Complete registration for MyNUCALA

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1. Which of the following statements best describes you?*

2. Have you been prescribed NUCALA for the treatment of your EGPA?*

3. Have you already received your first NUCALA treatment?*

4. How many treatments have you received?

5. When is your next treatment scheduled?

(If you're unsure, provide an approximate date)

Enter your information here:*

GSK believes your privacy is important. By providing your name, address, phone number, email address, and other information, you certify that you are at least 18 years old and that you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels (such as mail, email, websites, online advertising, applications, and services) regarding the medical condition(s) in which you have expressed an interest as well as other health-related information from GSK. GSK will not sell or transfer your name, address, phone number, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

As a patient being treated or about to start treatment with NUCALA, a Case Manager is available to support you.

Case Manager Consent:

I agree that GSK can contact me to participate in the Case Management Services offered by GSK. I understand and agree that in order to participate in the Case Management Services I will be providing personal information about myself, including about my health, to the Case Manager, and that this information will be retained by GSK.

I understand and agree with all of the following:

  • The Case Management Services and my discussions with a Case Manager are not medical advice and are not intended to replace any medical advice or instruction provided to me by my healthcare provider(s). Any questions related to my medical condition or my treatment or whether NUCALA is right for me will be referred to my healthcare professional.
  • The Case Management Services will begin only after my healthcare provider has recommended that I receive NUCALA.
  • I am a resident of the United States of America.
  • This consent will remain in effect until I no longer wish to be enrolled in Case Management Services. I also understand that I have the right to end my participation in Case Management Services at any time by calling 1-833-844-3472 or mailing a signed, written statement of my revocation to GSK, Attention: Support Team for NUCALA, 5 Moore Drive, P.O. Box 13398, Research Triangle Park, NC 27709-3398.
  • Participation in the Case Management Services is not required to receive treatment.
  • The Case Management Services are subject to change and may be discontinued at any time without notice.

4. When is your first treatment scheduled?

(If you're unsure, provide an approximate date)

Enter your information here:*

GSK believes your privacy is important. By providing your name, address, phone number, email address, and other information, you certify that you are at least 18 years old and that you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels (such as mail, email, websites, online advertising, applications, and services) regarding the medical condition(s) in which you have expressed an interest as well as other health-related information from GSK. GSK will not sell or transfer your name, address, phone number, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

As a patient being treated or about to start treatment with NUCALA, a Case Manager is available to support you.

Case Manager Consent:

I agree that GSK can contact me to participate in the Case Management Services offered by GSK. I understand and agree that in order to participate in the Case Management Services I will be providing personal information about myself, including about my health, to the Case Manager, and that this information will be retained by GSK.

I understand and agree with all of the following:

  • The Case Management Services and my discussions with a Case Manager are not medical advice and are not intended to replace any medical advice or instruction provided to me by my healthcare provider(s). Any questions related to my medical condition or my treatment or whether NUCALA is right for me will be referred to my healthcare professional.
  • The Case Management Services will begin only after my healthcare provider has recommended that I receive NUCALA.
  • I am a resident of the United States of America.
  • This consent will remain in effect until I no longer wish to be enrolled in Case Management Services. I also understand that I have the right to end my participation in Case Management Services at any time by calling 1-833-844-3472 or mailing a signed, written statement of my revocation to GSK, Attention: Support Team for NUCALA, 5 Moore Drive, P.O. Box 13398, Research Triangle Park, NC 27709-3398.
  • Participation in the Case Management Services is not required to receive treatment.
  • The Case Management Services are subject to change and may be discontinued at any time without notice.

Enter your information here:*

GSK believes your privacy is important. By providing your name, address, phone number, email address, and other information, you certify that you are at least 18 years old and that you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels (such as mail, email, websites, online advertising, applications, and services) regarding the medical condition(s) in which you have expressed an interest as well as other health-related information from GSK. GSK will not sell or transfer your name, address, phone number, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

2. Have you discussed NUCALA with your healthcare provider?

Enter your information here:*

GSK believes your privacy is important. By providing your name, address, phone number, email address, and other information, you certify that you are at least 18 years old and that you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels (such as mail, email, websites, online advertising, applications, and services) regarding the medical condition(s) in which you have expressed an interest as well as other health-related information from GSK. GSK will not sell or transfer your name, address, phone number, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

3. When is your next visit? (If you're unsure, provide an approximate date)

Enter your information here:*

GSK believes your privacy is important. By providing your name, address, phone number, email address, and other information, you certify that you are at least 18 years old and that you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels (such as mail, email, websites, online advertising, applications, and services) regarding the medical condition(s) in which you have expressed an interest as well as other health-related information from GSK. GSK will not sell or transfer your name, address, phone number, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

Enter your information here:*

GSK believes your privacy is important. By providing your name, address, phone number, email address, and other information, you certify that you are at least 18 years old and that you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels (such as mail, email, websites, online advertising, applications, and services) regarding the medical condition(s) in which you have expressed an interest as well as other health-related information from GSK. GSK will not sell or transfer your name, address, phone number, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

Approved Use

NUCALA is a prescription medicine used with other medicines for the treatment of adults with eosinophilic granulomatosis with polyangiitis (EGPA).

Important Safety Information

Do not use NUCALA if you are allergic to mepolizumab or any of the ingredients in NUCALA.

Approved Use

NUCALA is a prescription medicine used with other medicines for the treatment of adults with eosinophilic granulomatosis with polyangiitis (EGPA).

Important Safety Information

Do not use NUCALA if you are allergic to mepolizumab or any of the ingredients in NUCALA.

NUCALA can cause serious side effects, including:

  • allergic (hypersensitivity) reactions, including anaphylaxis. Serious allergic reactions can happen after you get your injection of NUCALA. Allergic reactions can sometimes happen hours or days after you get a dose of NUCALA. Tell your healthcare provider or get emergency help right away if you have any of the following symptoms of an allergic reaction:
    • swelling of your face, mouth, and tongue
    • breathing problems
    • fainting, dizziness, feeling light-headed (low blood pressure)
    • rash
    • hives
  • Herpes zoster infections that can cause shingles have happened in people who received NUCALA.

Before receiving NUCALA, tell your healthcare provider about all of your medical conditions, including if you:

  • are taking oral or inhaled corticosteroid medicines. Do not stop taking your other asthma medicines, including your corticosteroid medicines, unless instructed by your healthcare provider because this may cause other symptoms to come back.
  • have a parasitic (helminth) infection.
  • are pregnant or plan to become pregnant. It is not known if NUCALA may harm your unborn baby.
  • are breastfeeding or plan to breastfeed. You and your healthcare provider should decide if you will use NUCALA and breastfeed. You should not do both without talking with your healthcare provider first.
  • are taking prescription and over-the-counter medicines, vitamins, and herbal supplements.

The most common side effects of NUCALA include: headache, injection site reactions (pain, redness, swelling, itching, or a burning feeling at the injection site), back pain, and weakness (fatigue).

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.