to the affected areas 2 times each day.
• Wash your hands after applying EUCRISA, unless hands are being treated. If someone else applies EUCRISA for you, they should wash their hands after applying EUCRISA.

What Are The Possible Side Effects Of Eucrisa? ⮝

EUCRISA may cause side effects.

• Allergic reactions.EUCRISA may cause allergic reactions at or near the application site. These can be serious and may include hives, itching, swelling, and redness. If you have any of these symptoms, stop using EUCRISA and get medical help right away.

The most common side effect of EUCRISA is application site pain, such as burning or stinging.

This is not the only possible side effect of EUCRISA.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How Should I Store Eucrisa? ⮝

• Store EUCRISA at room temperature, between 68 F and 77 F (20 C and 25 C).
• Keep the tube tightly closed.

General information about the safe and effective use of EUCRISA

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use EUCRISA for a condition for which it was not prescribed. Do not give EUCRISA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about EUCRISA that is written for healthcare professionals.

Active Ingredient: ⮝

crisaborole

Inactive Ingredients: ⮝

white petrolatum, propylene glycol, mono- and di-glycerides, paraffin, butylated hydroxytoluene, and edetate calcium disodium.

For more information, call 1-866-EUCRISA [1-866-382-7472] or go to www.EUCRISA.com

LAB-0917-2.0

1. Highlights Of Prescribing Information
2. Indications And Usage
3. Dosage And Administration
4. Dosage Forms And Strengths
5. Contraindications
6. Warnings And Precautions
7. Adverse Reactions
8. 1 Indications And Usage
9. 2 Dosage And Administration
10. 3 Dosage Forms And Strengths
11. 4 Contraindications
12. 5 Warnings And Precautions
13. 6 Adverse Reactions
14. 8 Use In Specific Populations
15. 11 Description
16. 12 Clinical Pharmacology
17. 13 Nonclinical Toxicology
18. 14 Clinical Studies
19. 16 How Supplied/storage And Handling
20. Principal Display Panel - 60 G Tube Label
21. Principal Display Panel - 60 G Tube Carton
22. Principal Display Panel - 60 G Tube Label - Sample
23. Principal Display Panel - 60 G Tube Carton - Sample

Highlights Of Prescribing Information ⮝

These highlights do not include all the information needed to use EUCRISA safely and effectively. See full prescribing information for EUCRISA.

EUCRISA (crisaborole) ointment, 2%, for topical use
Initial U.S. Approval: 2016

Indications And Usage ⮝

EUCRISA is a phosphodiesterase 4 inhibitor indicated for topical treatment of mild to moderate atopic dermatitis in patients 2 years of age and older. (1)

Dosage And Administration ⮝

• Apply a thin layer twice daily to affected areas. (2)
• For topical use only. (2)
• Not for ophthalmic, oral, or intravaginal use. (2)

Dosage Forms And Strengths ⮝

Ointment, 2%. (3)

Contraindications ⮝

Known hypersensitivity to crisaborole or any component of the formulation. (4)

Warnings And Precautions ⮝

Hypersensitivity reactions: If signs and symptoms of hypersensitivity occur, discontinue EUCRISA immediately and initiate appropriate therapy. (5.1)

Adverse Reactions ⮝

The most common adverse reaction occurring in 1% in subjects is application site pain. (6.1)

To report SUSPECTED ADVERSE REACTIONS, contact Pfizer, Inc. at 1-800-438-1985 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling.

Revised: 12/2018

1 Indications And Usage ⮝

EUCRISA is indicated for topical treatment of mild to moderate atopic dermatitis in patients 2 years of age and older.

2 Dosage And Administration ⮝

Apply a thin layer of EUCRISA twice daily to affected areas.

EUCRISA is for topical use only and not for ophthalmic, oral, or intravaginal use.

3 Dosage Forms And Strengths ⮝

Ointment: 20 mg of crisaborole per gram (2%) of white to off-white ointment.

4 Contraindications ⮝

EUCRISA is contraindicated in patients with known hypersensitivity to crisaborole or any component of the formulation. [see Warnings and Precautions (5. 1)]

5 Warnings And Precautions ⮝

5.1 Hypersensitivity Reactions

Hypersensitivity reactions, including contact urticaria, have occurred in patients treated with EUCRISA. Hypersensitivity should be suspected in the event of severe pruritus, swelling and erythema at the application site or at a distant site. If signs and symptoms of hypersensitivity occur, discontinue EUCRISA immediately and initiate appropriate therapy.

6 Adverse Reactions ⮝

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In two double-blind, vehicle-controlled clinical trials (Trial 1 and Trial 2), 1012 subjects 2 to 79 years of age with mild to moderate atopic dermatitis were treated with EUCRISA twice daily for 4 weeks. The adverse reaction reported by 1% of EUCRISA-treated subjects is listed in Table 1.

