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Tarandovskiy ID, Surov SS, Parunov LA, Liang Y, Jankowski W, Sauna ZE, Ovanesov MV. Investigation of thrombin concentration at the time of clot formation in simultaneous thrombin and fibrin generation assays. Sci Rep 2024; 14:9225. [PMID: 38649717 PMCID: PMC11035586 DOI: 10.1038/s41598-023-47694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/16/2023] [Indexed: 04/25/2024] Open
Abstract
Thrombin generation (TG) and fibrin clot formation represent the central process of blood coagulation. Up to 95% of thrombin is considered to be generated after the clot is formed. However, this was not investigated in depth. In this study, we conducted a quantitative analysis of the Thrombin at Clot Time (TCT) parameter in 5758 simultaneously recorded TG and clot formation assays using frozen plasma samples from commercial sources under various conditions of activation. These samples were supplemented with clotting factor concentrates, procoagulant lipid vesicles and a fluorogenic substrate and triggered with tissue factor (TF). We found that TCT is often close to a 10% of thrombin peak height (TPH) yet it can be larger or smaller depending on whether the sample has low or high TPH value. In general, the samples with high TPH are associated with elevated TCT. TCT appeared more sensitive to some procoagulant phenotypes than other commonly used parameters such as clotting time, TPH or Thrombin Production Rate (TPR). In a minority of cases, TCT were not predicted from TG parameters. For example, elevated TCT (above 15% of TPH) was associated with either very low or very high TPR values. We conclude that clotting and TG assays may provide complementary information about the plasma sample, and that the TCT parameter may serve as an additional marker for the procoagulant potential in plasma sample.
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Affiliation(s)
- Ivan D Tarandovskiy
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Stepan S Surov
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Leonid A Parunov
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Yideng Liang
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Wojciech Jankowski
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Zuben E Sauna
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Mikhail V Ovanesov
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
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2
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Liang Y, Tarandovskiy I, Surov SS, Ovanesov MV. Comparative Thrombin Generation in Animal Plasma: Sensitivity to Human Factor XIa and Tissue Factor. Int J Mol Sci 2023; 24:12920. [PMID: 37629101 PMCID: PMC10454801 DOI: 10.3390/ijms241612920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Preclinical evaluation of drugs in animals helps researchers to select potentially informative clinical laboratory markers for human trials. To assess the utility of animal thrombin generation (TG) assay, we studied the sensitivity of animal plasmas to triggers of TG, human Tissue Factor (TF), and Activated Factor XI (FXIa). Pooled human, mouse, rat, guinea pig, rabbit, bovine, sheep, and goat plasmas were used in this study. TF- or FXIa-triggered TG and clotting were measured via fluorescence and optical density, respectively. Thrombin peak height (TPH) and time (TPT), clot time (CT), and fibrin clot density (FCD) were all analyzed. The trigger low and high sensitivity borders (LSB and HSB) for each assay parameter were defined as TF and FXIa concentrations, providing 20 and 80% of the maximal parameter value, unless the baseline (no trigger) value exceeded 20% of the maximal, in which case, LSB was derived from 120% of baseline value. Normal human samples demonstrated lower TPH HSB than most of the animal samples for both TF and FXIa. Animal samples, except mice, demonstrated lower TPT LSB for FXIa versus humans. Most rodent and rabbit samples produced baseline TG in the absence of TG triggers that were consistent with the pre-activation of blood coagulation. FCD was not sensitive to both TF and FXIa in either of the plasmas. Animal plasmas have widely variable sensitivities to human TF and FXIa, which suggests that optimization of trigger concentration is required prior to test use, and this complicates the extrapolation of animal model results to humans.
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Affiliation(s)
| | | | | | - Mikhail V. Ovanesov
- Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA; (Y.L.); (I.T.); (S.S.S.)
