Summary
Abstract
Sucrose-formulated octocog alfa (Kogenate® Bayer, Kogenate® FS, Helixate® FS, Helixate® nexgen) is a full-length recombinant human coagulation factor VIII (FVIII) product that is purified and formulated without the addition of human serum albumin and is stabilized with sucrose. The purification process of this formulation includes a solvent/detergent viral inactivation step. Sucrose-formulated octocog alfa is approved in the EU and US for the treatment of bleeding in patients with haemophilia A (congenital FVIII deficiency). Additionally, it is approved in the EU for the prophylaxis of bleeding in patients with haemophilia A and as a continuous infusion treatment in patients undergoing major surgery.
Sucrose-formulated octocog alfa is effective and well tolerated as a FVIII replacement therapy in patients with haemophilia A, including those with severe disease undergoing major surgery. The therapeutic profile of this sucrose-formulated product cannot be compared with that of other octocog alfa or moroctocog alfa products because of a lack of head-to-head comparative studies. Pathogen transmission has not been reported with use of sucrose-formulated octocog alfa. Available data indicate that sucrose-formulated octocog alfa is an appropriate alternative to other recombinant FVIII products for the treatment and prophylaxis of bleeding episodes in adults and children with haemophilia A.
Pharmacological Properties
Sucrose-formulated octocog alfa is produced by baby hamster kidney (BHK) cells transfected with the gene for human FVIII; it has the same biological activity as FVIII derived from human plasma.
Following bolus administration of sucrose-formulated octocog alfa ≈50 IU/kg to previously treated adults and children with severe haemophilia A, mean plasma FVIII levels rose rapidly to over 100% of normal before declining in a biphasic manner, with an elimination half-life that ranged from ≈13 to 19 hours in patients aged 12–60 years (≈11 hours in children aged ≈4–18 years). Sucrose-formulated octocog alfa generally demonstrated bioequivalence to its predecessor product (albumin-formulated octocog alfa) in clinical trials. Reported mean residence time values in individual studies following bolus injection of sucrose-formulated octocog alfa were 18.8 and 22.5 hours in patients aged 12–60 years (15.1 hours in children); reported mean FVIII clearance values were 1.5 and 1.9 dL/h (4.1 mL/h/ kg in children).
Clinical Efficacy
Several noncomparative clinical trials and postmarketing surveillance studies have demonstrated that sucrose-formulated octocog alfa is effective replacement therapy for the prophylaxis (both regular and preventative) and treatment of bleeding episodes in previously treated, minimally treated and previously untreated patients (both adults and children) with haemophilia A. In clinical trials, 89–94% of the bleeding episodes were controlled with one or two infusions of sucrose-formulated octocog alfa. Of the clinical responses to the infusion of sucrose-formulated octocog alfa for the treatment of a bleeding episode, 81–100% were rated by the patient or their caregiver or physician as good or excellent.
Sucrose-formulated octocog alfa administered via bolus injection and/or continuous infusion was also effective as replacement therapy in patients with severe haemophilia A undergoing minor or major surgical operations. Surgeons rated haemostasis during or after surgery as good or excellent in all cases; blood losses related to the surgeries performed were minimal or within expected (normal) limits.
Tolerability
In clinical trials, bolus administration of sucrose-formulated octocog alfa to patients with haemophilia A was well tolerated, as was bolus injection or continuous infusion of the drug in patients with severe haemophilia A undergoing surgery. Common adverse events that were considered at least remotely or possibly drug-related included injection site reactions and rash (with or without pruritus) in previously treated patients, and anti-FVIII neutralizing antibody (inhibitor) formation in minimally treated or previously untreated patients. Antibody responses to trace (recombinant FVIII, murine and BHK) proteins in sucrose-formulated octocog alfa (analysed by ELISA) were not associated with drug-related allergic/hypersensitivity adverse events. Sucrose-formulated octocog alfa was not associated with viral transmission or seroconversion.
The development of inhibitors has been evaluated in a meta-analysis of 2071 patients with haemophilia A who received sucrose-formulated octocog alfa (preliminary data). The overall incidence of de novo inhibitor formation was 8.2% in previously untreated patients or those with <20 exposure days and <0.2% in patients with >100 exposure days. The incidence of recurrent inhibitor formation was 7.6%.
