HEMOFIL M
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antihemophilic factor human
Baxter Healthcare Corporation
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HEMOFIL M Antihemophilic Factor (Human)HEMOFIL M, Antihemophilic Factor (Human) (AHF), Method M, Monoclonal Purified, is a sterile, nonpyrogenic, dried preparation of antihemophilic factor (Factor VIII, Factor VIII:C, AHF) in concentrated form with a specific activity range of 2 to 22 AHF International Units/mg of total protein. HEMOFIL M contains a maximum of 12.5 mg/mL Albumin, and per AHF International Unit, 0.07 mg polyethylene glycol (3350), 0.39 mg histidine as stabilizing agents, not more than 0.1 mg glycine, 0.1 ng mouse protein, 18 ng organic solvent (tri-n-butyl phosphate) and 50 ng detergent (octoxynol 9). In the absence of the added Albumin (Human), the specific activity is approximately 2,000 AHF International Units/mg of protein. See CLINICAL PHARMACOLOGY.
HEMOFIL M is prepared by the Method M process from pooled human plasma by immunoaffinity chromatography utilizing a murine monoclonal antibody to Factor VIII:C, followed by an ion exchange chromatography step for further purification. Source material may be provided by other US licensed manufacturers. HEMOFIL M also includes an organic solvent (tri-n-butyl phosphate) and detergent (octoxynol 9) virus inactivation step designed to reduce the risk of transmission of hepatitis and other viral diseases. However, no procedure has been shown to be totally effective in removing viral infectivity from coagulation factor products.
Use of an organic solvent (tri-n-butyl phosphate; TNBP) in the manufacture of Antihemophilic Factor (Human) has little or no effect on AHF activity, while lipid enveloped viruses, such as hepatitis B and human immunodeficiency virus (HIV) are inactivated.1
Each bottle of HEMOFIL M is labeled with the AHF activity expressed in International Units (IU) per bottle. This potency assignment is referenced to the World Health Organization International Standard.
The purity of HEMOFIL M has been thought to influence the difficulty of producing an accurate potency measurement. Experiments have shown that to achieve accurate activity levels, such a potency assay should be conducted using plastic test tubes and pipets as well as substrate containing normal levels of von Willebrand's Factor.
In vitro studies demonstrate that the HEMOFIL M manufacturing process provides for significant viral reduction. These studies, summarized in Table 1, demonstrate virus clearance during the HEMOFIL M manufacturing process using human immunodeficiency virus, Type 1 (HIV-1); bovine viral diarrhea virus (BVDV), a generic model for lipid enveloped RNA viruses, such as hepatitis C virus (HCV); pseudorabies virus (PRV), a model for lipid enveloped DNA viruses, such as hepatitis B virus (HBV); canine parvovirus (CPV), a model for non-lipid enveloped DNA viruses, such as human parvovirus B19 (B19V); and hepatitis A virus (HAV). These reductions are achieved through a combination of process chemistry, partitioning and/or inactivation during solvent/detergent treatment and immunoaffinity chromatography.
Process Step Evaluated | Virus Clearance, log10 | ||||
Lipid-enveloped | Non-Lipid enveloped | ||||
HIV-1 | BVDV | PRV | CPV | HAV | |
Solvent/Detergent Treatment | >4.8 | >6.8 | >6.9 | * | * |
Immunoaffinity Chromatography | N.A.† | N.A.† | N.A.† | ≥3.9 | ≥4.5 |
Cumulative Total, log10 | >4.8 | >6.8 | >6.9 | ≥3.9 | ≥4.5 |
Antihemophilic factor (AHF) is a protein found in normal plasma which is necessary for clot formation.
The administration of HEMOFIL M provides an increase in plasma levels of AHF and can temporarily correct the coagulation defect of patients with hemophilia A (classical hemophilia).
The half-life of HEMOFIL M administered to Factor VIII deficient patients has been shown to be 14.8 ± 3.0 hours.
The use of HEMOFIL M is indicated in hemophilia A (classical hemophilia) for the prevention and control of hemorrhagic episodes.
HEMOFIL M is not indicated in von Willebrand's disease.
HEMOFIL M is contraindicated in patients with a known hypersensitivity to the active substance, to excipients, or to mouse proteins.
Allergic-type hypersensitivity reactions, including anaphylaxis, have been reported with HEMOFIL M and have been manifested by, for example, bronchospasm, dyspnea, hypotension, chest pain, facial edema, urticaria, rash, flushing, pruritus, nausea.