Table 1: Adverse Reaction Occurring in 1% of Subjects in Atopic Dermatitis Trials through Week 4

Adverse Reaction	EUCRISA N=1012 n (%)	Vehicle N=499 n (%)
* Refers to skin sensations such as burning or stinging.
Application site pain*	45 (4)	6 (1)

Less common (<1%) adverse reactions in subjects treated with EUCRISA included contact urticaria [see Warnings and Precautions (5.1)].

8 Use In Specific Populations ⮝

8.1 Pregnancy

Risk Summary

There is no available data with EUCRISA in pregnant women to inform the drug-associated risk for major birth defects and miscarriage. In animal reproduction studies, there were no adverse developmental effects observed with oral administration of crisaborole in pregnant rats and rabbits during organogenesis at doses up to 3 and 2 times, respectively, the maximum recommended human dose (MRHD) [see Data].

The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies carry some risk of birth defect, loss, or other adverse outcomes. The background risk of major birth defects in the U.S. general population is 2% to 4% and of miscarriage is 15% to 20% of clinically recognized pregnancies.

Data

Animal Data

Rat and rabbit embryo-fetal development was assessed after oral administration of crisaborole. Crisaborole did not cause adverse effects to the fetus at oral doses up to 300 mg/kg/day in pregnant rats during the period of organogenesis (3 times the MRHD on an AUC comparison basis). No treatment-related fetal malformations were noted after oral treatment with crisaborole in pregnant rats at doses up to 600 mg/kg/day (13 times the MRHD on an AUC comparison basis) during the period of organogenesis. Maternal toxicity was produced at the high dose of 600 mg/kg/day in pregnant rats and was associated with findings of decreased fetal body weight and delayed skeletal ossification. Crisaborole did not cause adverse effects to the fetus at oral doses up to the highest dose tested of 100 mg/kg/day in pregnant rabbits during the period of organogenesis (2 times the MRHD on an AUC comparison basis).

In a prenatal/postnatal development study, pregnant rats were treated with crisaborole at doses of 150, 300, and 600 mg/kg/day by oral gavage during gestation and lactation (from gestation day 7 through day 20 of lactation). Crisaborole did not have any adverse effects on fetal development at doses up to 600 mg/kg/day (13 times the MRHD on an AUC comparison basis). Maternal toxicity was produced at the high dose of 600 mg/kg/day in pregnant rats and was associated with findings of stillbirths, pup mortality, and reduced pup weights.

8.2 Lactation

Risk Summary

There is no information available on the presence of EUCRISA in human milk, the effects of the drug on the breastfed infant or the effects of the drug on milk production after topical application of EUCRISA to women who are breastfeeding. EUCRISA is systemically absorbed. The lack of clinical data during lactation precludes a clear determination of the risk of EUCRISA to a breastfed infant. Therefore, the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for EUCRISA and any potential adverse effects on the breastfed infant from EUCRISA or from the underlying maternal condition.

8.4 Pediatric Use

The safety and effectiveness of EUCRISA have been established in pediatric patients age 2 years and older for topical treatment of mild to moderate atopic dermatitis. Use of EUCRISA in this age group is supported by evidence from two multicenter, randomized, double-blind, parallel-group, vehicle-controlled 28-day trials which included 1,313 pediatric subjects 2 years and older [see Adverse Reactions (6.1) and Clinical Studies (14)]. The safety and effectiveness of EUCRISA in pediatric patients below the age of 2 years have not been established.

8.5 Geriatric Use

Clinical studies of EUCRISA did not include sufficient numbers of subjects age 65 and over to determine whether they respond differently from younger subjects.

11 Description ⮝

EUCRISA contains 2% crisaborole (w/w) in a petrolatum-based, white to off-white ointment and is for topical use. The active ingredient, crisaborole, is a phosphodiesterase-4 (PDE-4) inhibitor.

Crisaborole is described chemically as 5-(4-cyanophenoxy)-1,3-dihydro-1-hydroxy-[2,1]-benzoxaborole. The empirical formula is C14H10BNO3 and the molecular weight is 251.1 g/mol.

The structural formula is represented below:

Crisaborole drug substance is freely soluble in common organic solvents such as isopropyl alcohol and propylene glycol, and insoluble in water.

Each gram of EUCRISA contains 20 mg of crisaborole in an ointment containing white petrolatum, propylene glycol, mono- and di-glycerides, paraffin, butylated hydroxytoluene, and edetate calcium disodium.

12 Clinical Pharmacology ⮝

12.1 Mechanism of Action

Crisaborole is a phosphodiesterase 4 (PDE-4) inhibitor. PDE-4 inhibition results in increased intracellular cyclic adenosine monophosphate (cAMP) levels. The specific mechanism(s) by which crisaborole exerts its therapeutic action for the treatment of atopic dermatitis is not well defined.