Similar content being viewed by others
Notes
The use of trade names is for product identification purposes only and does not imply endorsement.
References
Mannucci PM, Tuddenham EGD. The hemophilias: from royal genes to gene therapy. N Engl J Med 2001 Jun 7; 344(23): 1773–9
Schimpf K. On the way to virus-safe blood coagulation factor concentrates. Semin Thromb Hemost 2002 Apr; 28 Suppl. 1: 15–24
Josephson CD, Abshire T. The new albumin-free recombinant factor VIII concentrates for treatment of hemophilia: do they represent an actual incremental improvement? Clin Adv Hematol Oncol 2004 Jul; 2(7): 441–6
Lusher J, Chitlur M. KogenateFS: antihemophilic factor rFVIII-FS. Therapy 2006; 3(6): 699–708
Jiang R, Monroe T, McRogers R, et al. Manufacturing challenges in the commercial production of recombinant coagulation factor VIII. Haemophilia 2002 Mar; 8 Suppl. 2: 1–5
Boedeker BG. Production processes of licensed recombinant factor VIII preparations. Semin Thromb Hemost 2001 Aug; 27(4): 385–94
Antihemophilic factor (recombinant) Kogenate® FS formulated with sucrose prescribing information. Tarrytown (NY): Bayer Healthcare LLC, 2007 Jun
Lee DC, Stenland CJ, Miller JL, et al. A direct relationship between the partitioning of the pathogenic prion protein and transmissible spongiform encephalopathy infectivity during the purification of plasma proteins. Transfusion (Paris) 2001 Apr; 41(4): 449–55
Lee DC, Miller JL, Petteway Jr SR. Pathogen safety of manufacturing processes for biological products: special emphasis on KOGENATE Bayer. Haemophilia 2002 Mar; 8 Suppl. 2: 6–9
Lee DC, Stenland CJ, Hartwell RC, et al. Monitoring plasma processing steps with a sensitive Western Blot assay for the detection of the prion protein. J Virol Methods 2000 Jan; 84(1): 77–89
Prescribing information, Wyeth Pharmaceuticals Inc., Philadelphia (PA). XYNTHA® [antihemophilic factor (recombinant), plasma/albumin-free] for intravenous use, freeze-dried powder [online]. Available from URL: http://www.fda.gov/CBER/labeVxyntha022108LB.pdf [Accessed 2008 Mar 11]
Baxter Healthcare Corporation, Westlake Village (CA). AD-VATE. Antihemophilic factor (recombinant), plasma/albumin-free method (rAHF-PFM). Prescribing information [online]. Available from URL: http://www.fda.gov/cber/label/antibax072503LB.pdf [Accessed 2008 Mar 10]
Kogenate Bayer 250IU, 500IU & 1000 IU (Bio-Set) summary of product characteristics. Newbury: Bayer plc, 2007 Aug
Klinge J, Ananyeva NM, Häuser CA, et al. Semin Thromb Hemost 2002 Jun; 28(3): 309–22
Abshire TC, Brackmann HH, Scharrer I, et al. Sucrose formulated recombinant human antihemophilic factor VIII is safe and efficacious for treatment of hemophilia A in home therapy: results of a multicenter, international, clinical investigation. Thromb Haemost 2000 Jun; 83(6): 811–6
Barnes C, Lillicrap D, Pazmino-Canizares J, et al. Pharmacokinetics of recombinant factor VIII (Kogenate-FS) in children and causes of inter-patient pharmacokinetic variability. Haemophilia 2006; 12 Suppl. 4: 40–9
Morfini M, Gringeri A, Cinotti S, et al. Pharmacokinetic comparison of three FVIII preparations: full-length RFVIII, full-length sucrose-formulated RFVIII, and B-domain deleted RFVIII [abstract no. 2798]. Blood 2002; 100 (11 Pt 1): 710A
Luboshitz J, Lubetsky A, Enriquez MM, et al. Clinical evaluation of continuously infused sucrose-formulated recombinant factor VIII during surgery. Hemophilia World Congress; 2006 May 21–25; Vancouver (BC)
European Medicines Agency. Kogenate Bayer European public assessment report: scientific discussion [online]. Available from URL: http://www.emea.europa.eu/humandocs/PDFs/EPAR/Kogenatebayer/101600en6.pdf [Accessed 2007 Oct 8]