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3
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Anderson-Smits C, Ritchey ME, Huang Z, Chavan S, Souayah N, Ay H, Layton JB. Intravenous Immunoglobulin Treatment Patterns and Outcomes in Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A US Claims Database Analysis. Neurol Ther 2023; 12:1119-1132. [PMID: 37171778 PMCID: PMC10310601 DOI: 10.1007/s40120-023-00478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare progressive or relapsing inflammatory disease. Intravenous immunoglobulin (IVIG) is recommended as a first-line therapy. The aim of this study was to describe real-world treatment patterns and outcomes of patients with CIDP in the Define initiating IVIG treatment. METHODS This cohort study used health insurance claims data from the Merative MarketScan Research Databases (2008-2018). Adult patients (≥ 18 years old) with CIDP without prior immunoglobulin treatment were identified using International Statistical Classification of Diseases and Related Health Problems (ICD) codes, and patients subsequently initiating IVIG were included in the analysis. Real-world IVIG treatment patterns and treatment and safety outcomes (assessed via ICD codes) were described. RESULTS In total, 3975 patients (median age 58 years) with CIDP who initiated IVIG were identified. After the initial IVIG loading period, patients received IVIG at a median dosing interval of 21 days (quartile [Q]1, Q3: 7, 28), and continued treatment for a median of 129 days (Q1, Q3: 85, 271). After the 2-year follow-up period, 55% of patients had discontinued all IVIG treatment; more than one-half of these discontinuations occurred within 4 months. Diagnoses of impaired functional status were evident in more than 30% of patients at baseline, but at lower rates during follow-up. Rates of new-onset safety outcomes after IVIG treatment were low. CONCLUSION This real-world analysis of IVIG treatment patterns and treatment and safety outcomes of patients with CIDP who initiated IVIG highlights the unmet need for improved long-term management. Further research is needed to evaluate the use of functional status measures as endpoints for immunoglobulin treatment effectiveness.
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Affiliation(s)
- Colin Anderson-Smits
- Takeda Development Center Americas, Inc, 650 E. Kendall St, Cambridge, MA, 02142, USA.
| | - Mary E Ritchey
- RTI Health Solutions, Research Triangle Park, NC, USA
- Med Tech Epi, LLC, Philadelphia, PA, USA
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Zhongwen Huang
- Takeda Development Center Americas, Inc, 650 E. Kendall St, Cambridge, MA, 02142, USA
| | - Shailesh Chavan
- Takeda Development Center Americas, Inc, 650 E. Kendall St, Cambridge, MA, 02142, USA
- Veloxis Pharmaceuticals, Cambridge, MA, USA
| | - Nizar Souayah
- Department of Neurology, Rutgers University, Newark, NJ, USA
| | - Hakan Ay
- Takeda Development Center Americas, Inc, 650 E. Kendall St, Cambridge, MA, 02142, USA
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4
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Paris K, Wall LA. The Treatment of Primary Immune Deficiencies: Lessons Learned and Future Opportunities. Clin Rev Allergy Immunol 2022:10.1007/s12016-022-08950-0. [PMID: 35776401 PMCID: PMC9247903 DOI: 10.1007/s12016-022-08950-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
Primary immunodeficiency is a group of disorders associated with susceptibility to infectious agents and the development of various comorbidities. Many primary immunodeficiencies are complicated by immune dysregulation, autoinflammation, or autoimmunity which impacts multiple organ systems. Major advances in the treatment of these disorders have occurred over the last half-century, and deeper molecular understanding of many disorders combined with clinically available genetic testing is allowing for use of precision therapy for several primary immunodeficiencies. Patients with antibody deficiencies who rely on immunoglobulin replacement therapy now have many treatment options with products that are much safer and better tolerated compared to the past. Newborn screening for severe combined immunodeficiency, now implemented throughout the USA and in many countries worldwide, has lowered the age at which many patients are diagnosed with these diseases. Early diagnosis of severe combined immunodeficiency allows infants to proceed to definitive therapy such as stem cell transplantation or gene therapy prior to facing potentially life-threatening infections. While stem cell transplantation continues to carry significant risks, knowledge gained over recent decades is allowing for improved survival with less toxicity and less graft versus host disease.
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Affiliation(s)
- Kenneth Paris
- Department of Pediatrics, Division of Allergy and Immunology, Louisiana State University Health Sciences Center New Orleans and Children's Hospital New Orleans, New Orleans, LA, USA.
| | - Luke A Wall
- Department of Pediatrics, Division of Allergy and Immunology, Louisiana State University Health Sciences Center New Orleans and Children's Hospital New Orleans, New Orleans, LA, USA
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Self-controlled assessment of thromboembolic event (TEE) risk following intravenous immune globulin (IGIV) in the U.S. (2006-2012). J Thromb Thrombolysis 2021; 53:264-272. [PMID: 34817789 DOI: 10.1007/s11239-021-02610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Since 2013, the U.S. Food and Drug administration (FDA) has required that intravenous immune globulin (IGIV) products carry a boxed warning concerning the risk of thromboembolic events (TEEs). This study assessed the incidence of TEEs attributable to IGIV in a large population-based cohort. A self-controlled risk interval design was used to quantify the transient increase in TEE risk during the risk interval (days 0-2 and 0-13 following IGIV for arterial and venous TEEs, respectively) relative to a later control interval (days 14-27 following IGIV). Potential IGIV-exposed TEE cases from 2006 to 2012 were identified from the FDA-sponsored Sentinel Distributed Database and confirmed through medical record review. Inpatient IGIV exposures were not included in the venous TEE analysis due to concerns about time-varying confounding. 19,069 new users of IGIV who received 93,555 treatment episodes were included. Charts were retrieved for 62% and 70% of potential venous and arterial cases, respectively. There was a transient increase in the risk of arterial TEEs during days 0-2 following IGIV treatment (RR = 4.69; 95% CI 1.87, 11.90; absolute increase in risk = 8.86 events per 10,000 patients, 95% CI 3.25, 14.6), but no significant increase in venous TEE risk during days 0-13 following outpatient IGIV treatments (RR = 1.07, 95% CI 0.34, 3.48). Our results suggest there is a small increase in the absolute risk of arterial TEEs following IGIV. However, lower-than-expected chart retrieval rates and the possibility of time-varying confounding mean that our results should be interpreted cautiously. Continued pharmacovigilance efforts are warranted.
