Announcement regarding Medsafe Alert

19 February 2018

Price Sensitive

Arthrem - Medsafe Alert

Late last week Medsafe issued an advisory relating to 14 reports of liver toxicity associated with the use of
Arthrem, from February 2016 up until 31 December 2017.

Many of the reports included jaundice as a reaction. Where information was provided (liver function tests
and biopsy results), the pattern of liver toxicity was either hepatocellular or mixed (hepatocellular and
cholestatic). All the patients stopped taking Arthrem and at the time of reporting most had already
recovered or were improving.

Arthrem is a dietary supplement for maintenance and support of healthy joints. It is sold as soft gel
capsules that each contain 150 mg extract of Artemisia annua, grape-seed oil, glycerine and gelatine.

IS ARTHREM SAFE?

When taken as directed, Arthrem is safe and effective.

Safety is – and has always been - our top priority. That is why Arthrem is the world's only clinically trialled
and safety trialled Artemisia annua joint support product. Both trials were conducted by Otago University,
and published in peer-reviewed journals (Clinical Rheumatology and New Zealand Medical Journal). The
clinical trial informed the product formulation and dosage advice. Unlike other Artemisia annua-based
joint support products on the market, Arthrem is formulated deliberately in twice-daily dosages (rather
than a larger dose once daily) to reduce the risk of toxicity.

There have been an extremely small number of reported cases of adverse reaction. This level of adverse
reaction is considered to be very rare by the World Health Organization's adverse reactions guidelines –
less than 0.007% of all bottles sold (i.e. under 1 in 14,000).

WHAT WE ARE DOING

Promisia takes this Medsafe Alert very seriously. In addition to communication with pharmacies, retailers
and health professionals, we are also taking the following steps:

• Update bottle labelling to note that ‘In rare circumstances Artemisia annua may be associated with
liver harm’. Until new labels are available a sticker will be produced and sent to all pharmacies with the
above caution.
• Amending the advice provided on our website to note the potential but rare risk of liver harm,
identifying potential symptoms including: nausea (feeling sick), stomach pain, pale stools, dark urine,

itching all over, the whites of the eyes turning yellow or the skin is yellow (jaundice). In the event of
these symptoms being observed the person is advised to stop taking Arthrem and consult their doctor.
• Amending messaging on labels, point-of-sale material, etc., to stress that the product must be taken
strictly as directed.
• The amended point of sale material will be included with all product sold via our website.

For further information please contact:

Rene de Wit, Chief Executive, 021 571 000, or
Stephen Underwood, Chairman, 027 499 3387

END