Human Immunoglobulin G

FDA Drug Information • Also known as: Alyglo, Asceniv, Gammaplex, Hizentra, Privigen, Qivigy Kthm

Brand Names: Alyglo, Asceniv, Gammaplex, Hizentra, Privigen, Qivigy Kthm
Route: SUBCUTANEOUS
Dosage Form: LIQUID
Product Type: PLASMA DERIVATIVE

⚠ Boxed Warning (Black Box)

WARNING: THROMBOSIS, RENAL DYSFUNCTION AND ACUTE RENAL FAILURE Thrombosis may occur with immune globulin (IGIV) products, including ASCENIV. Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling central vascular catheters, hyperviscosity, and cardiovascular risk factors. Thrombosis may occur in the absence of known risk factors (see Warnings and Precautions [5.2], Patient Counseling Information [17]). Renal dysfunction, acute renal failure, osmotic nephrosis, and death may occur with the administration of IGIV products in predisposed patients. Renal dysfunction and acute renal failure occur more commonly in patients receiving IGIV products containing sucrose. ASCENIV does not contain sucrose. For patients at risk of thrombosis, renal dysfunction or renal failure, administer ASCENIV at the minimum dose and infusion rate practicable. Ensure adequate hydration in patients before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity ( see Dosage and Administration [2.1, 2.3] , Warnings and Precautions [5.3] ). WARNING: THROMBOSIS, RENAL DYSFUNCTION AND ACUTE RENAL FAILURE See full prescribing information for complete boxed warning. Thrombosis may occur with immune globulin intravenous (IGIV) products, including ASCENIV. Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling vascular catheters, hyperviscosity, and cardiovascular risk factors. Renal dysfunction, acute renal failure, osmotic nephrosis, and death may occur with the administration of IGIV products in predisposed patients. Renal dysfunction and acute renal failure occur more commonly in patients receiving IGIV products containing sucrose. ASCENIV does not contain sucrose. [5.3] For patients at risk of thrombosis, renal dysfunction or renal failure, administer ASCENIV at the minimum dose and infusion rate practicable. Ensure adequate hydration in patients before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity. [2.1, 2.3, 5.3]

Description

11 DESCRIPTION ASCENIV is a purified, sterile, ready-to-use preparation of concentrated human immunoglobulin G (IgG) antibodies. The distribution of IgG subclasses is similar to that of normal plasma. The active ingredient is human immunoglobulin purified from source human plasma and processed using a modified classical Cohn Method 6 / Oncley Method 9 fractionation process as well as anion and cation exchange steps for added purification. ASCENIV contains 100 ± 10 mg/mL protein, of which not less than 96% is human immunoglobulin obtained from source human plasma. It is formulated in water for injection containing 0.100-0.140 M sodium chloride, 0.20-0.29 M glycine, 0.15–0.25% polysorbate 80, and pH 4.0–4.6. ASCENIV contains ≤ 200 µg/mL of IgA. Each plasma donation used for the manufacture of ASCENIV is collected from FDA-licensed facilities and undergoes rigorous testing. Plasma donations must test negative for hepatitis B virus (HBV) surface antigen (HBsAg), antibodies to human immunodeficiency virus (HIV) strains 1 and 2 (anti-HIV-1/2), and antibodies to the hepatitis C virus (anti-HCV) as determined by enzyme immune assay (EIA). In addition, each plasma unit must test negative and/or non-reactive for HIV RNA, HCV RNA, HBV DNA, Hepatitis A Virus (HAV) RNA, and Parvovirus B19 (B19 virus) DNA as determined by Nucleic Acid Amplification Testing (NAT) of plasma minipools. NAT is also performed on a sample of the manufacturing pool and must be negative and/or non-reactive for HIV RNA, HCV RNA, HBV DNA, and Hepatatis A Virus (HAV) RNA, and the limit for B19 virus DNA in a manufacturing pool is set not to exceed 10 4 IU/mL. The manufacturing process of ASCENIV employs six steps to remove/inactivate adventitious viruses to minimize the risk of virus transmission. The steps are "Precipitation and removal of fraction III" during cold ethanol fractionation, "Q-membrane filtration", "Solvent/detergent treatment" (TnBP / Triton X-100), "Anion exchange chromatography" and...

What Is Human Immunoglobulin G Used For?