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Thrombin generation test based on a 96-channel pipettor for evaluation of FXIa procoagulant activity in pharmaceuticals. Nat Protoc 2021; 16:3981-4003. [PMID: 34215864 DOI: 10.1038/s41596-021-00568-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
Thrombin generation (TG) assays are used widely to investigate both diseases and drugs that impact thrombosis and bleeding. TG assays were also instrumental in the identification of thrombogenic impurities in immune globulin products, which were associated with thrombotic adverse events in patients. TG assays are therefore now used by quality control laboratories of plasma derivative drug manufacturers and regulatory agencies responsible for the safety testing and release of immune globulin products. In this protocol, we describe a robust and sensitive version of the TG assay for quantitative measurement of thrombogenic activity in immune globulin products. Compared with the version of the assay commonly used in clinical laboratories that compares individual patient plasma samples with normal donor samples, our TG assay is suitable for quick (170-260 min) semiautomated analysis of multiple drug samples against the World Health Organization international standard for factor XIa. Commercially available reagents can be used for the assay, and it does not require specialized equipment. The protocol can be easily adapted for the measurement of the procoagulant activity of other biopharmaceuticals, e.g., coagulation factors.
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7
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Liang Y, Jackson JW, Woodle SA, Surov SS, Parunov LA, Scott DE, Weinstein M, Lee TK, Ovanesov MV. Detecting factor XIa in immune globulin products: Commutability of international reference materials for traditional and global hemostasis assays. Res Pract Thromb Haemost 2021; 5:211-222. [PMID: 33537546 PMCID: PMC7845073 DOI: 10.1002/rth2.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Activated coagulation factor XIa (FXIa) is an impurity and primary source of procoagulant activity in thrombosis-implicated immune globulin (IG) products. Several assays, of varying quality and precision are used to assess FXIa-like procoagulant activity in units relevant to their respective principles. OBJECTIVES To advance unified reporting, we sought to employ the World Health Organization reference reagents (RRs) to present the results of differing methodologies in units of FXIa activity and rank the sensitivity and robustness of these methodologies. METHODS RR 11/236 served as a calibrator in several FXIa-sensitive blood coagulation tests: two commercial chromogenic FXIa assays (CAs); a nonactivated partial thromboplastin time (NaPTT); an in-house fibrin generation (FG) assay; an in-house thrombin generation (TG) assay; and an assay for FXIa- and kallikrein-like proteolytic activities based on cleavage of substrate SN13a. Some assays were tested in either normal or FXI-deficient plasma. RESULTS Each method demonstrated a sigmoidal dose-response to RRs. NaPTT was the least sensitive to FXIa and the least precise; our in-house TG was the most sensitive; and the two CAs were the most precise. All methods, except for SN13a, which is less specific for thrombotic impurities, gave comparable (within 20% difference) FXIa activity assignments for IG lots. CONCLUSIONS Purified FXIa reference standards support quantitation of FXIa levels in IG products in all tested assay methodologies. This should help to standardize the measurement of thrombotic potentials in IG products and prevent products exhibiting high procoagulant activity from distribution for patient use. Further research is needed to address the effect of IG product-specific matrixes on assay performance.
