Octaplaslg Solution For Infusion

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SUMMARY OF PRODUCT CHARACTERISTICS

1 NAME OF THE MEDICINAL PRODUCT

octaplasLG®, solution for infusion.

2 QUALITATIVE AND QUANTITATIVE COMPOSITION

A 200 ml bag contains 9 - 14 g of ABO-blood group specific human plasma proteins (45 - 70 mg/mL). OCTAPLASLG is supplied in separate presentations according to the following blood groups:

Blood group A

Blood group B

Blood group AB

Blood group O

For details about important coagulation factors and inhibitors, see section 5.1 and table 2.

For the full list of excipients, see section 6.1.

3 PHARMACEUTICAL FORM

Solution for infusion.

The frozen solution is (slightly) yellow.

4 CLINICAL PARTICULARS

4.1 Therapeutic indications

• Complex deficiencies of coagulation factors such as coagulopathy due to severe hepatic failure or massive transfusion.

• Substitution therapy in coagulation factor deficiencies, when a specific coagulation factor concentrate (e.g. factor V or factor XI) is not available for use or in emergency situations when a precise laboratory diagnosis is not possible.

• Rapid reversal of the effects of oral anticoagulants (coumarin or indanedione type), when a prothrombin complex concentrate is not available for use or administration of vitamin K is insufficient due to impaired liver function or in emergency situations.

• Potentially dangerous haemorrhages during fibrinolytic therapy, using e.g. tissue plasminogen activators, in patients who fail to respond to conventional measures.

Therapeutic plasma exchange procedures, including those in thrombotic thrombocytopenic purpura (TTP).

4.2 Posology and method of administration

Posology:

The dosage depends upon the clinical situation and underlying disorder, but 12-15 ml octaplasLG/kg body weight is a generally accepted starting dose. This should increase the patient's plasma coagulation factor levels by approximately 25%.

It is important to monitor the response, both clinically and with measurement of e.g. activated partial thromboplastin time (aPTT), prothrombin time (PT), and/or specific coagulation factor assays.

Dosage for coagulation factor deficiencies:

An adequate haemostatic effect in minor and moderate haemorrhages or surgery in coagulation factor deficient patients is normally achieved after the infusion of 5-20 mL octaplasLG/kg body weight. This should increase the patient's plasma coagulation factor levels by approximately 10-33 %. In the event of major haemorrhage or surgery, the expert advice of a haematologist should be sought.

Dosage for TTP and haemorrhages in intensive plasma exchange:

For therapeutic plasma exchange procedures, the expert advice of a haematologist should be sought.

In TTP patients the whole plasma volume exchanged should be replaced with octaplasLG.

Method of administration

Administration of octaplasLG must be based on ABO-blood group specificity. In emergency cases, octaplasLG blood group AB can be regarded as universal plasma since it can be given to all patients regardless of blood group.

octaplasLG must be administered by intravenous infusion after thawing, as described in section 6.6, using an infusion set with a filter. An aseptic technique must be used throughout the infusion.

After thawing the solution is clear to slightly opalescent and free of solid or gelatinous particles.

Due to the risk of citrate toxicity, the infusion rate should not exceed 0.020-0.025 mmol citrate/kg body mass/minute - equal to <1 ml octaplasLG/kg body mass/minute. Toxic effects of citrate can be minimised by giving calcium gluconate intravenously into another vein.

Paediatric population

The efficacy and safety of octaplasLG have not been evaluated in pediatric patients.

4.3 Contraindications

- IgA deficiency with documented antibodies against IgA

- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 or residues from the manufacturing process, as stated in section 53.

- Severe deficiencies of protein S

4.4 Special warnings and precautions for use

octaplasLG should not be used:

• As volume expander.

• In cases of bleeding caused by coagulation factor deficiencies where a specific factor concentrate is available for use.

• To correct hyperfibrinolysis in liver transplantation or other conditions with complex disturbances of haemostasis caused by a deficiency of plasmin inhibitor, also named a₂-antiplasmin.

octaplasLG should be used with caution under the following conditions:

• IgA deficiency.

• Plasma protein allergy.

• Previous reactions to fresh-frozen plasma (FFP) or octaplasLG.

• Manifest or latent cardiac decompensation.

• Pulmonary oedema.

In order to reduce the risk for venous thromboembolism caused by the reduced protein S activity of octaplasLG compared to normal plasma (see section 5.1), caution should be exercised and appropriate measures should be considered in all patients at risk for thrombotic complications.

