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Mahlaoui N, Fouyssac F, Mazingue F, Mallebranche C, Barthez-Toullec M, Denti L, Ruhier K, André-Bonnet MH, Marie-Cardine A, Aladjidi N, Stephan JL. Real-world experience with CLAIRYG® 50 mg/mL (intravenous immunoglobulin) in children under 12 years with primary immunodeficiency or immmune thrombocytopenia: a post-approval safety study. Front Pediatr 2023; 11:1260296. [PMID: 37849499 PMCID: PMC10577179 DOI: 10.3389/fped.2023.1260296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction This study presents the results of a real-life, multicenter, prospective, post-approval safety evaluation of Clairyg® 50 mg/mL, a 5% intravenous immunoglobulin (IVIg) liquid, in 59 children (aged < 12 years) with primary immunodeficiency diseases (PID) (n = 32) or immune thrombocytopenia (ITP) (n = 27) in France. Methods The primary objective of the study was to assess the safety and tolerability of Clairyg®, recording all serious and non-serious adverse events (AEs), whether related (rAEs) or not related to the product. Secondary objectives aimed at evaluating the administration of Clairyg® under routine conditions and the available efficacy data to better document the benefit/risk ratio in this pediatric population. An exploratory objective was added to evaluate the potential factors associated with the occurrence of rAEs. Patients received Clairyg® according to the approved dosage under normal conditions of prescriptions over a median follow-up period of 11.8 months. Results A total of 549 infusions (PID: n = 464 and ITP: n = 85), were administered, of which 58.8% were preceded by premedication. The most frequent rAEs were headache, vomiting, and pyrexia in both indications. Most of them were considered non-serious and mild or moderate in intensity. A severe single rAE was observed (aseptic meningitis) in a 4-year-old girl presenting with chronic ITP. The exploratory multivariate analysis of potential co-factors showed that the occurrence of rAEs is significantly linked to high IVIg doses and possibly to female gender. The annualized rate of serious bacterial infections was 0.11 for patients with PID. For patients with ITP, 74.1% experienced at least one bleeding episode during the follow-up, mostly a cutaneous one, and none had gastrointestinal, genitourinary, or central nervous system bleeding. Conclusion Clairyg® was well tolerated and allowed for control of serious bacterial infection in PID and serious bleeding in ITP, which are the main complications in these respective pediatric disorders. No new safety signal was detected in children less than 12 years-old in real-life conditions of use.
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Affiliation(s)
- Nizar Mahlaoui
- Pediatric Immunology Hematology and Rheumatology Unit, Necker University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fanny Fouyssac
- Pediatric Oncology and Hematology Unit, Children Hospital, Vandoeuvre-les-Nancy, France
| | | | - Coralie Mallebranche
- Pediatric Immuno-Hemato-Oncology Unit, Angers University Hospital, Angers, France
| | - Malika Barthez-Toullec
- Clinical Development and Medical Affairs Unit, Scientific, Medical and Regulatory Affairs Department, Laboratoire Français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Lamia Denti
- Pharmacovigilance Unit, Scientific, Medical and Regulatory Affairs Department, Laboratoire Français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Kalaivani Ruhier
- Clinical Development and Medical Affairs Unit, Scientific, Medical and Regulatory Affairs Department, Laboratoire Français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Marie-Hélène André-Bonnet
- Clinical Development and Medical Affairs Unit, Scientific, Medical and Regulatory Affairs Department, Laboratoire Français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Aude Marie-Cardine
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen, France
| | - Nathalie Aladjidi
- Pediatric Oncology Hematology Unit, University Hospital, Bordeaux, France
| | - Jean-Louis Stephan
- Department of Pediatric Oncology, University Hospital of Saint Etienne, North Hospital, Saint Etienne, France
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Bellon A, Fuseau E, Roumanie O, Lamazure J, Stevens W, Dahmane A, Barthez-Toullec M, Golly D, Henriet C, Bridey F. Population pharmacokinetics of a triple-secured fibrinogen concentrate administered to afibrinogenaemic patients: Observed age- and body weight-related differences and consequences for dose adjustment in children. Br J Clin Pharmacol 2020; 86:329-337. [PMID: 31658379 PMCID: PMC7015754 DOI: 10.1111/bcp.14147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 11/28/2022] Open
Abstract
Aims The pharmacokinetics (PK) of a triple‐secured fibrinogen concentrate (FC) was assessed in patients ≥40 kg by noncompartmental analysis over a period of 14 days with multiple blood samples. Limited PK time point assessments in children lead to consideration of using Bayesian estimation for paediatric data. The objectives were (i) to define the population PK of FC in patients with afibrinogenaemia; (ii) to detect age‐ and body weight‐related differences and consequences for dose adjustment. Methods A population PK model was built using plasma fibrinogen activity data collected in 31 patients aged 1 to 48 years who had participated in a single‐dose PK study with FC 0.06 g kg–1. Results A 1‐compartment model with allometric scaling accounting for body weight was found to best describe the kinetics of FC. Addition of age and sex as covariates did not improve the model. Incremental in vivo recovery assessed at the end of infusion with the predicted maximal concentrations was lower, weight‐adjusted clearance was higher, and fibrinogen elimination half‐life was shorter in patients <40 kg than patients ≥40 kg. Interpatient variability was similar in both groups. Conclusion Dosing in patients ≥40 kg based on the previous empirical finding using noncompartmental analysis where FC 1 g kg–1 raises the plasma fibrinogen activity by 23 g L–1 was confirmed. In patients <40 kg, (covering the age range from birth up to about 12 years old) FC 1 g kg–1 raises the plasma fibrinogen by 19 g L–1. Dosing should be adapted accordingly unless therapy is individualized.