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Affiliation(s)
- Yideng Liang
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Joseph W. Jackson
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Samuel A. Woodle
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Stepan S. Surov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Leonid A. Parunov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Dorothy E. Scott
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Mark Weinstein
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Timothy K. Lee
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
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8
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[Myocardial infarction in a patient on immunoglobulin therapy]. Ann Dermatol Venereol 2020; 147:785-786. [PMID: 32778353 DOI: 10.1016/j.annder.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/26/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022]
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Abstract
Immunoglobulin replacement therapy is standard of care in treatment of many primary immunodeficiency diseases. The goal of replacement therapy is to reduce infections in individuals with primary immune deficiency and improve their quality of life. Immunoglobulin replacement therapy is most often lifelong, therefore ease of administration is vital for adherence to treatment. Self-infusion via subcutaneous intravenous immunoglobulin (SCIG) allows patient input to design an individualized and optimal treatment plan. Because SCIG regimens are flexible and allow for increased autonomy, patients receiving SCIG report improved quality of life. This article summarizes the dosing, administration, and adverse event management of SCIG infusions.
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Affiliation(s)
- Carla Duff
- Department of Allergy and Immunology, College of Medicine, College of Nursing, University of South Florida, 601 5th Street South, St Petersburg, FL 33701, USA
| | - Mark Ballow
- Division of Allergy and Immunology, Department of Pediatrics, Children's Research Institute, University of South Florida, Johns Hopkins All Children's Hospital, 140 7th Avenue South, CRI 4008, St Petersburg, FL 33701, USA.
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10
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Le Guenno G, Guieze R, Audia S, Khellaf M, Michel M, Bonnotte B, Ruivard M, Godeau B. Characteristics, risk factors and management of venous thromboembolism in immune thrombocytopenia: a retrospective multicentre study. Intern Med J 2019; 49:1154-1162. [DOI: 10.1111/imj.14269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Guillaume Le Guenno
- Department of Internal MedicineUniversity Hospital Estaing, CHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Romain Guieze
- Department of HematologyUniversity Hospital Estaing Clermont‐Ferrand France
| | - Sylvain Audia
- Department of Internal MedicineUniversity Hospital François Mitterrand Dijon France
| | - Mehdi Khellaf
- Department of Internal MedicineReference Center of Autoimmune Cytopenias, University Hospital Henri‐Mondor Créteil France
| | - Marc Michel
- Department of Internal MedicineReference Center of Autoimmune Cytopenias, University Hospital Henri‐Mondor Créteil France
| | - Bernard Bonnotte
- Department of Internal MedicineUniversity Hospital François Mitterrand Dijon France
| | - Marc Ruivard
- Department of Internal MedicineUniversity Hospital Estaing, CHU Clermont‐Ferrand Clermont‐Ferrand France
- EA 4681 PEPRADEUniversité d'Auvergne Clermont‐Ferrand France
| | - Bertrand Godeau
- Department of Internal MedicineReference Center of Autoimmune Cytopenias, University Hospital Henri‐Mondor Créteil France
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11
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Sridhar G, Ekezue BF, Izurieta HS, Forshee RA, Selvam N, Mintz PD, Anderson SA, Menis MD. Occurrence of hemolytic reactions on the same day as immune globulin product administrations during 2008 to 2014. Transfusion 2017; 58:70-80. [DOI: 10.1111/trf.14384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Hector S. Izurieta
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | | | - Paul D. Mintz
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Mikhail D. Menis
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
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12
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Ekezue BF, Sridhar G, Forshee RA, Izurieta HS, Selvam N, Mintz PD, Anderson SA, Menis MD. Occurrence of acute renal failure on the same day as immune globulin product administrations during 2008 to 2014. Transfusion 2017; 57:2977-2986. [PMID: 29027208 DOI: 10.1111/trf.14330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute renal failure (ARF) is a rare serious adverse event after immune globulin (IG) use. Our large claims-based study evaluated occurrence of same-day ARF after administration of different IGs and ascertained potential risk factors, during the 2008 to 2014 study period. STUDY DESIGN AND METHODS A retrospective cohort study was conducted using a large commercial administrative database. The cohort included individuals exposed to IG products as identified by procedure codes. ARF was ascertained using ICD-9-CM diagnoses. Unadjusted same-day ARF rates (per 1000 persons exposed) were estimated overall and by age, sex, and IG products. Regression analyses were conducted to control for confounding and assess potential risk factors. RESULTS Of 20,440 persons exposed, 163 (7.97 per 1000) had a recorded same-day ARF. The unadjusted nonzero same-day ARF rates (per 1000) ranged from 1.92 (95% confidence interval [CI], 0.05-10.69) for Hizentra to 16.97 (95% CI, 11.36-24.37) for Privigen and differed by sex. In multivariate analyses, compared to Gammagard Liquid, no significantly elevated ARF risks were identified with any IGs. A significantly lower odds ratio was identified with Gamunex, 0.53 (95% CI, 0.30-0.93). Age 45 and over, prior renal impairment, hypertension, and other factors were associated with increased risk of same-day ARF. CONCLUSION The study showed variation in the risk of IG-related ARF by age, sex, and IG products. The study results suggest the importance of recipient factors, such as older age and underlying health conditions. Variations in ARF occurrence may also be explained by product dosage, administration route and rate, and manufacturing processes, which warrant further evaluation.
