Lexington, Mass. – December 2, 2016 – Shire plc (LSE: SHP, NASDAQ: SHPG), the leading biotechnology company focused on serving individuals with rare diseases, is presenting an update on its safety database describing 40 years of real-world experience with the bypassing agent FEIBA [Anti-Inhibitor Coagulant Complex]. Shire also revealed new in vitro data showing the potential for excessive thrombin generation when combining an investigational procoagulant bispecific antibody and bypass therapy for breakthrough bleeds. These data are now available online as part of the Proceedings of the 58th American Society of Hematology (ASH) Annual Meeting, to be held December 3-6 in San Diego, California.
Inhibitors are a rare but serious complication impacting about 5-7 percent of patients with hemophilia A. They form when the body’s immune system attacks the molecules in factor therapy, causing it to be ineffective.1,2 Bypassing agents help bypass the inhibitor to help the body form a clot and stop bleeding.3
Recently, concerns have emerged related to the use of an investigational non-factor product when combined with marketed bypassing agents for hemophilia patients with inhibitors. Shire conducted an analysis of a sequence analogue biosimilar of one investigational agent, emicizumab, in combination with bypassing agents. Researchers characterized in vitro the rate and level of thrombin generation resulting from combining the bypassing agent and investigational non-factor product. The data found a multi-fold increase in thrombin generation, indicating a potential thrombotic risk for patients who receive the investigational agent combined with an approved bypass agent for breakthrough bleeds. (Synergistic Effects of a Procoagulant Bispecific Antibody and Rescue Therapies on Thrombin Generation- a Potential Safety Risk, http://www.bloodjournal.org/content/128/22/4952.)4
“FEIBA is a widely approved treatment option for people with hemophilia A and B with inhibitors, and has a well-established safety and efficacy profile5,” said Leonard Valentino, M.D., Global Head of Hematology Medical Affairs, Shire. “Shire embraces new products with the potential to build on current standards of hemophilia care. As with any new product, rigorous clinical studies and careful review of safety and efficacy data are crucial to inform healthcare providers and patients on the best way to safely and effectively incorporate potential new therapeutic agents into existing management strategies.”
Shire continually evaluates the safety profile of its products through ongoing safety surveillance. The risk of thromboembolic events (TEEs) is well characterized in the FEIBA label. FEIBA has a boxed warning for identified thromboembolic risk.5 Approximately three TEEs have been reported per 100,000 infusions based upon more than seven billion units (equivalent to about two million infusions) distributed over the past 40 years.6
During ASH, Shire is presenting an update on its safety database describing the real-world experience with FEIBA. The global review of safety databases for AE reports of FEIBA received from 1975 through July 2016 showing the reporting rate of TEEs associated with FEIBA is comparable with previously reported data. (Four Decade Cumulative Review of Thrombo-Embolic Events Reported with the Use of Activated Prothrombin Complex Concentrate in Congenital Haemophilia, http://www.bloodjournal.org/content/128/22/503.)6
Indications for FEIBA [Anti-Inhibitor Coagulant Complex]
FEIBA is an Anti-Inhibitor Coagulant Complex indicated for use in hemophilia A and B patients with inhibitors for:
FEIBA is not indicated for the treatment of bleeding episodes resulting from coagulation factor deficiencies in the absence of inhibitors to coagulation factor VIII or coagulation factor IX.
Detailed Important Risk Information for FEIBA [Anti-Inhibitor Coagulant Complex]
WARNING: THROMBOEMBOLIC EVENTS
The use of FEIBA is contraindicated in patients with:
Thromboembolic events (including venous thrombosis, pulmonary embolism, myocardial infarction, and stroke) can occur with FEIBA, particularly following the administration of high doses (above 200 units per kg per day) and/or in patients with thrombotic risk factors.
Infusion of FEIBA should not exceed a dose of 100 units per kg body weight every 6 hours and daily doses of 200 units per kg body weight. Maximum injection or infusion rate must not exceed 2 units per kg of body weight per minute. Monitor patients receiving more than 100 units per kg of body weight of FEIBA for the development of DIC, acute coronary ischemia and signs and symptoms of other thromboembolic events. If clinical signs or symptoms occur, such as chest pain or pressure, shortness of breath, altered consciousness, vision, or speech, limb or abdomen swelling and/or pain, discontinue the infusion and initiate appropriate diagnostic and therapeutic measures.
Hypersensitivity and allergic reactions, including severe anaphylactoid reactions, can occur following the infusion of FEIBA. The symptoms include urticaria, angioedema, gastrointestinal manifestations, bronchospasm, and hypotension. These reactions can be severe and systemic (e.g., anaphylaxis with urticaria and angioedema, bronchospasm, and circulatory shock). Other infusion reactions, such as chills, pyrexia, and hypertension have also been reported. If signs and symptoms of severe allergic reactions occur, immediately discontinue administration of FEIBA and provide appropriate supportive care.
Because FEIBA is made from human plasma it may carry a risk of transmitting infectious agents, e.g., viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.
The most frequently reported adverse reactions observed in >5% of subjects in the prophylaxis trial were anemia, diarrhea, hemarthrosis, hepatitis B surface antibody positive, nausea, and vomiting.
The serious adverse reactions seen with FEIBA are hypersensitivity reactions and thromboembolic events, including stroke, pulmonary embolism and deep vein thrombosis.
Use of antifibrinolytics within approximately 6 to 12 hours after the administration of FEIBA is not recommended.
For FEIBA Full Prescribing Information, visit http://www.shirecontent.com/PI/PDFs/FEIBA_USA_ENG.pdf
SHIRE and the Shire Logo are registered trademarks of Shire Pharmaceutical Holdings Ireland Limited or its affiliates.
FEIBA is a registered trademark of Baxalta Incorporated, a wholly owned, indirect subsidiary of Shire plc.
1. WFH Inhibitors Working Group. “About Bleeding Disorders: What are inhibitors?” World Federation of Hemophilia website. http://www.wfh.org/en/page.aspx?pid=651 Accessed November 7, 2016.
2. Wight J. Paisley S. “The Epidemiology of Inhibitors in Haemophilia A: A Systematic Review.” Haemophilia 2003.
3. Center for Disease Control and Prevention. “Inhibitors.” CDC website. https://www.cdc.gov/ncbddd/hemophilia/inhibitors.html Accessed November 30, 2016.
4. Knappe S. et al. “Synergistic Effects of a Procoagulant Bispecific Antibody and Rescue Therapies on Thrombin Generation- a Potential Safety Risk.” American Society of Hematology. San Diego, California. December 3-6, 2016. Available at: http://www.bloodjournal.org/content/128/22/4952
5. FEIBA Prescribing Information.
6. Crea R. et al. “Four Decade Cumulative Review of Thrombo-Embolic Events Reported with the Use of Activated Prothrombin Complex Concentrate in Congenital Haemophilia.” American Society of Hematology. San Diego, California. December 3-6, 2016. Available at: http://www.bloodjournal.org/content/128/22/503
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Shire is the leading global biotechnology company focused on serving people with rare diseases and other highly specialized conditions. We strive to develop best-in-class products, many of which are available in more than 100 countries, across core therapeutic areas including Hematology, Immunology, Neuroscience, Ophthalmics, Lysosomal Storage Disorders, Gastrointestinal / Internal Medicine / Endocrine and Hereditary Angioedema; and a growing franchise in Oncology.
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