Gadavist® (gadobutrol) injection 1 mmol/mL

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Gadavist® (gadobutrol) injection

Indication Approval Timeline

Use the slider below to explore Gadavist®'s indications.

CNS

Breast

Pediatric

MRA

2011

2014

2014

2016

  • Gadavist® is approved for use with magnetic resonance imaging (MRI) to detect and visualize areas with disrupted blood brain barrier (BBB) and/or abnormal vascularity of the central nervous system in patients 2 years of age and older

    Efficacy in CNS Clinical Trials

    In 2 US Phase III clinical trials of 657 patients (18-85), compared to pre-contrast MRI, Gadavist®-enhanced MRI demonstrated:

    Improved lesion visualization (average reader)¹

    • Superior contrast enhancement (P<0.001)
    • Superior border delineation (P<0.001)
    • Superior internal morphology (P<0.001)

    Improved assessment of normal and abnormal CNS anatomy¹

    WARNING: NEPHROGENIC SYSTEMIC FIBROSIS (NSF)

    Gadolinium-based contrast agents (GBCAs) increase the risk for NSF among patients with impaired elimination of the drugs. Avoid use of GBCAs in these patients unless the diagnostic information is essential and not available with non-contrasted MRI or other modalities. NSF may result in fatal or debilitating fibrosis affecting the skin, muscle and internal organs.

    • The risk for NSF appears highest among patients with:
      • - Chronic, severe kidney disease (GFR <30 mL/min/1.73m²), or
      • - Acute kidney injury
    • Screen patients for acute kidney injury and other conditions that may reduce renal function. For patients at risk for chronically reduced renal function (for example, age >60 years, hypertension or diabetes), estimate the glomerular filtration rate (GFR) through laboratory testing.
    • For patients at highest risk for NSF, do not exceed the recommended GADAVIST dose and allow a sufficient period of time for elimination of the drug from the body prior to any re-administration.

    Pediatric Patients

    Two studies in 44 pediatrics patients age younger than 2 years and 135 pediatric patients age 2 to less than 18 years supported extrapolation of adult CNS efficacy findings. For example, comparing pre vs paired pre- and post-contrast images, investigators selected the best of four descriptors under the heading, "Visualization of lesion-internal morphology (lesion characterization) or homogeneity of vessel enhancement" for 27/44 (62% = pre) vs 43/44 (98% = paired) MR images from patients age 0 to less than 2 years and 106/135 (78% = pre) vs 108/135 (80% = paired) MR images from patients age 2 to less than 18 years.1

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016.

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    High Relaxivity*, Macrocyclic Bond

    Strong Signal Enhancement

    Factors involved in signal enhancement

    Signal enhancement is based on multiple factors, including relaxivity, magnet field strength, and concentration in tissue.¹

    What is relaxivity?

    Relaxivity is a measure of the ability of magnetic compounds—like MR-contrast agents—to increase the relaxation rates of surrounding water protons. A high-relaxivity contrast agent may improve signal enhancement in contrast-enhanced images.

    *Relaxivity of Gadavist is 5.2 L•mmol–1• s–1 at 1.5 Tesla (r1 in plasma at 37°C)

    Macrocyclic Structure

    Gadolinium-chelate complexes

    The most widely used MRI-contrast agents are gadolinium-based, due to the high paramagnetism of the gadolinium ion, and are manufactured with a ligand bound to the central gadolinium (Gd3+) ion. The ligand forms a stable chelated complex around the gadolinium ion and reduces the chance of toxicity that could result from exposure to free gadolinium in the body.2

    Structural classes of GBCA

    There are 2 structural classes of GBCA chelates—macrocyclic and linear.3 Macrocyclic ligands bind gadolinium ions in a cage structure, while linear ligands bind gadolinium ions with a chain structure.4 Gadavist® is 1 of 3 macrocyclic contrast agents approved for use in CNS imaging in the US. Molecular structures of representative agents from each class are shown below.

    Structures of GBCA approved for CNS imaging:

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. Marie-France Bellin, Aart J. Van Der Molen. Extracellular gadolinium-based contrast media: An overview. European Journal of Radiology. 2008;66:160-167. 3. Frenzel T, Lengsfeld P, Schirmer H, et al. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 degrees C. Invest Radiol. 2008;43(12):817-828. 4. Morcos SK. Extracellular gadolinium contrast agents: Differences in stability. European Journal of Radiology. 2008;66:175-179.

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    Safety in Clinical Trials

    Safety

    In clinical trials of 6,809 patients (including 184 pediatric patients, ages 0 to 17 years), Gadavist® established the following safety profile¹. Adverse reactions associated with the use of Gadavist® are usually mild to moderate in severity and transient in nature. The adverse reactions that occured in ≥0.1% of subjects who received Gadavist® were¹:

    *Hypersensitivity/anaphylactoid reaction may occur with one or more of the following adverse reactions: for example, hypotension, urticaria, face edema, eyelid edema, flushing.

    Contraindication and Important Information about Hypersensitivity Reactions

    Gadavist® is contraindicated in patients with history of severe hypersensitivity reactions to Gadavist®. Anaphylactoid and anaphylactic reactions with cardiovascular, respiratory, or cutaneous manifestations, ranging from mild to severe, including death, have uncommonly occurred following Gadavist® administration. Patients with any history of a reaction to contrast media, bronchial asthma, and/or allergic disorders may have an increased risk for a hypersensitivity reaction to Gadavist®.