12.2 Pharmacodynamics

At therapeutic doses, EUCRISA ointment is not expected to prolong QTc to any clinically relevant extent.

12.3 Pharmacokinetics

Absorption

The pharmacokinetics (PK) of EUCRISA were investigated in 33 pediatric subjects 2 to 17 years of age with mild to moderate atopic dermatitis and a mean SD body surface area involvement of 49 20% (range 27% to 92%). In this study, subjects applied approximately 3 mg/cm2 of EUCRISA ointment (dose range was approximately 6 g to 30 g per application) twice daily for 8 days.

Plasma concentrations were quantifiable in all the subjects. The mean SD maximum plasma concentration (Cmax) and area under the concentration time curve from 0 to 12 hours post dose (AUC0 12) for crisaborole on Day 8 were 127 196 ng/mL and 949 1240 ng*h/mL, respectively. Systemic concentrations of crisaborole were at steady state by Day 8. Based on the ratios of AUC0 12 between Day 8 and Day 1, the mean accumulation factor for crisaborole was 1.9.

Distribution

Based on an in vitro study, crisaborole is 97% bound to human plasma proteins.

Elimination

Metabolism

Crisaborole is substantially metabolized into inactive metabolites. The major metabolite 5-(4-cyanophenoxy)-2-hydroxyl benzylalcohol (metabolite 1), is formed via hydrolysis; this metabolite is further metabolized into downstream metabolites, among which 5-(4-cyanophenoxy)-2-hydroxyl benzoic acid (metabolite 2), formed via oxidation, is also a major metabolite.

PK of metabolites 1 and 2 were assessed in the PK study described above and the systemic concentrations were at or near steady state by Day 8. Based on the ratios of AUC0 12 between Day 8 and Day 1, the mean accumulation factors for metabolites 1 and 2 were 1.7 and 6.3, respectively.

Excretion

Renal excretion of metabolites is the major route of elimination.

Drug Interaction Studies

In vitro studies using human liver microsomes indicated that under the conditions of clinical use, crisaborole and metabolite 1 are not expected to inhibit cytochrome P450 (CYP) 1A2, 2B6, 2C8, 2C9, 2C19, 2D6, and 3A4.

In vitro human liver microsomes studies for metabolite 2 showed that it did not inhibit activities of CYP2C19, 2D6, and 3A4; was a weak inhibitor of CYP1A2 and 2B6; and a moderate inhibitor of CYP2C8 and 2C9. The most sensitive enzyme, CYP2C9, was further investigated in a clinical trial using warfarin as a CYP2C9 substrate. The results of this study showed no drug interaction potential.

In vitro studies in human hepatocytes showed that under the conditions of clinical use, crisaborole and metabolites 1 and 2 are not expected to induce CYP enzymes.

13 Nonclinical Toxicology ⮝

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

In an oral carcinogenicity study in Sprague-Dawley rats, oral doses of 30, 100, and 300 mg/kg/day crisaborole were administered to rats once daily. A drug-related increased incidence of benign granular cell tumors in the uterus with cervix or vagina (combined) was noted in 300 mg/kg/day crisaborole treated female rats (2 times the MRHD on an AUC comparison basis). The clinical relevance of this finding is unknown.

In a dermal carcinogenicity study in CD-1 mice, topical doses of 2%, 5% and 7% crisaborole ointment were administered once daily. No drug-related neoplastic findings were noted at topical doses up to 7% crisaborole ointment (1 times the MRHD on an AUC comparison basis).

Crisaborole revealed no evidence of mutagenic or clastogenic potential based on the results of two in vitro genotoxicity tests (Ames assay and human lymphocyte chromosomal aberration assay) and one in vivo genotoxicity test (rat micronucleus assay).

No effects on fertility were observed in male or female rats that were administered oral doses up to 600 mg/kg/day crisaborole (13 times the MRHD on an AUC comparison basis) prior to and during early pregnancy.

14 Clinical Studies ⮝

Two multicenter, randomized, double-blind, parallel-group, vehicle-controlled trials (Trials 1 and 2) treated a total of 1522 subjects 2 to 79 years of age (86.3% of subjects were 2 to 17 years of age) with a 5% to 95% treatable body surface area. At baseline, 38.5% of the subjects had an Investigator's Static Global Assessment [ISGA] score of 2 (mild), and 61.5% had an ISGA score of 3 (moderate), in the overall assessment of atopic dermatitis (erythema, induration/papulation, and oozing/crusting) on a severity scale of 0 to 4.