Kreuz W, Gill JC, Rothschild C, et al. Full-length sucrose-formulated recombinant factor VIII for treatment of previously untreated or minimally treated young children with severe haemophilia A: results of an international clinical investigation. Thromb Haemost 2005 Mar; 93(3): 457–67
Shi J, Zhao Y, Wu J, et al. Safety and efficacy of a sucrose-formulated recombinant factor VIII product for the treatment of previously treated patients with haemophilia A in China. Haemophilia 2007 Jul; 13(4): 351–6
Yoshioka A, Shima M, Fukutake K, et al. Safety and efficacy of a new recombinant FVIII formulated with sucrose (rFVIII-FS) in patients with haemophilia A: a long-term, multicentre clinical study in Japan. Haemophilia 2001 May; 7(3): 242–9
Scharrer I, Brackmann HH, Sultan Y, et al. Efficacy of a sucrose-formulated recombinant factor VIII used for 22 surgical procedures in patients with severe haemophilia A. Haemophilia 2000 Nov; 6(6): 614–8
Scharrer I. Experience with KOGENATE Bayer in surgical procedures. Haemophilia 2002 Mar; 8 Suppl. 2: 15–8
Musso R, Santagostino E, Faradji A, et al. Safety and efficacy of sucrose-formulated full-length recombinant factor VIII: experience in the standard clinical setting. Thromb Haemost 2008 Jan; 99(1): 52–8
Delumeau JC. An observational study of sucrose-formulated recombinant factor VIII for Japanese patients with hemophilia A [abstract no. P-S-171]. J Thromb Haemost 2007; 5 Suppl. 2. Plus poster presented at the XXIst Congress of the International Society on Thrombosis and Haemostasis; 2007 Jul 6–12; Geneva
Rothschild C, Scharrer I, Brackmann HH, et al. European data of a clinical trial with a sucrose formulated recombinant factor VIII in previously treated haemophilia A patients. Haemophilia 2002 Mar; 8 Suppl. 2: 10–4
Wight J, Paisley S, Knight C. Immune tolerance induction in patients with haemophilia A with inhibitors: a systematic review. Haemophilia 2003 Jul; 9(4): 436–63
Dimichele D. Immune tolerance therapy for factor VIII inhibitors: moving from empiricism to an evidence-based approach. J Thromb Haemost 2007 Jul; 5 Suppl.: 143–50
Larson P, Zhang C, Gorina E, et al. IgG formation to mammalian proteins in hemophilia A patients following treatment with a new recombinant human factor VIII [letter]. J Thromb Haemost 2004 Jun; 2(6): 1011–2
Maas-Enriquez M, Gorina E, Bajwa N, et al. Meta-analysis of inhibitor formation in patients with hemophilia A treated with sucrose-formulated recombinant factor VIII. XXIst Congress of the International Society on Thrombosis and Haemostasis; 2007 Jul 6–12; Geneva
Rubinger M, Lillicrap D, Rivard GE, et al. A prospective surveillance study of factor VIII inhibitor development in the Canadian haemophilia A population following the switch to a recombinant factor VIII product formulated with sucrose. Haemophilia 2008 Mar; 14(2): 281–6
Singleton E, Smith J, Kavanagh M, et al. Low risk of inhibitor formation in haemophilia patients after a change in treatment from Chinese hamster ovary cell-produced to baby hamster kidney cell-produced recombinant factor VIII. Thromb Haemost 2007; 98(6): 1188–92
World Federation of Hemophilia [online]. Available from URL: http://www.wfh.org [Accessed 2007 Oct 3]
Dargaud Y, Negrier C. Haemophilia therapies. Expert Opin Biol Ther 2007 May; 7(5): 651–63
Ananyeva N, Khrenov A, Darr F, et al. Treating haemophilia A with recombinant blood factors: a comparison. Expert Opin Pharmacother 2004 May; 5(5): 1061–70
National Hemophilia Foundation. MASAC recommendations concerning the treatment of hemophilia and other bleeding disorders (revised October 2006). MASAC document #177 [online]. Available from URL: http://www.hemophilia.org [Accessed 2007 Nov 1]