    Acute Kidney Injury

    In patients with chronic renal impairment, acute kidney injury sometimes requiring dialysis has been observed with the use of some GBCAs. Do not exceed the recommended dose; the risk of acute kidney injury may increase with higher than recommended doses.

    Overestimation of Extent of Malignant Disease in MRI of the Breast

    Gadavist® MRI of the breast overestimated the histologically confirmed extent of malignancy in the diseased breast in up to 50% of the patients.

    Low Sensitivity for Significant Arterial Stenosis

    The performance of Gadavist® MRA for detecting arterial segments with significant stenosis (>50% renal, >70% supra-aortic) has not been shown to exceed 55%. Therefore, a negative MRA study alone should not be used to rule out significant stenosis.

    Please see Full Prescribing Information.

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction. FDA website. http://www.fda.gov/Drugs/DrugSafety/ucm223966.htm. Updated September 9, 2010. Accessed November 13, 2012

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    Dosing

    Double the Concentration, Half the Volume

    Concentration

    Compared to 0.5 molar gadolinium-based contrast agents, the higher concentration of Gadavist® results in half the volume of administration and more a compact contrast bolus injection. At the site of imaging, the relative height and width of the time intensity curve for Gadavist® varies as a function of imaging location and multiple patient, injection, and device-specific factors.

    Extravasation and Injection Site Reactions

    Ensure catheter and venous patency before the injection of Gadavist®. Extravasation into tissues during Gadavist® administration may result in moderate irritation.

    Please see Additional Safety Information.

    Dosing

    The recommended dose of Gadavist® for adult and pediatric patients (including term neonates) is 0.1 mL/kg body weight (0.1 mmol/kg). Refer to the chart below to determine the volume to be administered.

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    Packaging

    Gadavist® is a clear, colorless-to-pale yellow solution containing 1 mmol gadobutrol per milliliter (equivalent to 604.72 mg gadobutrol per mL).

    Gadavist® is supplied in the following sizes:

    Ordering Information

    Gadavist® is available through all suppliers currently providing our other imaging products. To establish an account, call Bayer HealthCare LLC's master distributor, McKesson Specialty Distribution, at 1-877-259-4624 (option #1), or contact your local distributor.

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    Close Menu
    Reimbursement

    Reimbursement Helpline

    The Bayer Imaging Reimbursement Helpline is available to all institutions to provide further information. The Helpline can be reached at 1-800-423-7539.

    Billing for Gadavist®

    HCPCS code A9585 has been established by the Centers for Medicare and Medicaid Services (CMS) for Gadavist®. CMS sought to assign a code which would allow for accurate billing of Gadavist® presentations.

    The code descriptor for A9585 is per 0.1mL. When billing it is important to remember to multiply the amount of Gadavist® used by 10 in order to list the correct number of units on the claim form.

    • 2 mL = 20 units
    • 7.5 mL = 75 units
    • 10 mL = 100 units
    • 15 mL = 150 units

    Hospital-based outpatient HCPCS code for use with Gadavist®

    Freestanding HCPCS code for use with Gadavist

    Information provided in this resource is for informational purposes only and does not guarantee that codes will be appropriate or that coverage and reimbursement will result. Customers should consult with their payers for all relevant coverage, coding, and reimbursement requirements. It is the sole responsibility of the provider to select proper codes and ensure the accuracy of all claims used in seeking reimbursement. Neither this resource nor the Bayer Healthcare Medical Reimbursement Helpline is intended as a legal advice or as a substitute for a provider's independent professional judgment.

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    Purchasing
  • Gadavist® is approved for use with magnetic resonance imaging (MRI) to assess the presence and extent of malignant breast disease

    The First and Only Contrast Agent Indicated for Breast MRI (BMR)

    Breast MRI is a Radiation-free Imaging Modality with High Sensitivity

    According to the American College of Radiology (ACR), some key uses of breast MRI include:

    • Detection and characterization of disease1
    • Assessment of local extent of disease1
    • Guidance for biopsy and localization1

    For women with greater than 20% lifetime risk for development of breast cancer, both the Society of Breast Imaging and the American College of Radiology recommend annual screening breast MRI be performed in addition to annual mammography.2

    Gadavist® is approved for use with MRI to assess the presence and extent of malignant breast disease.

    Who is At Risk for Breast Cancer

    1 in 8 mothers, sisters, daughters, and friends in the United States will be diagnosed with Breast Cancer

    *Both invasive and in situ breast cancer

    Overestimation of Extent of Malignant Disease in MRI of the Breast

    Gadavist® MRI of the breast overestimated the histologically confirmed extent of malignancy in the diseased breast in up to 50% of the patients.

    References: 1. American College of Radiology. ACR Practice Guideline for the Performance of Contrast-enhanced Magnetic Resonance Imaging (MRI) of the Breast. http://www.acr.org/~/media/2a0eb28eb59041e28 25179afb72ef624.pdf. Accessed May 27, 2014. 2. Lee CH, Dershaw DD, Kopans D, et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol. 2010;7(1):18-27. 3. American Cancer Society. Breast Cancer Overview. http://www.cancer.org/acs/groups/cid/documents/webcontent/003037-pdf.pdf. Accessed May 27, 2014.

