UP FRONT
Pulling Back the Curtain: Ranjana Advani, MD
life is important to keeping a
balance, because I think if that
part of your life is not balanced,
you likely won’t succeed in your
career.
In a typical day, what is the
best part of your day and
what is the part you least
look forward to?
I could spend all day with my
patients in the clinic. It’s so
engaging that I completely lose
track of time. I love the clinical
aspect of what I do because I get
to form very meaningful relation-
ADYNOVATE [Antihemophilic Factor (Recombinant), PEGylated]
Lyophilized Powder for Solution For Intravenous Injection
Brief Summary of Prescribing Information: Please see package insert for full Prescribing Information.
INDICATIONS AND USAGE
ADYNOVATE, Antihemophilic Factor (Recombinant), PEGylated,
is a human antihemophilic factor indicated in adolescent and
adult patients (12 years and older) with hemophilia A
(congenital factor VIII deficiency) for:
• On-demand treatment and control of bleeding episodes
Table 2: Adverse Reactions Reported for ADYNOVATE
MedDRA
Preferred
Term
Number of
Subjects n (%)
(N=169)
Percent per
Infusion
(N = 13579)
Diarrhea
1 (0.6%)
0.01%
Nausea
2 (1.2%)
0.01%
Nervous System Disorders
Headache
5 (3.0%)
0.06%
Vascular Disorders
Flushing
1 (0.6%)
0.01%
MedDRA
System Organ Class
Gastrointestinal Disorders
• Routine prophylaxis to reduce the frequency of bleeding episodes
ADYNOVATE is not indicated for the treatment of
von Willebrand disease.
CONTRAINDICATIONS
ADYNOVATE is contraindicated in patients who have had prior
anaphylactic reaction to ADYNOVATE, to the parent molecule
(ADVATE), mouse or hamster protein, or excipients of ADYNOVATE
(e.g. Tris, mannitol, trehalose, glutathione, and/or polysorbate 80).
WARNINGS AND PRECAUTIONS
Hypersensitivity Reactions
Hypersensitivity reactions are possible with ADYNOVATE.
Allergic-type hypersensitivity reactions, including anaphylaxis,
have been reported with other recombinant antihemophilic factor
VIII products, including the parent molecule, ADVATE. Early signs
of hypersensitivity reactions that can progress to anaphylaxis may
include angioedema, chest tightness, dyspnea, wheezing, urticaria,
and pruritus. Immediately discontinue administration and initiate
appropriate treatment if hypersensitivity reactions occur.
Neutralizing Antibodies
Formation of neutralizing antibodies (inhibitors) to factor VIII can
occur following administration of ADYNOVATE. Monitor patients
regularly for the development of factor VIII inhibitors by appropriate
clinical observations and laboratory tests. Perform an assay that
measures factor VIII inhibitor concentration if the plasma factor VIII
level fails to increase as expected, or if bleeding is not controlled
with expected dose.
Monitoring Laboratory Tests
• Monitor plasma factor VIII activity by performing a validated onestage clotting assay to confirm the adequate factor VIII levels have
been achieved and maintained [see Dosage and Administration (2)].
• Monitor for the development of factor VIII inhibitors. Perform the
Bethesda inhibitor assay to determine if factor VIII inhibitor is
present. If expected factor VIII activity plasma levels are not
attained, or if bleeding is not controlled with the expected dose of
ADYNOVATE, use Bethesda Units (BU) to determine inhibitor levels.
ADVERSE REACTIONS
Common adverse reactions (≥1% of subjects) reported in the
clinical studies were headache and nausea.
No events of hypersensitivity were reported.
Immunogenicity
The risk of the development of factor VIII inhibitors with the use of
ADYNOVATE was evaluated in 2 completed and 3 ongoing clinical
trials. Study subjects consisted of adult (n=143 with ≥ prior 150 EDs)
and pediatric PTPs [(< 6 years of age with ≥50 prior EDs (n= 3),
≥6 years of age with ≥150 prior EDs (n= 23)]. In 120 adult and pediatric
PTPs who were treated for at least 50 exposure days with ADYNOVATE,
the factor VIII inhibitor frequency was 0 (95% CI of 0 to 0.03) for the
risk of any factor VIII inhibitor. None of the 169 individual subjects
who received at least one infusion of ADYNOVATE developed
neutralizing antibodies to factor VIII.