The development of neutralizing antibodies (inhibitors) to Factor VIII is a known complication of the treatment of patients with Hemophilia A. Inhibitors have predominantly been reported in previously untreated patients. The risk of developing inhibitors is correlated to the extent of exposure to Factor VIII, the risk being highest within the first 20 exposure days, and to other genetic and environmental factors. The risk for inhibitor development depends on a number of factors relating to the characteristics of the patient (e.g., type of the Factor VIII gene mutation, family history, ethnicity), which are believed to represent the most significant risk factors for inhibitor formation.
HEMOFIL M is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, that can cause disease. The risk that such products will transmit an infectious agent has been reduced by screening plasma donors for prior exposure to certain viruses, by testing for the presence of certain current virus infections, and by inactivating and/or removing certain viruses. Appropriate vaccination (against hepatitis A and B) should be considered for patients in regular/repeated receipt of plasma-derived products including HEMOFIL M. Despite these measures, such products can still potentially transmit disease. Because this product is made from human plasma, a risk of transmitting infectious agents, e.g., viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent, cannot be totally excluded. This also applies to unknown or emerging viruses and other pathogens. ALL infections thought by a physician possibly to have been transmitted by this product should be reported by the physician or other healthcare provider to Baxter Healthcare Corporation at 1-800-423-2862 (in the U.S.). The physician should discuss the risks and benefits of this product with the patient.
Individuals who receive infusions of blood or plasma products may develop signs and/or symptoms of some viral infections, particularly non A, non B hepatitis. As indicated under CLINICAL PHARMACOLOGY, however, a group of such patients treated with HEMOFIL M did not demonstrate signs or symptoms of non A, non B hepatitis over observation periods ranging from three to nine months.
Identification of the clotting defect as a Factor VIII deficiency is essential before the administration of HEMOFIL M is initiated.
Patients should be evaluated for the development of Factor VIII inhibitors if the expected plasma Factor VIII activity levels are not attained, or if bleeding is not controlled with an appropriate dose.
No benefit may be expected from this product in treating other deficiencies.
HEMOFIL M contains trace amounts of mouse protein (less than 0.1 ng/AHF activity units). The possibility exists that patients treated with HEMOFIL M may develop hypersensitivity to the mouse proteins . There have been no cases of hypersensitivity to the mouse proteins reported.
The pulse rate should be determined before and during administration of HEMOFIL M. Should a significant increase occur, reducing the rate of administration or temporarily halting the injection usually allows the symptoms to disappear promptly.
Certain components used in the packaging of this product contain natural rubber latex which may cause allergic reactions. Use precaution when treating patients with sensitivity to natural rubber latex.
Although dosage can be estimated by the calculations which follow, it is strongly recommended that whenever possible, appropriate laboratory tests be performed on the patient's plasma at suitable intervals to assure that adequate AHF levels have been reached and are maintained.
If the AHF content of the patient's plasma fails to reach expected levels or if bleeding is not controlled after apparently adequate dosage, the presence of inhibitor should be suspected. By appropriate laboratory procedures, the presence of inhibitor can be demonstrated and quantified in terms of AHF units neutralized by each mL of plasma or by the total estimated plasma volume.
If the inhibitor is at low levels (i.e., <10 Bethesda Units/mL), after administration of sufficient AHF units to neutralize the inhibitor, additional AHF units will elicit the predicted response.
Pregnancy Category C. Animal reproduction studies have not been conducted with HEMOFIL M. The safety of HEMOFIL M for use in pregnant women has not been established. It is not known whether HEMOFIL M can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. HEMOFIL M should be given to a pregnant woman only if clearly needed.
The safety of HEMOFIL M for use in nursing mothers has not been established. It is not known whether this drug is excreted into human milk. Physicians should carefully consider the potential risks and benefits for each specific patient before prescribing HEMOFIL M. HEMOFIL M should be given to nursing mothers only if clinically indicated.
The adverse reactions presented in this section have been identified based on clinical trial experience with HEMOFIL M in patients previously treated with other Factor VIII concentrates or blood products (N = 74), and previously untreated patients (PUPs; N = 50).
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Clinical Trial Adverse Reactions | ||
System Organ Class (SOC) | Preferred MedDRA Term |
Number of Cases (Frequency Percentage) |
BLOOD AND LYMPHATIC SYSTEM DISORDERS | Factor VIII inhibition | 3 (5.7%)* |
NERVOUSSYSTEM DISORDERS | Dizziness | 1 (0.8%) |
Headache | 1 (0.8%) | |
Dysgeusia | 1 (0.8%) | |
GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS | Pyrexia | 1 (0.8%) |
Infusion site inflammation | 2 (1.6%) |
HEMOFIL M was administered to 11 patients previously untreated with Antihemophilic Factor (Human). They have shown no signs of hepatitis or HIV infection following three to nine months of evaluation.