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    Efficacy in Clinical Trials - Breast

    Clinical Trial Design Overview

    Gadavist® is Indicated for Intravenous Use in MRI of the Breast to Assess the Presence and Extent of Malignant Breast Disease.

    Bayer demonstrated the benefit of Gadavist® in breast MRI in two identical Phase III clinical trials.1

    Clinical Trial Design Overview
    • Standard of Truth was determined through a two-physician panel:
    • All available reports from biopsies, surgery, pathology, X-Ray mammography (XRM), and ultrasound (excluding MRI)
    • Histology for all malignant lesions
    • Ultrasound plus XRM for disease-free breast regions

    Sensitivity of BMR with Gadavist® for Detection of Malignant Breast Disease

    The within-patient sensitivity of BMR with Gadavist® was superior to that of unenhanced MRI. The lower bound of the 95% confidence interval (CI) for the difference in within-subject sensitivity ranged from 19% to 42% for study 1 and from 12% to 27% for Study 2.2

    BMR with Gadavist® demonstrated superior within-patient sensitivity (presence and extent) of malignant disease to that of unenhanced MRI for all six readers. Within-patient sensitivity for Gadavist® ranged from 80-89%.2

    Readers reported statistically significant improvement in diagnostic confidence with Gadavist®-enhanced BMR (versus unenhanced).1

    Assessment of malignant disease was performed using region-based within-subject sensitivity. Sensitivity for each reading modality was defined as the mean of the percentage of malignant breast regions correctly interpreted for each subject. The false positive detection rates for Gadavist® BMR ranged from 39% to 53% (95% CI Upper Bounds ranged from 44% to 58%).2

    Sensitivity Charts 1 and 2

    Three additional readers in each study read XRM alone. Based on this patient population, within-patient sensitivity ranged from 68% to 73% and specificity in non-malignant breasts ranged from 86% to 94% for these readers over both studies.2

    Specificity of Gadavist® BMR in Non-malignant Breasts

    BMR with Gadavist® demonstrated breast-level specificity surpassing a performance threshold of 80% in non-malignant breasts for five out of six readers.2

    In breasts with malignancy, a false positive detection rate was calculated as the percentage of subjects for which the readers assessed a region as malignant which could not be verified by SoT. The false positive detection rates for Gadavist® BMR ranged from 39% to 53% (95% CI Upper Bounds ranged from 44% to 58%).2 Three additional readers in each study read XRM alone. Based on this patient population, specificity in non-malignant breasts ranged from 86% to 94% for these readers over both studies.2

    Specificity was defined as the percentage of non-malignant breasts correctly identified as non-malignant.2

    References: 1. Data on File. Bayer HealthCare. 2. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016.

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    High Relaxivity*, Macrocyclic Bond

    Strong Signal Enhancement

    Factors involved in signal enhancement

    Signal enhancement is based on multiple factors, including relaxivity, magnet field strength, and concentration in tissue.¹

    What is relaxivity?

    Relaxivity is a measure of the ability of magnetic compounds—like MR-contrast agents—to increase the relaxation rates of surrounding water protons. A high-relaxivity contrast agent may improve signal enhancement in contrast-enhanced images.

    *Relaxivity of Gadavist is 5.2 L•mmol–1• s–1 at 1.5 Tesla (r1 in plasma at 37°C)

    Macrocyclic Structure

    Gadolinium-chelate complexes

    The most widely used MRI-contrast agents are gadolinium-based, due to the high paramagnetism of the gadolinium ion, and are manufactured with a ligand bound to the central gadolinium (Gd3+) ion. The ligand forms a stable chelated complex around the gadolinium ion and reduces the chance of toxicity that could result from exposure to free gadolinium in the body.2

    Structural classes of GBCA

    There are 2 structural classes of GBCA chelates—macrocyclic and linear.3 Macrocyclic ligands bind gadolinium ions in a cage structure, while linear ligands bind gadolinium ions with a chain structure.4 Gadavist® is 1 of 3 macrocyclic contrast agents approved for use in CNS imaging in the US. Molecular structures of representative agents from each class are shown below.

    Structures of GBCA approved for CNS imaging:

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. Marie-France Bellin, Aart J. Van Der Molen. Extracellular gadolinium-based contrast media: An overview. European Journal of Radiology. 2008;66:160-167. 3. Frenzel T, Lengsfeld P, Schirmer H, et al. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 degrees C. Invest Radiol. 2008;43(12):817-828. 4. Morcos SK. Extracellular gadolinium contrast agents: Differences in stability. European Journal of Radiology. 2008;66:175-179.

    Back to top
    Close Menu
    Safety in Clinical Trials

    Safety

    In clinical trials of 6,809 patients (including 184 pediatric patients, ages 0 to 17 years), Gadavist® established the following safety profile¹. Adverse reactions associated with the use of Gadavist® are usually mild to moderate in severity and transient in nature. The adverse reactions that occured in ≥0.1% of subjects who received Gadavist® were¹:

    *Hypersensitivity/anaphylactoid reaction may occur with one or more of the following adverse reactions: for example, hypotension, urticaria, face edema, eyelid edema, flushing.

