For pediatric patients,ALPROLIX® offers personalized dosing today that they can count on tomorrow
For children aged <12 years, the
recommended prophylaxis starting regimen is
60 IU/kg once weekly,
with adjustments made based on patient response2
- More frequent or higher doses may be needed in children aged <12 years, and especially in children aged <6 years
- On average, 1 IU of ALPROLIX per kg of body weight increases the level of circulating factor IX by approximately 0.74% in children aged ≥6 years and 0.6% in children aged <6 years
In the Kids B-LONG trial, 80% of patients
had a reduction in their dosing frequency
compared with prestudy factor IX therapy1
- These patients experienced a 39% reduction in weekly prophylactic consumption1
96% of pediatric patients maintained or extended their dosing interval through the B-YOND extension trial3
- In B-YOND, 18 patients maintained and 4 patients extended their dosing interval
Dr De Angulo discusses ALPROLIX
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The circulation of ALPROLIX is not limited to the plasma2,7,8
- ALPROLIX has a high volume of distribution, suggesting it may leave the plasma and enter the extravascular space after infusion
- For ALPROLIX 50 IU/kg, the volume of distribution is 327 mL/kg, which is substantially higher than the estimated total plasma volume*
- This widespread distribution of ALPROLIX and circulation outside the plasma may be related to the binding of ALPROLIX to the neonatal Fc receptor (FcRn)
- Additional research is being conducted to understand the full clinical relevance of extravascular distribution
Based on the theoretical plasma volume of 40 mL/kg. The subgroup receiving 100 IU/kg of ALPROLIX has a reported volume of distribution of 236 mL/kg. The difference in reported values is within normal variation and may be due to intersubject variability.2,7,9
ALPROLIX has the widest range of dosage strengths in hemophilia B, including a 4000-IU vial2,10-17
Important Safety Information
CONTRAINDICATIONS: ALPROLIX® is contraindicated in patients who have a known history of hypersensitivity reactions, including anaphylaxis, to the product or its excipients.
WARNINGS AND PRECAUTIONS: Allergic-type hypersensitivity reactions, including anaphylaxis, are possible with factor replacement therapies, and have been reported with ALPROLIX. Discontinue use of ALPROLIX if hypersensitivity symptoms occur, and initiate appropriate treatment.
Formation of neutralizing antibodies (inhibitors) to Factor IX has been reported following administration of ALPROLIX, including in previously untreated patients. Patients using ALPROLIX should be monitored for the development of Factor IX inhibitors. Clotting assays (e.g., one-stage) may be used to confirm that adequate Factor IX levels have been achieved and maintained.
The use of Factor IX products has been associated with the development of thromboembolic complications.
Nephrotic syndrome has been reported following attempted immune tolerance induction in hemophilia B patients with Factor IX inhibitors and a history of allergic reactions to Factor IX. The safety and efficacy of using ALPROLIX for immune tolerance induction have not been established.
ADVERSE REACTIONS: Common adverse reactions (incidence ≥1%) observed in clinical trials were headache, oral paresthesia, and obstructive uropathy.
- On-demand treatment and control of bleeding episodes
- Perioperative management of bleeding
- Routine prophylaxis to reduce the frequency of bleeding episodes
Please see Full Prescribing Information.
References: 1. Fischer K, Kulkarni R, Nolan B, et al. Recombinant factor IX Fc fusion protein in children with haemophilia B (Kids B-LONG): results from a multicentre, non-randomised phase 3 study. Lancet Haematol. 2017;4:e75-e82. 2. ALPROLIX® [package insert]. Waltham, MA: Bioverativ®, a Sanofi Company; 2018. 3. Pasi KJ, Fischer K, Ragni M, et al. Long-term safety and efficacy of extended-interval prophylaxis with recombinant factor IX Fc fusion protein (rFIXFc) in subjects with haemophilia B. Thromb Haemost. 2017;117:508-518. 4. Powell JS, Pasi KJ, Ragni MV, et al. Phase 3 study of recombinant factor IX Fc fusion protein in hemophilia B. N Engl J Med. 2013;369(24):2313-2323. 5. Data on file, Bioverativ®, a Sanofi Company. 6. Blanchette VS, Key NS, Ljung LR, Manco-Johnson MJ, van den Berg HM, Srivastava A. Definitions in hemophilia: communication from the SSC of the ISTH. J Thromb Haemost. 2014;12:1935-1939. 7. Iorio A, Fischer K, Blanchette V, et al. Tailoring treatment of haemophilia B: accounting for the distribution and clearance of standard and extended half-life FIX concentrates. Thromb Haemost. 2017;117(6):1023-1030. 8. Diao L, Li S, Ludden T, Gobburu J, Nestorov I, Jiang H. Population pharmacokinetic modelling of recombinant factor IX Fc fusion protein (rFIXFc) in patients with haemophilia B. Clin Pharmacokinet. 2014;53:467-477. 9. Björkman S. Population pharmacokinetics of recombinant factor IX: implications for dose tailoring. Haemophilia. 2013;19:753‐757. 10. IDELVION® [package insert]. Marburg, Germany: CSL Behring GmbH; 2017. 11. AlphaNine® SD [package insert]. Los Angeles, CA: Grifols Biologicals Inc; 2017. 12. BeneFIX® [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals Inc, a subsidiary of Pfizer Inc; 2017. 13. Ixinity® [package insert]. Berwyn, PA: Aptevo BioTherapeutics LLC; 2016. 14. Mononine® [package insert]. Kankakee, IL: CSL Behring LLC; 2016. 15. Profilnine® [package insert]. Los Angeles, CA: Grifols Biologicals Inc; 2013. 16. Rixubis® [package insert]. Westlake Village, CA: Baxalta US Inc; 2016. 17. Rebinyn® [package insert]. Plainsboro, NJ: Novo Nordisk Inc; 2017. 18. Powell JS, Pasi KJ, Ragni MV, et al. Phase 3 study of recombinant factor IX Fc fusion protein in hemophilia B. N Engl J Med. 2013;369(suppl):1-14. https://www.nejm.org/doi/suppl/10.1056/NEJMoa1305074/suppl_file/nejmoa1305074_appendix.pdf. Accessed May 2, 2018. 19. Powell J, Shapiro A, Ragni M, et al. Switching to recombinant factor IX Fc fusion protein prophylaxis results in fewer infusions, decreased factor IX consumption and lower bleeding rates. Br J Haematol. 2015;168:113-123. 20. Kaneko Y, Nimmerjahn F, Ravetch JV. Anti-inflammatory activity of immunoglobulin G resulting from Fc sialylation. Science. 2006;313:670-673. 21. Shapiro A. Development of long-acting recombinant FVIII and FIX Fc fusion proteins for the management of hemophilia. Expert Opin Biol Ther. 2013;13(9):1287-1297. 22. National Hemophilia Foundation. Digital Hemophilia Treatment Center Monitoring Linked to Significant Reduction in Bleeding Rates. https://www.hemophilia.org/Newsroom/Medical-News/Digital-Hemophilia-Treatment-Center-Monitoring-Linked-to-Significant-Reduction-in-Bleeding-Rates. Accessed June 7, 2018.