In intensive plasma exchange procedures, octaplasLG should only be used to correct the coagulation abnormality when abnormal haemorrhage occurs.

Standard measures to prevent infections resulting from the use of medical products prepared from human blood or plasma include selection of donors, screening of individual donations and plasma pool for specific markers of infection and the inclusion of effective manufacturing steps for the inactivation/removal of viruses. Despite this, when medicinal products prepared from human blood or plasma are administered, the possibility of transmitting infective agents cannot be totally excluded. This also applies to unknown and emerging viruses and other pathogens.

The measures taken are considered effective for enveloped viruses such as HIV,

HBV, and HCV. The measures taken may be of limited value against non-enveloped virus such as HAV, HEV and Parvovirus B19.

Parvovirus B19 infection may be serious for pregnant woman (fetal infection) and for individuals with immunodeficiency or increased erythropoiesis (e.g. haemolytic anaemia). HEV may also seriously affect seronegative pregnant women. Therefore octaplasLG should only be administered to these patients if strongly indicated.

Appropriate vaccination (e.g. against HBV and HAV) for patients in regular receipt of medicinal products derived from human blood or plasma should be considered.

Additionally, a step to remove prions is incorporated.

It is strongly recommended that every time that octaplasLG is administered to a patient, the name and batch number of the product are recorded in order to maintain a link between the patient and the batch of the product.

Patients should be observed for at least 20 minutes after the administration.

In case of anaphylactic reaction or shock, the infusion must be stopped immediately. Treatment should follow the guidelines for shock therapy.

Data on the use of octaplasLG in premature babies are very limited, therefore, the product should only be administered to these individuals if the likely benefits clearly outweigh potential risks.

4.5 Interaction with other medicinal products and other forms of interaction

Interactions:

No interactions with other drugs have been identified.

Incompatibilities:

• octaplasLG product can be mixed with red blood cells and platelets if ABO compatibility of both preparations is respected.

• octaplasLG must not be mixed with other medicinal products, as inactivation and precipitation may occur.

• To avoid the possibility of clot formation, solutions containing calcium must not be administered by the same intravenous line as octaplasLG.

4.6 Fertility, pregnancy and lactation

The safety of octaplasLG for use in human pregnancy has not been established in controlled clinical trials. It is not known whether octaplasLG can affect reproduction capacity. The product should be administered to a pregnant or lactating woman only if alternative therapies are regarded inappropriate.

For potential risk of Parvovirus B19 and HEV transmission, see section 4.4.

4.7 Effects on ability to drive and use machines

After ambulant infusion, the patient should rest for one hour.

octaplasLG has no or negligible influence on the ability to drive and use machines.

4.8 Undesirable effects

- Acute mild allergic reaction due to hypersensitivity to infused proteins and characterised by urticaria, fever, chills, nausea, vomiting, and abdominal or back pain may commonly be observed.

- Acute and sometimes severe allergic (anaphylactic or anaphylactoid) type of reactions characterised by flushing, hypotension, chest pain, bronchospasms, dyspnoea, and cardio-respiratory collapse may rarely be observed.

- High infusion rates may rarely cause cardiovascular effects as a result of citrate toxicity (fall in ionised calcium), especially in patients with liver function disorders.

In the course of plasma exchange procedures, symptoms attributable to citrate toxicity such as fatigue, paraesthesia, tremor, and hypocalcemia may be observed rarely.

- Administration of octaplasLG must be based on ABO-blood group specificity. In case of an incompatible transfusion by mistake, ABO-antibodies in octaplasLG will bind to the antigens of recipient red blood cells and cause an immediate or delayed type of haemolytic transfusion reactions.

- For safety with respect to transmissible agents, see section 4.4.

During clinical trials with octaplasLG’s predecessor product, and its post-approval use, the following adverse reactions have been identified:

Frequencies have been evaluated according to the following convention: very common (>1/10); common (>1/100 to <1/10); uncommon (>1/1,000 to <1/100); rare (>1/10,000 to <1/1,000); very rare (<1/10,000), not known (cannot be estimated from the available data).