Villar A, Jimenez-Yuste V, Quintana M, et al. The use of haemostatic drugs in haemophilia: desmopressin and antifibri-nolytic agents. Haemophilia 2002 May; 8(3): 189–93
Franchini M. The use of desmopressin as a hemostatic agent: a concise review. Am J Hematol 2007 Aug; 82(8): 731–5
Lethagen S. Desmopressin in mild haemophilia A: indications, limitations, efficacy and safety. Semin Thromb Hemost 2003 Feb; 29(1): 101–6
Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999 Jun; 57(6): 1005–32
Spotnitz WD, Prabhu R. Fibrin sealant tissue adhesive: review and update. J Long Term Eff Med Implants 2005; 15(3): 245–70
Giangrande PLF. Blood products for hemophilia: past, present and future. Biodrugs 2004; 18(4): 225–34
Meeks SL, Josephson CD. Should hemophilia treaters switch to albumin-free recombinant factor VIII concentrates. Curr Opin Hematol 2006 Nov; 13(6): 457–61
Pipe SW. Consideration in hemophilia therapy selection. Semin Hematol 2006 Apr; 43 (2 Suppl. 3): S23-7
Pipe SW. The physician's role in selecting a factor replacement therapy. Haemophilia 2006; 12 Suppl. 1: 21–5
Cai K, Gierman TM, Hotta J, et al. Ensuring the biologic safety of plasma-derived therapeutic proteins. Biodrugs 2005; 19(2): 79–96
Tabor E. The epidemiology of virus transmission by plasma derivatives: clinical studies verifying the lack of transmission of hepatitis B and C viruses and HIV type 1. Transfusion (Paris) 1999 Nov; 39(11-12): 1160–8
National Hemophilia Foundation. MASAC recommendation 169 regarding the use of recombinant clotting factor products with respect to pathogen transmission [online]. Available from URL: http://www.hemophilia.org [Accessed 2007 Oct 5]
Parvovirus B19 transmission by heat-treated clotting factor concentrates. Transfusion (Paris) 2002 Nov; 42 (11): 1473–81
Association of Hemophilia Clinic Directors of Canada (AHCDC). Hemophilia and von Willebrand's disease: 2. Management. CMAJ 1995 Jul 15; 153 (2): 147–57
United Kingdom Haemophilia Centre Doctors' Organisation (UKHCDO). Guidlelines on the selection and use of therapeutic products to treat haemophilia and other hereditary bleeding disorders. Haemophilia 2003; 9: 1–23
Manco-Johnson MJ, Abshire TC, Shapiro AD, et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. N Engl J Med 2007 Aug 9; 357(6): 535–44
National Hemophilia Foundation. MASAC recommendation concerning prophylaxis (regular administration of clotting factor concentrate to prevent bleeding). MASAC document #170 [online]. Available from URL: http://www.hemophilia.org [Accessed 2007 Nov 7]
Hay CR. Prophylaxis in adults with haemophilia. Haemophilia 2007 Sep; 13 Suppl. 2: 10–5
Carcao MD, Aledort L. Prophylactic factor replacement in hemophilia. Blood Rev 2004 Jun; 18(2): 101–13
Hoots WK, Nugent DJ. Evidence for the benefits of prophylaxis in the management of hemophilia A. Thromb Haemost 2006 Oct; 96(4): 433–40
Stachnik JM, Gabay MP. Continuous infusion of coagulation factor products. Ann Pharmacother 2002 May; 36: 882–91
Batorova A, Martinowitz U. Continuous infusion of coagulation factors. Haemophilia 2002 May; 8(3): 170–7
Batorova A, Martinowitz U. Continuous infusion of coagulation factors: current opinion. Curr Opin Hematol 2006 Sep; 13(5): 308–15
Woloschuk DM, Benson HA. In-vitro stability of recombinant factor VIII (Kogenate-SF) stored in an ambulatory microinfuser device [abstract no. 4021]. Blood 2000; 96 (11 Pt 2): 79B
Regan L, Chew J, Vo K, et al. Stability and sterility of sucrose-formulated recombinant factor VIII (Kogenate® FS/Bayer) for use during continuous infusion [abstract no. 4004]. Blood 2006; 108 (11 Pt 2): 79B