1 INDICATIONS AND USAGE ASCENIV (immune globulin intravenous, human – slra) is a 10% immune globulin liquid for intravenous injection, indicated for the treatment of primary humoral immunodeficiency (PI) in adults and adolescents (12 to 17 years of age). PI includes, but is not limited to, the humoral immune defect in congenital agammaglobulinemia, common variable immunodeficiency (CVID), X-linked agammaglobulinemia, Wiskott-Aldrich syndrome, and severe combined immunodeficiencies (SCID). ASCENIV (immune globulin intravenous, human – slra) is a 10% immune globulin liquid for intravenous injection, indicated for the treatment of primary humoral immunodeficiency (PI) in adults and adolescents (12 to 17 years of age). [1]

Dosage and Administration

2 DOSAGE AND ADMINISTRATION For intravenous use only. Dose Initial Infusion Rate Maintenance Infusion Rate (if tolerated) 300-800 mg/kg every 3- 4 weeks 0.5 mg/kg/min (0.005 mL/kg/min) for the first 15 minutes Increase gradually every 15 minutes (if tolerated) up to 8 mg/kg/min (0.08 mL/kg/min) Ensure that patients with pre-existing renal insufficiency are not volume depleted; discontinue ASCENIV if renal function deteriorates. [5.3] For patients at risk of renal dysfunction or thrombotic events, administer ASCENIV at the minimum infusion rate practicable. [5.2, 5.3] 2.1 Dose The recommended dose of ASCENIV for replacement therapy in primary humoral immunodeficiency (PI) is 300 to 800 mg/kg body weight administered every 3 to 4 weeks. The dose may be adjusted over time to achieve the desired trough levels and clinical response. ASCENIV dose adjustments may be required in patients who fail to maintain trough total IgG concentrations of at least 500 mg/ dL with a target of 600 mg/dL. Starting with the second infusion, adjust the dose proportionally, targeting a trough of ≥ 600 mg/dL, based on the previous trough and the associated dose. For intravenous use only. Table 1 Dose Initial Infusion Rate Maintenance Infusion Rate (if tolerated) 300-800 mg/kg every 3-4 weeks 0.5 mg/kg/min (0.005 mL/kg/min) for the first 15 minutes Increase gradually every 15 minutes (if tolerated) up to 8 mg/kg/min (0.08 mL/kg/min) 2.2 Preparation and Handling ASCENIV is a clear to opalescent, colorless to pale yellow solution. Inspect visually for particulate matter and discoloration prior to administration. Do not use if the liquid is cloudy or turbid, or if it contains visible particulate matter. Allow refrigerated product to come to room temperature before use and maintain ASCENIV at room temperature during administration. DO NOT MICROWAVE. DO NOT SHAKE. DO NOT MIX with other IGIV products or other intravenous medications. DO NOT DILUTE. ASCENIV contains no preservatives. Each vial is for single use only. Do not reuse or save for future use. If large doses are required, several vials may be pooled using aseptic technique into sterile infusion bags and infused. 2.3 Administration Begin with an initial infusion rate of 0.5 mg/kg/min. If there are no adverse reactions, the infusion rate for subsequent infusions can be slowly increased to the maximum rate. Monitor patient vital signs throughout the infusion. Slow or stop the infusion if adverse reactions occur. If symptoms subside promptly, the infusion may be resumed at a slower rate which is comfortable for the patient. Ensure that patients with pre-existing renal insufficiency are not volume-depleted. For patients judged to be at risk for renal dysfunction or thrombotic events, administer ASCENIV at the minimum infusion rate practicable, and consider discontinuation of administration if renal function deteriorates ( see Boxed Warning, Warnings and Precautions [5.2, 5.3] ).

Side Effects (Adverse Reactions)