    Contraindication and Important Information about Hypersensitivity Reactions

    Gadavist® is contraindicated in patients with history of severe hypersensitivity reactions to Gadavist®. Anaphylactoid and anaphylactic reactions with cardiovascular, respiratory, or cutaneous manifestations, ranging from mild to severe, including death, have uncommonly occurred following Gadavist® administration. Patients with any history of a reaction to contrast media, bronchial asthma, and/or allergic disorders may have an increased risk for a hypersensitivity reaction to Gadavist®.

    Acute Kidney Injury

    In patients with chronic renal impairment, acute kidney injury sometimes requiring dialysis has been observed with the use of some GBCAs. Do not exceed the recommended dose; the risk of acute kidney injury may increase with higher than recommended doses.

    Overestimation of Extent of Malignant Disease in MRI of the Breast

    Gadavist® MRI of the breast overestimated the histologically confirmed extent of malignancy in the diseased breast in up to 50% of the patients.

    Low Sensitivity for Significant Arterial Stenosis

    The performance of Gadavist® MRA for detecting arterial segments with significant stenosis (>50% renal, >70% supra-aortic) has not been shown to exceed 55%. Therefore, a negative MRA study alone should not be used to rule out significant stenosis.

    Please see Full Prescribing Information.

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction. FDA website. http://www.fda.gov/Drugs/DrugSafety/ucm223966.htm. Updated September 9, 2010. Accessed November 13, 2012

    Back to top
    Close Menu
    Dosing

    Double the Concentration, Half the Volume

    Concentration

    Compared to 0.5 molar gadolinium-based contrast agents, the higher concentration of Gadavist® results in half the volume of administration and more a compact contrast bolus injection. At the site of imaging, the relative height and width of the time intensity curve for Gadavist® varies as a function of imaging location and multiple patient, injection, and device-specific factors.

    Extravasation and Injection Site Reactions

    Ensure catheter and venous patency before the injection of Gadavist®. Extravasation into tissues during Gadavist® administration may result in moderate irritation.

    Please see Additional Safety Information.

    Dosing

    The recommended dose of Gadavist® for adult and pediatric patients (including term neonates) is 0.1 mL/kg body weight (0.1 mmol/kg). Refer to the chart below to determine the volume to be administered.

    Back to top
    Close Menu
    Packaging

    Gadavist® is a clear, colorless-to-pale yellow solution containing 1 mmol gadobutrol per milliliter (equivalent to 604.72 mg gadobutrol per mL).

    Gadavist® is supplied in the following sizes:

    Ordering Information

    Gadavist® is available through all suppliers currently providing our other imaging products. To establish an account, call Bayer HealthCare LLC's master distributor, McKesson Specialty Distribution, at 1-877-259-4624 (option #1), or contact your local distributor.

    Back to top
    Close Menu
    Reimbursement

    Reimbursement Helpline

    The Bayer Imaging Reimbursement Helpline is available to all institutions to provide further information. The Helpline can be reached at 1-800-423-7539.

    Billing for Gadavist®

    HCPCS code A9585 has been established by the Centers for Medicare and Medicaid Services (CMS) for Gadavist®. CMS sought to assign a code which would allow for accurate billing of Gadavist® presentations.

    The code descriptor for A9585 is per 0.1mL. When billing it is important to remember to multiply the amount of Gadavist® used by 10 in order to list the correct number of units on the claim form.

    • 2 mL = 20 units
    • 7.5 mL = 75 units
    • 10 mL = 100 units
    • 15 mL = 150 units

    Hospital-based outpatient HCPCS code for use with Gadavist®

    Freestanding HCPCS code for use with Gadavist

    Information provided in this resource is for informational purposes only and does not guarantee that codes will be appropriate or that coverage and reimbursement will result. Customers should consult with their payers for all relevant coverage, coding, and reimbursement requirements. It is the sole responsibility of the provider to select proper codes and ensure the accuracy of all claims used in seeking reimbursement. Neither this resource nor the Bayer Healthcare Medical Reimbursement Helpline is intended as a legal advice or as a substitute for a provider's independent professional judgment.

    Back to top
    Close Menu
    Purchasing
  • Gadavist® is approved for use with magnetic resonance imaging (MRI) to detect and visualize areas with disrupted blood brain barrier (BBB) and/or abnormal vascularity of the central nervous system in pediatric patients less than 2 years of age (including term neonates)

    Efficacy in CNS Clinical Trials

    In 2 US Phase III clinical trials of 657 patients (18-85), compared to pre-contrast MRI, Gadavist®-enhanced MRI demonstrated:

    Improved lesion visualization (average reader)¹

    • Superior contrast enhancement (P<0.001)
    • Superior border delineation (P<0.001)
    • Superior internal morphology (P<0.001)

    Improved assessment of normal and abnormal CNS anatomy¹

    WARNING: NEPHROGENIC SYSTEMIC FIBROSIS (NSF)

    Gadolinium-based contrast agents (GBCAs) increase the risk for NSF among patients with impaired elimination of the drugs. Avoid use of GBCAs in these patients unless the diagnostic information is essential and not available with non-contrasted MRI or other modalities. NSF may result in fatal or debilitating fibrosis affecting the skin, muscle and internal organs.