Henze W, Kellermann E, Larson P, et al. Stability of full-length recombinant FVIII formulated with sucrose during continuous infusion using a mini-pump infusion device [letter]. J Thromb Haemost 2005 Jul; 3(7): 1530–1
Peerlinck K, Hermans C. Epidemiology of inhibitor formation with recombinant factor VIII replacement therapy. Haemophilia 2006 Nov; 12(6): 579–90
Goudemand J, Laurian Y, Calvez T. Risk of inhibitors in haemophilia and the type of factor replacement. Curr Opin Hematol 2006 Sep; 13(5): 316–22
Gouw SC, van der Bom JG, Auerswald G, et al. Recombinant versus plasma-derived factor VIII products and the development of inhibitors in previously untreated patients with severe hemophilia A: the CANAL cohort study. Blood 2007 Jun 1; 109(11): 4693–7
Gouw SC, van den Berg HM, Le Cessie S, et al. Treatment characteristics and the risk of inhibitor development: a multi-center cohort study among previously untreated patients with severe hemophilia A. J Thromb Haemost 2007 Jul; 5(7): 1383–90
Goudemand J, Rothschild C, Demiguel V, et al. Influence of the type of factor VIII concentrate on the incidence of factor VIII inhibitors in previously untreated patients with haemophilia A. Blood 2006; 107: 46–51
Goldmann G, Klamroth R, Haupt V, et al. Patients' satisfaction with a new reconstitution system for Kogenate Bayer: initial German experiences [abstract no. PO965]. Haemophilia 2006; 12: S2
Butler R, Larson P, Mannix S, et al. Evaluation of user preference for a needleless factor VIII delivery device for haemophilia patients. J Outcomes Res 2004; 8: 63–78
Smith PS, Teutsch SM, Shaffer PA, et al. Episodic versus prophylactic infusions for hemophilia A: a cost-effectiveness analysis. J Pediatr 1996 Sep; 129(3): 424–31
Globe DR, Curtis RG, Koerper MA. Utilisation of care in haemophilia: a resouce-based method for cost analysis from the Haemophilia Utilisation Group Study (HUGS). Haemophilia 2004 Mar; 10 Suppl. 1: 63–70
Fischer K, van den berg HM, Thomas R, et al. Dose and outcome of care in haemophilia: how do we define cost-effectiveness? Haemophilia 2004 Oct; 10 Suppl. 4: 216–20
Author information
Authors and Affiliations
Corresponding author
Additional information
Various sections of the manuscript reviewed by: L.M. Aledort, Mount Sinai School of Medicine, New York, New York, USA; J.M. Lusher, Division of Hematology/Oncology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan, USA; S.W. Pipe, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA; I. Scharrer, Department of Hematology, University of Mainz, Mainz, Germany; J.M. Stachnik, Department of Pharmacy Practice, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA; R. Yang, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
Data Selection
Sources: Medical literature published in any language since 1980 on ‘octocog alfa’, identified using MEDLINE and EMBASE, supplemented by AdisBase (a proprietary database of Wolters Kluwer Health | Adis). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.
Search strategy: MEDLINE, EMBASE and AdisBase search terms were ‘recombinant coagulation factor-VIII’ or ‘rFVIII’ or ‘octocog alfa’. Searches were last updated 7 March 2008.
Selection: Studies in patients with haemophila who received octocog alfa formulated with sucrose in clinical trials. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included.
Index terms: Octocog alfa, recombinant factor VIII, haemophilia A, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability.
Rights and permissions
About this article
Cite this article
Frampton, J.E., Wagstaff, A.J. Sucrose-Formulated Octocog Alfa. Drugs 68, 839–853 (2008). https://doi.org/10.2165/00003495-200868060-00007
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-200868060-00007