Table 1: Adverse reactions that have been identified for octaplasLG’s predecessor product

System organ class	Common (> 1% to < 10%)	Uncommon (> 0.1% to < 1%)	Rare (> 0.01% to <0.1%)	Very rare (< 0.01%)
Blood and lymphatic system disorders				Haemolytic anaemia
Immune system disorders			Anaphylactic reaction Anaphylactoid reaction Hypersensitivity	Anaphylactic shock
Metabolism and nutrition disorders			Citrate toxicity	Alkalosis
Psychiatric disorders			Agitation
Cardiac			Transfusion- related	Arrhythmia

disorders			circulatory overload Tachycardia	Cardiac arrest
Vascular disorders		Hypotension	Flushing Haemorrhagic diathesis	Thromboembolism Hypertension Circulatory collapse
Respiratory, thoracic and mediastinal disorders		Bronchospasm Respiratory disorder	Dyspnoea	Acute pulmonary oedema Pulmonary haemorrhage
Gastrointestinal disorders	Nausea	Vomiting
Skin and subcutaneous tissue disorders	Rash Pruritus	Urticaria	Rash Erythematous Hyperhidrosis
General disorders and administration site conditions	Chills Pyrexia	Localised oedema	Chest pain	Application site reaction
Investigations			Antibody test positive
Injury, poisoning and procedural complications				Haemolytic transfusion reaction

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

4.9 Overdose

• High dosages or infusion rates may induce hypervolaemia, pulmonary oedema and/or cardiac failure.

• High infusion rates may cause cardiovascular effects as a result of citrate toxicity (fall in ionised calcium), especially in patients with liver function disorders.

5 PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Blood substitutes and plasma protein fractions,

ATC code: B05A A.

The content and distribution of plasma proteins in octaplasLG remain in the final product at comparable levels to those in the raw material FFP, i.e. 45-70 mg/mL, and the major plasma proteins are all within the reference ranges for healthy blood donors (see table 2). Out of a mean total protein content of 58 mg/ml, albumin accounts for 50% (29 mg/ml), whereas the immunoglobulin classes G, A, and M are present at levels of 8.1, 1.6, and 0.8 mg/ml, respectively. As a result of the S/D treatment and purification, the content in lipids and lipoproteins is reduced. This is of no relevance within the indications for octaplasLG.

The manufacturing process levels out inter-donor variations and maintain the plasma proteins in a functional state. Therefore, octaplasLG possesses the same clinical activity as the average single-donor FFP unit, but is more standardised. The finished product is tested for coagulation factors V, VIII, and XI, and the inhibitors protein C, protein S, and plasmin inhibitor. A minimum of 0.5 IU/mL is obtained for each of the three coagulation factors, whereas the inhibitor levels are guaranteed equal or higher than 0.7, 0.3, and 0.2 IU/mL. The fibrinogen content is between 1.5 and 4.0 mg/mL. In routine production, all clinically important parameters are within the 2.5-97.5 percentiles reference range for single-donor FFP, except plasmin inhibitor (also known as a₂-antiplasmin) that is just below (see table 2). octaplasLG displays the same von Willebrand factor multimeric pattern as normal plasma.

Table 2: Global coagulation parameters and specific coagulation factors and inhibitors in octaplasLG

Parameter	octaplasLG Mean ± standard deviation (n = 5)	Reference range*
Activated partial thromboplastin time [sec]	30 ± 1	28-41
Prothrombin time [sec]	11 ± 0	10-14**
Fibrinogen [mg/mL]	2.6 ± 0.1	1.5-4.0**
Coagulation factor II [IU/mL]	1.01 ± 0.07	0.65-1.54
Coagulation factor V [IU/mL]	0.76 ± 0.05	0.54-1.45
Coagulation factor VII [IU/mL]	1.09 ± 0.05	0.62-1.65
Coagulation factor VIII [IU/mL]	0.80 ± 0.07	0.45-1.68
Coagulation factor IX [IU/mL]	0.88 ± 0.10	0.45-1.48
Coagulation factor X [IU/mL]	0.99 ± 0.05	0.68-1.48
Coagulation factor XI [IU/mL]	0.88 ± 0.04	0.42-1.44
Coagulation factor XII [IU/mL]	1.04 ± 0.08	0.40-1.52