    • The risk for NSF appears highest among patients with:
      • - Chronic, severe kidney disease (GFR <30 mL/min/1.73m²), or
      • - Acute kidney injury
    • Screen patients for acute kidney injury and other conditions that may reduce renal function. For patients at risk for chronically reduced renal function (for example, age >60 years, hypertension or diabetes), estimate the glomerular filtration rate (GFR) through laboratory testing.
    • For patients at highest risk for NSF, do not exceed the recommended GADAVIST dose and allow a sufficient period of time for elimination of the drug from the body prior to any re-administration.

    Pediatric Patients

    Two studies in 44 pediatrics patients age younger than 2 years and 135 pediatric patients age 2 to less than 18 years supported extrapolation of adult CNS efficacy findings. For example, comparing pre vs paired pre- and post-contrast images, investigators selected the best of four descriptors under the heading, "Visualization of lesion-internal morphology (lesion characterization) or homogeneity of vessel enhancement" for 27/44 (62% = pre) vs 43/44 (98% = paired) MR images from patients age 0 to less than 2 years and 106/135 (78% = pre) vs 108/135 (80% = paired) MR images from patients age 2 to less than 18 years.1

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016.

    Back to top
    Close Menu
    High Relaxivity*, Macrocyclic Bond

    Strong Signal Enhancement

    Factors involved in signal enhancement

    Signal enhancement is based on multiple factors, including relaxivity, magnet field strength, and concentration in tissue.¹

    What is relaxivity?

    Relaxivity is a measure of the ability of magnetic compounds—like MR-contrast agents—to increase the relaxation rates of surrounding water protons. A high-relaxivity contrast agent may improve signal enhancement in contrast-enhanced images.

    *Relaxivity of Gadavist is 5.2 L•mmol–1• s–1 at 1.5 Tesla (r1 in plasma at 37°C)

    Macrocyclic Structure

    Gadolinium-chelate complexes

    The most widely used MRI-contrast agents are gadolinium-based, due to the high paramagnetism of the gadolinium ion, and are manufactured with a ligand bound to the central gadolinium (Gd3+) ion. The ligand forms a stable chelated complex around the gadolinium ion and reduces the chance of toxicity that could result from exposure to free gadolinium in the body.2

    Structural classes of GBCA

    There are 2 structural classes of GBCA chelates—macrocyclic and linear.3 Macrocyclic ligands bind gadolinium ions in a cage structure, while linear ligands bind gadolinium ions with a chain structure.4 Gadavist® is 1 of 3 macrocyclic contrast agents approved for use in CNS imaging in the US. Molecular structures of representative agents from each class are shown below.

    Structures of GBCA approved for CNS imaging:

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. Marie-France Bellin, Aart J. Van Der Molen. Extracellular gadolinium-based contrast media: An overview. European Journal of Radiology. 2008;66:160-167. 3. Frenzel T, Lengsfeld P, Schirmer H, et al. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 degrees C. Invest Radiol. 2008;43(12):817-828. 4. Morcos SK. Extracellular gadolinium contrast agents: Differences in stability. European Journal of Radiology. 2008;66:175-179.

    Back to top
    Close Menu
    Safety in Clinical Trials

    Safety

    In clinical trials of 6,809 patients (including 184 pediatric patients, ages 0 to 17 years), Gadavist® established the following safety profile¹. Adverse reactions associated with the use of Gadavist® are usually mild to moderate in severity and transient in nature. The adverse reactions that occured in ≥0.1% of subjects who received Gadavist® were¹:

    *Hypersensitivity/anaphylactoid reaction may occur with one or more of the following adverse reactions: for example, hypotension, urticaria, face edema, eyelid edema, flushing.

    Contraindication and Important Information about Hypersensitivity Reactions

    Gadavist® is contraindicated in patients with history of severe hypersensitivity reactions to Gadavist®. Anaphylactoid and anaphylactic reactions with cardiovascular, respiratory, or cutaneous manifestations, ranging from mild to severe, including death, have uncommonly occurred following Gadavist® administration. Patients with any history of a reaction to contrast media, bronchial asthma, and/or allergic disorders may have an increased risk for a hypersensitivity reaction to Gadavist®.

    Acute Kidney Injury

    In patients with chronic renal impairment, acute kidney injury sometimes requiring dialysis has been observed with the use of some GBCAs. Do not exceed the recommended dose; the risk of acute kidney injury may increase with higher than recommended doses.

    Overestimation of Extent of Malignant Disease in MRI of the Breast

    Gadavist® MRI of the breast overestimated the histologically confirmed extent of malignancy in the diseased breast in up to 50% of the patients.

    Low Sensitivity for Significant Arterial Stenosis

    The performance of Gadavist® MRA for detecting arterial segments with significant stenosis (>50% renal, >70% supra-aortic) has not been shown to exceed 55%. Therefore, a negative MRA study alone should not be used to rule out significant stenosis.

    Please see Full Prescribing Information.

