What are the precautions for vosoritide?

Voxzogo (vosoritide) is a C-type natriuretic peptide (CNP) analogue administered by subcutaneous injection that is used to increase linear bone growth in children with achondroplasia who have open bone growth plates (epiphyses). In its clinical studies, warnings and precautions such as the risk of hypotension emerged.

Achondroplasia affects endochondral bone growth, the process by which growing cartilage is systematically replaced by bone tissue to form growing bone. In children with achondroplasia, bone growth is impaired due to an imbalance in the relationship between fibroblast growth factor receptor 3 (FGFR3) and CNP signaling pathways within growth plate cells. FGFR3 slows bone growth, while CNP promotes bone growth. Voxzogo works by stimulating CNP, improving the balance between FGFR3 and CNP, and increasing bone growth in children with open growth plates.

Transient decreases in blood pressure have been observed in clinical studies of Voxzogo. Subjects with severe heart or blood vessel disease and patients taking antihypertensive medications were excluded from Voxzogo clinical trials because pediatric patients taking antihypertensive medications are at greater risk. To reduce the risk of a drop in blood pressure and associated symptoms (dizziness, fatigue, and/or nausea), instruct patients to stay well hydrated and eat enough food before using Voxzogo.

In clinical trials, patients were injected with Voxzogo at a dose that was 2 to 3 times the recommended daily dose of 15 micrograms/kg, and no relevant adverse reactions occurred. If overdose is suspected, initiate supportive measures as clinically indicated. and not recommended for children with renal impairment (eGFR<60 ml/min/1.73 square meters).