6 ADVERSE REACTIONS The most common adverse reactions to ASCENIV (reported in ≥5% of clinical study subjects) were headache, sinusitis, diarrhea, gastroenteritis viral, nasopharyngitis, upper respiratory tract infection, bronchitis, and nausea. The most common adverse reactions to ASCENIV (≥5% of study subjects) were headache, sinusitis, diarrhea, gastroenteritis viral, nasopharyngitis, upper respiratory tract infection, bronchitis, and nausea. [6] To report SUSPECTED ADVERSE REACTIONS, contact ADMA Biologics at (1-800-458-4244) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials cannot be directly compared to rates in the clinical trials of another product and may not reflect the rates observed in clinical practice. In a multicenter, open-label, non-randomized clinical trial, 59 subjects with PI, on regular IGIV replacement therapy, received doses of ASCENIV ranging from 284 to 1008 mg/kg (mean dose 505 mg/kg) every 3 weeks or 4 weeks for up to 12 months (mean 346 days; range 36 to 385 days) (see Clinical Studies [14] ). The use of pre-medication was discouraged; however, if after two infusions of ASCENIV subjects required pre-medication (antipyretic, antihistamine, or antiemetic agent) for recurrent reactions, they could continue those medications for the duration of the trial. Of the 793 infusions administered during this trial, only 7 (11.9%) subjects received premedication prior to 7 (0.9%) infusions. Fifty-eight subjects (98%) had an adverse reaction during the study. The proportion of subjects who had at least one adverse reaction was similar for both the 3- and 4-week cycles. The most common adverse reactions observed in this clinical trial were headache (22 subjects, 37%), sinusitis (16 subjects, 27%), diarrhea (14 subjects, 23%), gastroenteritis viral (13 subjects, 22%), nasopharyngitis (13 subjects, 22%), upper respiratory tract infection (13 subjects, 22%), bronchitis (12 subjects, 20%), nausea (12 subjects, 20%), and acute sinusitis (11 subjects, 19%). Adverse reactions (ARs) occurring during or within 72 hours after the end of an infusion are presented in Table 2 . In this study, the upper bound of the 1-sided 95% confidence interval for the proportion of ASCENIV infusions with one or more temporally associated adverse reactions was 16.4%. The total number of adverse reactions was 158 (a rate of 0.20 ARs per infusion). Table 2: Adverse Reactions (ARs) (within 72 hours after the end of an ASCENIV infusion) in ≥ 5% of Subjects Preferred Term (MedDRA v16.0) Number (%) of Subjects (N=59) Number (%) of Infusions (N=793) Headache 14 (24) 21 (2.6) Sinusitis 6 (10) 7 (0.9) Nausea 5 (9) 5 (0.6) Acute sinusitis 4 (7) 4 (0.5) Fatigue 4 (7) 9 (1.1) Muscle spasms 4 (7) 4 (0.5) Bronchitis 3 (5) 3 (0.4) Diarrhea 3 (5) 3 (0.4) Nose Bleed 3 (5) 4 (0.5) Muscle Pain 3 (5) 5 (0.6) Oropharyngeal pain 3 (5) 3 (0.4) Pain in extremity 3 (5) 3 (0.4) Itching 3 (5) 3 (0.4) 6.2 Postmarketing Experience Because postmarketing reporting of adverse reactions is voluntary and from a population of uncertain size, it is not always possible to reliably estimate the frequency of these reactions or establish a causal relationship to product exposure. The following adverse reactions have been identified and reported during the post-approval use of IGIV products: Respiratory: Apnea, Acute Respiratory Distress Syndrome (ARDS), cyanosis, dyspnea, bronchospasm. Cardiovascular: Cardiac arrest, vascular collapse, hypotension. Neurological: Coma, loss of consciousness, seizures, tremor. Integumentary: Stevens-Johnson syndrome, epidermolysis, erythema multiforme, bullous dermatitis. Hematologic: Pancytopenia, leukopenia. General/Body as a Whole: Pyrexia, rigors. Gastrointestinal: Hepatic dysfunction, abdominal pain.

Drug Interactions

7 DRUG INTERACTIONS Immunoglobulin administration may transiently impair the efficacy of live attenuated virus vaccines such as measles, mumps, rubella, and varicella because the continued presence of high levels of passively acquired antibody may interfere with an active antibody response. 15,16 The immunizing physician should be informed of recent therapy with ASCENIV so that appropriate measures may be taken ( see Patient Counseling Information [17] ). Passive transfer of antibodies may transiently interfere with the immune response to live virus vaccines, such as measles, mumps, rubella, and varicella. [7] Passive transfer of antibodies may confound the results of serological testing. [5.10]

Contraindications

4 CONTRAINDICATIONS ASCENIV is contraindicated in: patients who have had an anaphylactic or severe systemic reaction to the administration of human immune globulin. IgA-deficiency patients with antibodies to IgA and a history of hypersensitivity. History of anaphylactic or severe systemic reactions to human immunoglobulin. [4] IgA-deficient patients with antibodies to IgA and a history of hypersensitivity. [4, 5.1]

Pregnancy and Breastfeeding

8.1 Pregnancy Risk Summary No human data are available to indicate the presence or absence of drug-associated risk. Animal reproduction studies have not been conducted with ASCENIV. It is not known whether ASCENIV can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Immune globulins cross the placenta from maternal circulation increasingly after 30 weeks of gestation. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20% respectively. ASCENIV should be given to pregnant women only if clearly needed. 17,18

Overdosage

10 OVERDOSAGE With intravenous administration, overdose may lead to fluid overload and hyperviscosity. Patients at risk of complications of fluid overload and hyperviscosity include elderly patients and those with cardiac or renal impairment.

How Supplied

16 HOW SUPPLIED/STORAGE AND HANDLING ASCENIV is supplied in a single-use, tamper-evident vial. The components used in the packaging for ASCENIV are not made with natural rubber latex. ASCENIV is supplied in 50 mL size containing 5 grams of protein (NDC 69800-0250-1). Store at 2 to 8°C (36 to 46°F) for up to 36 months from the date of manufacture. Do not freeze. Product may be stored up to 4 weeks at ≤ 25° C (77° F). After storage at room temperature product must be used or discarded.

About This Information

This drug information is sourced from FDA-approved labeling via the openFDA database. It is intended for educational and reference purposes only. This is not medical advice. Always consult your healthcare provider before making decisions about medication. Drug information may be updated by the FDA; check with your pharmacist for the most current information.

What are side effects?

Side effects are unwanted reactions that can occur when taking a medication. They range from mild (headache, nausea) to severe (allergic reactions, organ damage). Not everyone experiences side effects, and severity varies. Report any concerning side effects to your doctor.

What are drug interactions?

Drug interactions occur when a medication is affected by another drug, food, or supplement. Interactions can make medications less effective or cause dangerous side effects. Always tell your doctor about all medications and supplements you take.