Parameter	octaplasLG Mean ± standard deviation (n = 5)	Reference range*
Coagulation factor XIII [IU/mL]	1.03 ± 0.06	0.65-1.65
Antithrombin [IU/mL]	0.86 ± 0.11	0.72-1.45
Heparin cofactor II [IU/mL]	1.12 ± 0.05	0.65-1.35
Protein C [IU/mL]	0.86 ± 0.08	0.58-1.64
Protein S [IU/mL]	0.63 ± 0.08	0.56-1.68
Von Willebrand factor ristocetin cofactor activity [IU/mL]	0.93 ± 0.08	0.45-1.75
ADAMTS13# activity [IU/mL]	1.13 ± 0.17	0.50-1.10**
Plasminogen [IU/mL]	0.84 ± 0.06	0.68-1.44
Plasmin inhibitor## [IU/mL]	0.61 ± 0.04	0.72-1.32

*According [1,2] based on the testing of 100 healthy blood donors and defined by the 2.5 and 97.5 percentiles; or **according package insert of test kit.

^#A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13. Also known as von Willebrand factor-cleaving protease (VWFCP).

##Also known as a₂-antiplasmin.

5.2 Pharmacokinetic properties

octaplasLG® has similar pharmacokinetic properties as FFP.

5.3 Preclinical safety data

Virus inactivation is carried out using Tri (N-Butyl) Phosphate (TNBP) and Octoxynol (Triton X-100). These S/D reagents are removed during the purification process. The maximum amounts of TNBP and Octoxynol in the finished product are < 2 pg/ml and < 5 pg/ml, respectively.

6 PHARMACEUTICAL PARTICULARS

6.1 List of excipients

Sodium citrate dihydrate

Sodium dihydrogenphosphate dihydrate

Glycine

6.2 Incompatibilities

- octaplasLG product can be mixed with red blood cells and platelets if ABO compatibility of both preparations is respected.

- octaplasLG must not be mixed with other medicinal products, as inactivation and precipitation may occur.

- To avoid the possibility of clot formation, solutions containing calcium must not be administered by the same intravenous line as octaplasLG.

6.3 Shelf life

4 years.

After thawing, chemical and physical in-use stability has been demonstrated for 24 hours at 2-8°C or 8 hours at room temperature (20-25°C).

From a microbiological point of view, unless the method of opening precludes the risk of microbial contamination, the product should be used immediately. If not used immediately, in-use storage times and conditions are the responsibility of the user.

6.4 Special precautions for storage

Store and transport frozen (at < -18°C).

Store in the original package in order to protect from light.

6.5 Nature and contents of container

200 ml of ABO-blood group specific human plasma proteins in bag (polyvinyl chloride) over-wrapped with a film.

Pack size of 1 and 10.

6.6 Special precautions for disposal

Do not use after the expiry date given on the label.

There are several options for thawing frozen octaplasLG:

Water bath:

Thaw in the outer wrapper for not less than 30 minutes in a circulating water bath at +30°C to +37°C. An overwrap bag may be used to provide further protection of contents if appropriate.

Prevent water from contaminating the entry port. The minimum thawing time is 30 minutes at 37°C. Temperature in the water bath must never exceed +37 °C and should not be lower than +30 °C.

The thawing time depends on the number of bags in the water bath. If more plasma bags are thawed in parallel, the thawing time can be prolonged, but should not be longer than 60 minutes.

- Using a dry tempering system such as the SAHARA-III:

Place the octaplasLG bags on the agitation plate according to the manufacturer instructions and thaw plasma using the fast tempering function. When a +37°C blood component temperature is indicated on the temperature display, terminate the tempering process and remove the bags.

During thawing of octaplasLG using a dry tempering system, it is recommended to use the protocol printer to record the course of the blood component temperature and error messages in event of failure.

- Others:

Other thawing systems for frozen octaplasLG can be used on the condition that the methods are validated for that purpose.

Allow the content of the bag to warm to approximately +37 °C before infusion. The temperature of octaplasLG must not exceed +37 °C. Remove the outer wrapper and examine the bag for cracks or leaks.

Avoid shaking.

After thawing the solution is clear to slightly opalescent and free of solid or gelatinous particles.

Do not use solutions which are cloudy or have deposits and/or discoloration.

Thawed octaplasLG must not be refrozen. Unused product must be discarded.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

7 MARKETING AUTHORISATION HOLDER

Octapharma Limited The Zenith Building 26 Spring Gardens Manchester M2 1AB

MARKETING AUTHORISATION NUMBER(S)

PL 10673/0009

DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

04/03/2008

DATE OF REVISION OF THE TEXT

17/06/2016