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Affiliation(s)
- Anne Bellon
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | | | | | - Jennifer Lamazure
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Wil Stevens
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Amel Dahmane
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Malika Barthez-Toullec
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Dominique Golly
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Céline Henriet
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Françoise Bridey
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
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Djambas Khayat C, El Khorassani M, Lambert T, Gay V, Barthez-Toullec M, Lamazure J, Bellon A, Henriet C, Bridey F, Négrier C. Clinical pharmacology, efficacy and safety study of a triple-secured fibrinogen concentrate in adults and adolescent patients with congenital fibrinogen deficiency. J Thromb Haemost 2019; 17:635-644. [PMID: 30661302 DOI: 10.1111/jth.14392] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 11/29/2022]
Abstract
Essentials A novel fibrinogen concentrate was evaluated in patients with congenital fibrinogen deficiency. An open-label, phase 2-3 trial studied pharmacology, efficacy, and safety in patients >6 years. The product offers safe and effective therapy in the treatment and prophylaxis of bleeding. Data in recovery show the need of adjusted treatment and further investigation in children. SUMMARY: Background Single-factor replacement therapy is considered the most suitable treatment option for hereditary fibrinogen deficiency. A triple-secured plasma-derived human fibrinogen product was developed to increase the safety of the former fibrinogen concentrate. Objectives This non-randomized, open-label, prospective study investigated pharmacokinetics, efficacy, and safety of a novel fibrinogen concentrate (FibCLOT® /CLOTTAFACT® LFB, France) in inherited deficiency. Patients/Methods Fourteen patients ≥40 kg received fibrinogen concentrate for pharmacology and 16 ≥ 23 kg received treatment for bleeding or surgery. Each treatment was followed by a 3-week safety observation period. Key outcomes included number of infusions, dose, bleeding control, daily assessment, hemoglobin, blood loss, transfusions, and physicians' global assessment of response. Results Incremental recovery was 2.35 mg mL-1 per mg kg-1 and maximal concentration 1.41 g L-1 (geometric mean) after 0.060 g kg-1 infusion in 14 afibrinogenemic patients. Terminal half-life was 69.3 h (non-compartmental analysis). The maximum clot firmness was increased by a mean of 10.3 mm from baseline to maximal effect. Sixteen patients participated to the efficacy phase: 32 bleeding episodes were treated in 9 patients, and 15 patients underwent 38 surgical/invasive procedures. All patients achieved appropriate hemostasis: response to treatment was successful in all bleeds (95% CI, 0.89-1.00) and procedures (95% CI, 0.91-1.00). Most (94%) bleeds were controlled with a single infusion (median 0.050 g kg-1 ). Two patients experienced asymptomatic distal venous thromboses identified by systematic ultrasound. Conclusion FibCLOT® /CLOTTAFACT® showed a pharmacokinetic profile comparable to that of other fibrinogen concentrates and provides safe and clinically effective substitution therapy for fibrinogen-deficient patients.
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Affiliation(s)
| | | | | | | | - Malika Barthez-Toullec
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Jennifer Lamazure
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Anne Bellon
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Céline Henriet
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Françoise Bridey
- Clinical Development, Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - Claude Négrier
- Hematology Division, Hemophilia Comprehensive Care Center, Louis Pradel Hospital, University Lyon1, Bron, France
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