Immunogenicity also was evaluated by measuring the development
of binding IgG and IgM antibodies against factor VIII, PEGylated
(PEG)-factor VIII, PEG and Chinese hamster ovary (CHO) protein
using validated ELISA assays. N one of the 169 treated subjects with
at least one infusion of ADYNOVATE developed a persistent binding
antibody response to any of these antigens. Thirteen subjects in total
showed pre-existing antibodies to factor VIII (n=1), PEG-factor VIII
(n=12) and/or PEG (n=3) prior to the first exposure to ADYNOVATE.
Eight subjects who tested negative at screening developed
transient IgG antibodies against factor VIII (n=5), or PEG-FVIII (n=3)
at one or two consecutive study visits. Binding antibodies that were
detected prior to exposure to ADYNOVATE or that transiently
developed during the study could not be correlated to an impaired
treatment efficacy, altered PK parameters or adverse reactions.
No subject had pre-existing or treatment-emergent antibodies to
CHO protein.
The detection of antibodies that are reactive to factor VIII is
highly dependent on many factors, including: the sensitivity
and specificity of the assay, sample handling, timing of sample
collection, concomitant medications and underlying disease.
For these reasons, comparison of the incidence of antibodies to
ADYNOVATE with the incidence of antibodies to other products
may be misleading.
Clinical Trials Experience
Because clinical trials are conducted under widely varying
conditions, adverse reaction rates observed in the clinical trials
of a drug cannot be directly compared to rates in clinical trials of
another drug and may not reflect the rates observed in practice.
The safety of ADYNOVATE was evaluated in 169 previously treated
patients (PTPs) with severe hemophilia A (factor VIII less than 1% of
normal), who received at least one dose of ADYNOVATE in 2 multi-center,
prospective, open label clinical studies and 3 ongoing clinical studies.
The median duration of participation per subject was 333 (min-max:
1-593) days and the median number of exposure days to ADYNOVATE
per subject was 96 (min-max: 1-170). Table 2 lists the adverse
reactions reported during clinical studies.
ships with the patients and their
extended families, especially in
my long-term follow-up clinic for
patients with Hodgkin lymphoma. I see patients we treated more
than 20 years ago coming back
with their children, or showing
me photographs of their grandchildren, or handing me invitations to their children’s weddings
– it’s so satisfying.
But, the flipside of that is the
documentation that comes at the
end of a 25- or 30-patient day. It’s
getting more and more complex.
Of course, there is bureaucracy
like this in any job – whether it’s
a corporation or a university or a
private practice – so I try to stay
focused on the positive aspects
and try to ignore the negatives.
What is a skill that
you’d like to add to your
repertoire?
I trained under the British system of medicine, which is very
structured. In the ninth grade you
chose sciences and there was no
room for a liberal arts education. Watching my children go
to college in the United States, I
thought, “Wow, they’re getting a
real, well-rounded education.” My
husband is retired, and he actually
is a full-time student again, taking
classes in the environment, policy,
art history – all kinds of things.
I would like to go back to take
classes in some of the broader
aspects of undergraduate education, like philosophy, music, or
something completely different
– not for a degree, but just for the
exposure to the broader aspects of
a liberal arts education.
Professionally, if I had the
time and the bandwidth, I would
like to expand my statistics
knowledge a bit more or take an
“immunology 101” class. So many
things have changed since I went
through medical school, and so
much progress has been made. I
think it would be interesting to
take some basic classes to learn
different perspectives on how we
got to where we are now. ●
Baxalta, Advate, Adynovate, and Baxject are trademarks of
Baxalta US Inc.
Patented: see www.baxalta.com/productpatents/.
Baxalta US Inc.
Westlake Village, CA 91362 USA
U.S. License No. 2020
Issued 11/2015
15E001-ADY-US
May 2016