A study of 25 patients treated with HEMOFIL M, and monitored for three to six months has demonstrated no evidence of antibody response to mouse protein. More than 1,000 infusions of HEMOFIL M have been administered during the clinical trials. Reported events included a single episode each of chest tightness, fuzziness and dizziness, and one patient reported an unusual taste after each infusion.
In addition to clinical trials, the following adverse reactions have been reported in the post-marketing experience, listed by MedDRA System Organ Class (SOC), then by Preferred Term.
IMMUNE SYSTEM DISORDERS: Anaphylaxis, Hypersensitivity reactions
EYE DISORDERS: Visual impairment, Ocular hyperemia
CARDIAC DISORDERS: Cyanosis, Bradycardia, Tachycardia
VASCULAR DISORDERS: Hypotension, Flushing
RESPIRATORY, THORACIC, AND MEDIASTINAL DISORDERS: Bronchospasm, Dyspnea, Cough, Hyperventilation
GASTROINTESTINAL DISORDERS: Diarrhea, Vomiting, Nausea, Abdominal pain
SKIN AND SUBCUTANEOUS TISSUE DISORDERS: Urticaria, Rash, Pruritus, Hyperhidrosis
GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS: Facial edema, Edema, Chills, Fatigue, Chest pain, Musculoskeletal pain, Irritability
HEMOFIL M is to be administered only intravenously.
The expected in vivo peak AHF level, expressed as IU/dL of plasma or % (percent) of normal, can be calculated by multiplying the dose administered per kg body weight (IU/kg) by two. This calculation is based on the clinical finding by Abildgaard, et al,2 which is supported by data from the collaborative study of in vivo recovery and survival with 15 different lots of HEMOFIL M on 56 hemophiliacs that demonstrated a mean peak recovery point above the mean pre-infusion baseline of about 2.0 IU/dL per infused IU/kg body weight.3
Example:
(1) A dose of 1750 IU AHF administered to a 70 kg patient, i.e., 25 IU/kg (1750/70), should be expected to cause a peak post-infusion AHF increase of 25 x 2 = 50 IU/dL (50% of normal).
(2) A peak level of 70% is required in a 40 kg child. In this situation the dose would be 70/2 x 40 = 1400 IU.
Recommended Dosage Schedule
Physician supervision of the dosage is required. The following dosage schedule may be used as a guide.
HEMORRHAGE | ||
Degree of hemorrhage | Required peak post-infusion AHF activity in the blood (as % of normal or IU/dL plasma) | Frequency of infusion |
Early hemarthrosis or muscle bleed or oral bleed | 20-40 | Begin infusion every 12 to 24 hours for one-three days until the bleeding episode as indicated by pain is resolved or healing is achieved. |
More extensive hemarthrosis, muscle bleed, or hematoma | 30-60 | Repeat infusion every 12 to 24 hours for usually three days or more until pain and disability are resolved. |
Life threatening bleeds such as head injury, throat bleed, severe abdominal pain | 60-100 | Repeat infusion every 8 to 24 hours until threat is resolved. |
SURGERY | ||
Type of operation | ||
Minor surgery, including tooth extraction | 60-80 | A single infusion plus oral antifibrinolytic therapy within one hour is sufficient in approximately 70% of cases. |
Major surgery | 80-100 (pre- and post-operative) | Repeat infusion every 8 to 24 hours depending on state of healing. |
If bleeding is not controlled with the prescribed dose, the plasma level of Factor VIII should be determined and a sufficient dose of HEMOFIL M administered to achieve a satisfactory clinical response.
Under certain circumstances (e.g., presence of a low titer inhibitor) doses larger than those recommended may be necessary as per standard care. In patients with high titer Factor VIII inhibitors, HEMOFIL M therapy may not be effective and other therapeutic options should be considered.
The dosage and duration of treatment depend on the severity of Factor VIII deficiency, the location and extent of the bleeding, and the patient’s clinical condition. Careful control of replacement therapy is especially important in cases of major surgery or life threatening hemorrhages.
Although dosage can be estimated by the calculations above, it is strongly recommended that whenever possible, appropriate laboratory tests including serial AHF assays be performed on the patient’s plasma at suitable intervals to assure that adequate AHF levels have been reached and are maintained.
Note: Do not refrigerate after reconstitution.
Administer at room temperature.
HEMOFIL M should be administered not more than three hours after reconstitution.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not administer if particulate matter or discoloration is found.
Plastic syringes are recommended for use with this product The ground glass surface of all-glass syringes tend to stick with solutions of this type.