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction. FDA website. http://www.fda.gov/Drugs/DrugSafety/ucm223966.htm. Updated September 9, 2010. Accessed November 13, 2012

    Back to top
    Close Menu
    Dosing

    Double the Concentration, Half the Volume

    Concentration

    Compared to 0.5 molar gadolinium-based contrast agents, the higher concentration of Gadavist® results in half the volume of administration and more a compact contrast bolus injection. At the site of imaging, the relative height and width of the time intensity curve for Gadavist® varies as a function of imaging location and multiple patient, injection, and device-specific factors.

    Extravasation and Injection Site Reactions

    Ensure catheter and venous patency before the injection of Gadavist®. Extravasation into tissues during Gadavist® administration may result in moderate irritation.

    Please see Additional Safety Information.

    Dosing

    The recommended dose of Gadavist® for adult and pediatric patients (including term neonates) is 0.1 mL/kg body weight (0.1 mmol/kg). Refer to the chart below to determine the volume to be administered.

    Back to top
    Close Menu
    Packaging

    Gadavist® is a clear, colorless-to-pale yellow solution containing 1 mmol gadobutrol per milliliter (equivalent to 604.72 mg gadobutrol per mL).

    Gadavist® is supplied in the following sizes:

    Ordering Information

    Gadavist® is available through all suppliers currently providing our other imaging products. To establish an account, call Bayer HealthCare LLC's master distributor, McKesson Specialty Distribution, at 1-877-259-4624 (option #1), or contact your local distributor.

    Back to top
    Close Menu
    Reimbursement

    Reimbursement Helpline

    The Bayer Imaging Reimbursement Helpline is available to all institutions to provide further information. The Helpline can be reached at 1-800-423-7539.

    Billing for Gadavist®

    HCPCS code A9585 has been established by the Centers for Medicare and Medicaid Services (CMS) for Gadavist®. CMS sought to assign a code which would allow for accurate billing of Gadavist® presentations.

    The code descriptor for A9585 is per 0.1mL. When billing it is important to remember to multiply the amount of Gadavist® used by 10 in order to list the correct number of units on the claim form.

    • 2 mL = 20 units
    • 7.5 mL = 75 units
    • 10 mL = 100 units
    • 15 mL = 150 units

    Hospital-based outpatient HCPCS code for use with Gadavist®

    Freestanding HCPCS code for use with Gadavist

    Information provided in this resource is for informational purposes only and does not guarantee that codes will be appropriate or that coverage and reimbursement will result. Customers should consult with their payers for all relevant coverage, coding, and reimbursement requirements. It is the sole responsibility of the provider to select proper codes and ensure the accuracy of all claims used in seeking reimbursement. Neither this resource nor the Bayer Healthcare Medical Reimbursement Helpline is intended as a legal advice or as a substitute for a provider's independent professional judgment.

    Back to top
    Close Menu
    Purchasing
  • Gadavist® is approved for use in magnetic resonance angiography (MRA) to evaluate known or suspected supra-aortic or renal artery disease in adult and pediatric patients (including term neonates)

    See the Difference

    Gadavist®: The first and only gadolinium-based contrast agent approved for magnetic resonance angiography (MRA) of the supra-aortic vasculature

    COMPARED TO UNENHANCED TIME-OF-FLIGHT (ToF) MRA, GADAVIST®-ENHANCED MRA DEMONSTRATED¹:

    Improved visualization of accessory renal arteries for surgical planning and renal donor evaluation (Study D only). Of 1,752 main arteries visualized by the central computed tomography angiography (CTA) readers, 266 (15%) were also assoviated with positive visualization of at least one accessory (duplicate) artery. With central MRA readers, the comparable rates were 232 of 1,752 (13%) for Gadavist MRA compared to 53 of 1,752 (3%) for ToF MRA.¹

    Variability in the amount of stenosis measured by the readers was high for CTA and MRA, but numerically lower for Gadavist® compared to unenhanced ToF MRA.

    Low Sensitivity for Significant Arterial Stenosis

    The performance of Gadavist® MRA for detecting arterial segments with significant stenosis (>50% renal, >70% supra-aortic) has not been shown to exceed 55%. Therefore, a negative MRA study alone should not be used to rule out significant stenosis.

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016.

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    Efficacy in MRA Clinical Trials

    • Three central readers blinded to clinical information interpreted time-of-flight (ToF) and Gadavist®-enhanced MRA images¹
    • Three additional blinded central readers interpreted separately acquired computed tomography angiography (CTA) images¹

    Primary Endpoints¹

    The efficacy of Gadavist®-enhanced was evaluated based on anatomical visualization and performance for evaluation of clincially significant disease.

    • Visualization was defined as readers' ability to visualize each segment along its entire length
    • Performance metrics included sensitivity and specificity of arterial segments with clinically significant stenosis, which was defined as at least 70% in Study C and 50% in Study D

    SUPRA-AORTIC MAGNETIC RESONANCE ANGIOGRAPHY

    In a Phase III Clinical Trial, Gadavist® demostrated superiority in visualization of supra-aortic segments, and non-inferiority for sensitivity and specificity for clinically significant disease compared to unenhanced time-of-flight (ToF) magnetic resonance angiography (MRA)¹

    RENAL MAGNETIC RESONANCE ANGIOGRAPHY

    In a Phase III Clinical Trial, compared to unenhanced time-of-flight (ToF) magnetic resonance agiography (MRA) Gadavist® demonstrated:

    • Superiority in visualization of renal arterial segments, and non-inferiority for specificity for clinically significant disease¹
    • Identification of 10% more renal accessory arteries¹

    Low Sensitivity for Significant Arterial Stenosis

    The performance of Gadavist® MRA for detecting arterial segments with significant stenosis (>50% renal, >70% supra-aortic) has not been shown to exceed 55%. Therefore, a negative MRA study alone should not be used to rule out significant stenosis.