In both trials, subjects were randomized 2:1 to receive EUCRISA or vehicle applied twice daily for 28 days. The primary efficacy endpoint was the proportion of subjects at Day 29 who achieved success, defined as an ISGA grade of Clear (score of 0) or Almost Clear (score of 1) with a 2-grade or greater improvement from baseline, comparing EUCRISA-treated subjects to vehicle-treated subjects.

Efficacy results from the two trials are summarized in Table 2.

Table 2: Primary Efficacy Outcomes in Subjects with Mild to Moderate Atopic Dermatitis at Day 29

	Trial 1		Trial 2
	EUCRISA (N=503)	Vehicle (N=256)	EUCRISA (N=513)	Vehicle (N=250)
* Defined as an ISGA score of Clear (0) or Almost Clear (1) with a 2-grade or greater improvement from baseline.
Success in ISGA*	32.8%	25.4%	31.4%	18.0%

The success rates over time are presented in Figure 1.

* Success is defined as an ISGA score of Clear (0) or Almost Clear (1) with a 2-grade or greater improvement from baseline.
Figure 1: Success in ISGA* Over Time in Subjects with Mild to Moderate Atopic Dermatitis
Trial 1	Trial 2

16 How Supplied/storage And Handling ⮝

16.1 How Supplied

EUCRISA is a white to off-white ointment containing 2% crisaborole and is supplied in 60 g and 100 g laminate tubes.

60 g tube: NDC 55724-211-21
100 g tube: NDC 55724-211-11

16.2 Storage and Handling

Store at 20 C 25 C (68 F 77 F); excursions permitted to 15 C 30 C (59 F 86 F).
[see USP Controlled Room Temperature].

Keep tube tightly closed.

Principal Display Panel - 60 G Tube Label ⮝

eucrisa
(crisaborole) ointment 2%

NDC 55724-211-21
60 g
Rx only

For Topical Use Only.

Not for ophthalmic, oral, or intravaginal use.

Principal Display Panel - 60 G Tube Carton ⮝

eucrisa
(crisaborole) ointment 2%

For Topical Use Only.
Not for ophthalmic, oral, or intravaginal use.

NDC 55724-211-21

60 g
Rx only

Principal Display Panel - 60 G Tube Label - Sample ⮝

eucrisa
(crisaborole) ointment 2%

PROFESSIONAL SAMPLE - NOT FOR SALE
NDC 55724-211-23

60 g
Rx only

For Topical Use Only.

Not for ophthalmic, oral, or intravaginal use.

Principal Display Panel - 60 G Tube Carton - Sample ⮝

eucrisa
(crisaborole) ointment 2%

PROFESSIONAL SAMPLE - NOT FOR SALE

For Topical Use Only.
Not for ophthalmic, oral, or intravaginal use.

NDC 55724-211-23

60 g
Rx only

EUCRISA crisaborole ointment

Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:55724-211 Route of Administration TOPICAL

Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength CRISABOROLE (UNII: Q2R47HGR7P) (CRISABOROLE - UNII:Q2R47HGR7P) CRISABOROLE 20 mg in 1 g

Inactive Ingredients Ingredient Name Strength PETROLATUM (UNII: 4T6H12BN9U) PROPYLENE GLYCOL (UNII: 6DC9Q167V3) GLYCERYL MONOSTEARATE (UNII: 230OU9XXE4) PARAFFIN (UNII: I9O0E3H2ZE) BUTYLATED HYDROXYTOLUENE (UNII: 1P9D0Z171K) EDETATE CALCIUM DISODIUM (UNII: 25IH6R4SGF)

Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:55724-211-21 1 in 1 CARTON 01/30/2017 1 60 g in 1 TUBE; Type 0: Not a Combination Product 2 NDC:55724-211-11 1 in 1 CARTON 01/30/2017 2 100 g in 1 TUBE; Type 0: Not a Combination Product 3 NDC:55724-211-42 6 in 1 CARTON 01/30/2017 3 2.5 g in 1 TUBE; Type 0: Not a Combination Product 4 NDC:55724-211-23 1 in 1 CARTON 01/30/2017 4 60 g in 1 TUBE; Type 0: Not a Combination Product

Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date NDA NDA207695 01/30/2017

Labeler - Pfizer Laboratories Div Pfizer Inc (134489525)

Registrant - Pfizer Inc (113480771)

Establishment
Name	Address	ID/FEI	Business Operations
Pharmacia and Upjohn Company LLC		618054084	ANALYSIS(55724-211) , LABEL(55724-211) , MANUFACTURE(55724-211) , PACK(55724-211)

Revised: 1/2019 Document Id: 3e1699e3-9d55-4b36-b93c-4493008271f0 34391-3 Set id: 609b77de-1ca3-4783-b8f5-01a9c0f1d77d Version: 5 Effective Time: 20190122 Pfizer Laboratories Div Pfizer Inc