Preparations of HEMOFIL M can be administered at a rate of up to 10 mL per minute with no significant reactions. (see PRECAUTIONS: Increase in Pulse Rate)
HEMOFIL M is available as single dose bottles that contain the following nominal potencies:
Nominal Potency | NDC Number |
250 IU | 0944-2930-01 |
500 IU | 0944-2931-01 |
1000 IU | 0944-2932-01 |
1700 IU | 0944-2933-01 |
Each bottle is labeled with the potency in International Units, and is packaged together with 10 mL of Sterile Water for Injection, USP, a double-ended needle, and a filter needle.
HEMOFIL M can be stored at 2° - 8°C (36° - 46°F) or at room temperature, not to exceed 30°C (86°F), until expiration date noted on the package.
Avoid freezing to prevent damage to the diluent bottle.
To enroll in the confidential, industry-wide Patient Notification System, call 1-888-UPDATE U (1-888-873-2838)
Baxter and Hemofil are trademarks of Baxter International Inc.
and are registered in the U.S. Patent and Trademark office.
Baxter Healthcare Corporation
Westlake Village, CA 91362 USA
U.S. License No. 140
Printed in USA
Revised Nov 10, 2010
HEMOFIL M 1000 unit carton
10 mL size, dried
NDC 0944-2932-01
Antihemophilic Factor (Human)
Method M, Monoclonal Purified
HEMOFIL M
FVIII
For intravenous administration only. Administer within three hours after reconstitution is complete. See package insert for more information. Store at 2°-8°C (38°-46°F) or room temperature, not to exceed 30°C (86°F) until the expiration date noted on the package. Avoid freezing to prevent damage to the diluent bottle.
Sterile Nonpyrogenic No preservatives
Warning: This product is prepared from large pools of human plasma. Human blood and its components may transit infectious agents. The patient and the physician should discuss the risks and benefits of this product.
Rx Only
Read both front and back panels
Baxter Healthcare Corporation
Westlake Village , CA 91362 USA
U.S. License No. 140
Baxter and Hemofil are trademarks of Baxter International, Inc., and are registered in the U.S Patent and Trademark office.
HEMOFIL M 1000 vial label
10 mL size, dried
List 1501807
NDC 0944-2932-02
Antihemophilic Factor (Human)
Method M, Monoclonal Purified
HEMOFIL M
FVII
Store at 2°-8°C (38°-46°F) or room temperature, not to exceed 30°C (86°F) until the expiration date noted on the package. See package insert for more information. Contains no preservative.
For intravenous administration only.
Warning: This product is prepared from large pools of human plasma. Human blood and its components may transit infectious agents. The patient and the physician should discuss the risks and benefits of this product.
Rx Only
Baxter Healthcare Corporation
Westlake Village, CA 91362 USA
U.S. License No. 140
Sterile Water vial label
NDC 0338-0764-61
Nonpyrogenic
Single-Dose Container
10 mL
Sterile Water for Injection, USP for reconstitution of accompanying product
Do not use unless clear. No antimicrobial agent or other substance has been added. Do not use for intravascular injection without making approximately isotonic by injection of suitable solute. Discard unused portion.
Rx Only.
This Product Contains Dry Natural Rubber.
Baxter
Manufactured by
Baxter Healthcare Corporation
Deerfield, IL 60015 USA
HEMOFIL M
antihemophilic factor human kit |
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Marketing Information | |||
Marketing Category | Application Number or Monograph Citation | Marketing Start Date | Marketing End Date |
BLA | BLA101448 | 03/15/2011 |
HEMOFIL M
antihemophilic factor human kit |
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Marketing Information | |||
Marketing Category | Application Number or Monograph Citation | Marketing Start Date | Marketing End Date |
BLA | BLA101448 | 03/15/2011 |
HEMOFIL M
antihemophilic factor human kit |
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Marketing Information | |||
Marketing Category | Application Number or Monograph Citation | Marketing Start Date | Marketing End Date |
BLA | BLA101448 | 03/15/2011 |
HEMOFIL M
antihemophilic factor human kit |
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Marketing Information | |||
Marketing Category | Application Number or Monograph Citation | Marketing Start Date | Marketing End Date |
BLA | BLA101448 | 03/15/2011 |
Labeler - Baxter Healthcare Corporation (039121363) |
Establishment | |||
Name | Address | ID/FEI | Operations |
BAXTER HEALTHCARE CORPORATION | 085206634 | MANUFACTURE |
Establishment | |||
Name | Address | ID/FEI | Operations |
Baxter Healthcare Corporation | 001728059 | MANUFACTURE |