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016.

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    High Relaxivity*, Macrocyclic Bond

    Strong Signal Enhancement

    Factors involved in signal enhancement

    Signal enhancement is based on multiple factors, including relaxivity, magnet field strength, and concentration in tissue.¹

    What is relaxivity?

    Relaxivity is a measure of the ability of magnetic compounds—like MR-contrast agents—to increase the relaxation rates of surrounding water protons. A high-relaxivity contrast agent may improve signal enhancement in contrast-enhanced images.

    *Relaxivity of Gadavist is 5.2 L•mmol–1• s–1 at 1.5 Tesla (r1 in plasma at 37°C)

    Macrocyclic Structure

    Gadolinium-chelate complexes

    The most widely used MRI-contrast agents are gadolinium-based, due to the high paramagnetism of the gadolinium ion, and are manufactured with a ligand bound to the central gadolinium (Gd3+) ion. The ligand forms a stable chelated complex around the gadolinium ion and reduces the chance of toxicity that could result from exposure to free gadolinium in the body.2

    Structural classes of GBCA

    There are 2 structural classes of GBCA chelates—macrocyclic and linear.3 Macrocyclic ligands bind gadolinium ions in a cage structure, while linear ligands bind gadolinium ions with a chain structure.4 Gadavist® is 1 of 3 macrocyclic contrast agents approved for use in CNS imaging in the US. Molecular structures of representative agents from each class are shown below.

    Structures of GBCA approved for CNS imaging:

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. Marie-France Bellin, Aart J. Van Der Molen. Extracellular gadolinium-based contrast media: An overview. European Journal of Radiology. 2008;66:160-167. 3. Frenzel T, Lengsfeld P, Schirmer H, et al. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 degrees C. Invest Radiol. 2008;43(12):817-828. 4. Morcos SK. Extracellular gadolinium contrast agents: Differences in stability. European Journal of Radiology. 2008;66:175-179.

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    Safety in Clinical Trials

    Safety

    In clinical trials of 6,809 patients (including 184 pediatric patients, ages 0 to 17 years), Gadavist® established the following safety profile¹. Adverse reactions associated with the use of Gadavist® are usually mild to moderate in severity and transient in nature. The adverse reactions that occured in ≥0.1% of subjects who received Gadavist® were¹:

    *Hypersensitivity/anaphylactoid reaction may occur with one or more of the following adverse reactions: for example, hypotension, urticaria, face edema, eyelid edema, flushing.

    Contraindication and Important Information about Hypersensitivity Reactions

    Gadavist® is contraindicated in patients with history of severe hypersensitivity reactions to Gadavist®. Anaphylactoid and anaphylactic reactions with cardiovascular, respiratory, or cutaneous manifestations, ranging from mild to severe, including death, have uncommonly occurred following Gadavist® administration. Patients with any history of a reaction to contrast media, bronchial asthma, and/or allergic disorders may have an increased risk for a hypersensitivity reaction to Gadavist®.

    Acute Kidney Injury

    In patients with chronic renal impairment, acute kidney injury sometimes requiring dialysis has been observed with the use of some GBCAs. Do not exceed the recommended dose; the risk of acute kidney injury may increase with higher than recommended doses.

    Overestimation of Extent of Malignant Disease in MRI of the Breast

    Gadavist® MRI of the breast overestimated the histologically confirmed extent of malignancy in the diseased breast in up to 50% of the patients.

    Low Sensitivity for Significant Arterial Stenosis

    The performance of Gadavist® MRA for detecting arterial segments with significant stenosis (>50% renal, >70% supra-aortic) has not been shown to exceed 55%. Therefore, a negative MRA study alone should not be used to rule out significant stenosis.

    Please see Full Prescribing Information.

    References: 1. Gadavist [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 2. FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction. FDA website. http://www.fda.gov/Drugs/DrugSafety/ucm223966.htm. Updated September 9, 2010. Accessed November 13, 2012

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    Dosing

    Double the Concentration, Half the Volume

    Concentration

    Compared to 0.5 molar gadolinium-based contrast agents, the higher concentration of Gadavist® results in half the volume of administration and more a compact contrast bolus injection. At the site of imaging, the relative height and width of the time intensity curve for Gadavist® varies as a function of imaging location and multiple patient, injection, and device-specific factors.

    Extravasation and Injection Site Reactions

    Ensure catheter and venous patency before the injection of Gadavist®. Extravasation into tissues during Gadavist® administration may result in moderate irritation.

    Please see Additional Safety Information.

    Dosing

    The recommended dose of Gadavist® for adult and pediatric patients (including term neonates) is 0.1 mL/kg body weight (0.1 mmol/kg). Refer to the chart below to determine the volume to be administered.

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    Packaging

    Gadavist® is a clear, colorless-to-pale yellow solution containing 1 mmol gadobutrol per milliliter (equivalent to 604.72 mg gadobutrol per mL).

    Gadavist® is supplied in the following sizes:

    Ordering Information

    Gadavist® is available through all suppliers currently providing our other imaging products. To establish an account, call Bayer HealthCare LLC's master distributor, McKesson Specialty Distribution, at 1-877-259-4624 (option #1), or contact your local distributor.

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    Reimbursement

    Reimbursement Helpline

    The Bayer Imaging Reimbursement Helpline is available to all institutions to provide further information. The Helpline can be reached at 1-800-423-7539.

    Billing for Gadavist®

    HCPCS code A9585 has been established by the Centers for Medicare and Medicaid Services (CMS) for Gadavist®. CMS sought to assign a code which would allow for accurate billing of Gadavist® presentations.

    The code descriptor for A9585 is per 0.1mL. When billing it is important to remember to multiply the amount of Gadavist® used by 10 in order to list the correct number of units on the claim form.

    • 2 mL = 20 units
    • 7.5 mL = 75 units
    • 10 mL = 100 units
    • 15 mL = 150 units

    Hospital-based outpatient HCPCS code for use with Gadavist®

    Freestanding HCPCS code for use with Gadavist

    Information provided in this resource is for informational purposes only and does not guarantee that codes will be appropriate or that coverage and reimbursement will result. Customers should consult with their payers for all relevant coverage, coding, and reimbursement requirements. It is the sole responsibility of the provider to select proper codes and ensure the accuracy of all claims used in seeking reimbursement. Neither this resource nor the Bayer Healthcare Medical Reimbursement Helpline is intended as a legal advice or as a substitute for a provider's independent professional judgment.

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    Purchasing

Reference: 1. Morcos SK. Extracellular gadolinium contrast agents: Differences in stability. European Journal of Radiology. 2008;66:175-179.

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A 45-year-old male presented with altered mental status. Initial CT scan indicated a mass lesion within the CNS. The patient was immediately admitted for follow up with a Gadavist®-enhanced MRI.

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INDICATIONS and IMPORTANT SAFETY INFORMATION

INDICATIONS AND USAGE

Gadavist® (gadobutrol) injection is a gadolinium-based contrast agent indicated for use with magnetic resonance imaging (MRI):

  • To detect and visualize areas with disrupted blood brain barrier (BBB) and/or abnormal vascularity of the central nervous system in adult and pediatric patients (including term neonates)
  • To assess the presence and extent of malignant breast disease

Gadavist® is indicated for use in magnetic resonance angiography (MRA):

  • To evaluate known or suspected supra-aortic or renal artery disease in adult and pediatric patients (including term neonates)

IMPORTANT SAFETY INFORMATION

WARNING: NEPHROGENIC SYSTEMIC FIBROSIS (NSF)

Gadolinium-based contrast agents (GBCAs) increase the risk for NSF among patients with impaired elimination of the drugs. Avoid use of GBCAs in these patients unless the diagnostic information is essential and not available with non-contrasted MRI or other modalities. NSF may result in fatal or debilitating fibrosis affecting the skin, muscle and internal organs.

  • The risk of NSF appears highest among patients with:
    • - Chronic, severe kidney disease (GFR <30 mL/min/1.73m2), or
    • - Acute kidney injury
  • Screen patients for acute kidney injury and other conditions that may reduce renal function. For patients at risk for chronically reduced renal function (for example, age >60 years, hypertension or diabetes), estimate the glomerular filtration rate (GFR) through laboratory testing.
  • For patients at highest risk for NSF, do not exceed the recommended GADAVIST dose and allow a sufficient period of time for elimination of the drug from the body prior to any re-administration.

Contraindication and Important Information about Hypersensitivity Reactions: Gadavist® is contraindicated in patients with history of severe hypersensitivity reactions to Gadavist®. Anaphylactic and other hypersensitivity reactions with cardiovascular, respiratory, or cutaneous manifestations, ranging from mild to severe, including death, have uncommonly occurred following Gadavist® administration. Before Gadavist® administration, assess all patients for any history of a reaction to contrast media, bronchial asthma and/or allergic disorders. These patients may have an increased risk for a hypersensitivity reaction to Gadavist®.

Acute Kidney Injury: In patients with chronic renal impairment, acute kidney injury sometimes requiring dialysis has been observed with the use of some GBCAs. Do not exceed the recommended dose; the risk of acute kidney injury may increase with higher than recommended doses.

Extravasation and Injection Site Reactions: Ensure catheter and venous patency before the injection of Gadavist®. Extravasation into tissues during Gadavist® administration may result in moderate irritation.

Overestimation of Extent of Malignant Disease in MRI of the Breast: Gadavist® MRI of the breast overestimated the histologically confirmed extent of malignancy in the diseased breast in up to 50% of the patients.

Low Sensitivity for Significant Arterial Stenosis: The performance of Gadavist® MRA for detecting arterial segments with significant stenosis (>50% renal, >70% supra-aortic) has not been shown to exceed 55%. Therefore, a negative MRA study alone should not be used to rule out significant stenosis.

Adverse Reactions: The most frequent (≥0.5%) adverse reactions associated with Gadavist® in clinical studies were headache (1.5%), nausea (1.1%) and dizziness (0.5%).

Please see Full Prescribing Information.

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