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Affiliation(s)
| | | | - Richard A Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Paul D Mintz
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Steven A Anderson
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Mikhail D Menis
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
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Wietek S, Svorc D, Debes A, Svae TE. Tolerability and safety of the intravenous immunoglobulin octagam® 10% in patients with immune thrombocytopenia: a post-authorisation safety analysis of two non-interventional phase IV trials. Hematology 2017; 23:242-247. [DOI: 10.1080/10245332.2017.1385892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Stefan Wietek
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
| | - Daniel Svorc
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
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14
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Washburn N, Meccariello R, Hu S, Hains M, Bhatnagar N, Sarvaiya H, Kapoor B, Schaeck J, Pino I, Manning A, Lansing JC, Bosques CJ. High-resolution physicochemical characterization of different intravenous immunoglobulin products. PLoS One 2017; 12:e0181251. [PMID: 28759653 PMCID: PMC5536303 DOI: 10.1371/journal.pone.0181251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/28/2017] [Indexed: 01/12/2023] Open
Abstract
Intravenous immunoglobulin (IVIg) is a complex mixture drug comprising diverse immunoglobulins and non-IgG proteins purified from the plasma of thousands of healthy donors. Approved IVIg products on the market differ regarding source of plasma, isolation process, and formulation. These products are used widely, and often interchangeably, for the treatment of immunodeficiency and autoimmune and inflammatory diseases, but their mechanisms of action in different indications are not well understood. A primary limitation to understanding the therapeutic relevance of specific components within IVIg has been the limited resolution of analytics historically implemented to characterize its complex mixture. In this study, high-resolution analytics were applied to better understand the composition of IVIg and product variations. We characterized three approved IVIg products: Gammagard®, Privigen®, and Octagam®. Differences in the distribution of molecular weight species, IgG sequence variants, isoforms, glycoforms, and the repertoire of previously reported antibody specificities were identified. We also compared the effect of aging on these products to identify changes in size distribution and posttranslational modifications. This type of characterization may provide insights into the specific factors and components of IVIg that may influence its activity and ultimately lead to optimization of IVIg products for use in autoimmune diseases.
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Affiliation(s)
- Nathaniel Washburn
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Robin Meccariello
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Shaohui Hu
- Research, CDI Laboratories, Baltimore, Maryland, United States of America
| | - Maurice Hains
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Naveen Bhatnagar
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Hetal Sarvaiya
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Bulbul Kapoor
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - John Schaeck
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Ignacio Pino
- Research, CDI Laboratories, Mayaguez, Puerto Rico
| | - Anthony Manning
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Jonathan C. Lansing
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
| | - Carlos J. Bosques
- Research, Momenta Pharmaceuticals, Cambridge, Massachusetts, United States of America
- * E-mail:
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15
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Wasserman RL. The Nuts and Bolts of Immunoglobulin Treatment for Antibody Deficiency. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:1076-1081.e3. [DOI: 10.1016/j.jaip.2016.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 01/09/2023]
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16
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Nikolov N, Reisinger J, Schwarz HP. 10% liquid human immunoglobulin (KIOVIG®) for immunomodulation in autoimmune disorders. Immunotherapy 2016; 8:923-40. [DOI: 10.2217/imt-2016-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intravenous immunoglobulins have been used to treat autoimmune disorders (ADs) for over 50 years. The etiologies of various ADs are not fully understood and although intravenous immunoglobulin treatment has proved its immunomodulatory properties, the roles of proposed mechanisms of action also remain a matter of speculation. A systemic search of the literature regarding KIOVIG® (Baxalta US, Inc., MA, USA) use in clinical trials on patients with ADs and a detailed review of retrieved articles revealed eight relevant publications. These articles reported KIOVIG use in multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, idiopathic thrombocytopenic purpura, Kawasaki disease, Guillain–Barré syndrome and other autoimmune and neurologic disorders and showed that KIOVIG is an effective, safe and well-tolerated treatment in the studied populations. Nevertheless, further studies on larger patient cohorts are needed.
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Affiliation(s)
- Nikolai Nikolov
- Baxalta GmbH, Medical Affairs, Thurgauerstrasse 130, Zurich, Switzerland
| | - Jürgen Reisinger
- Baxalta Innovations GmbH, Clinical Scientific Affairs, Industriestraße 67, 1220, Vienna, Austria
| | - Hans P Schwarz
- Baxalta Innovations GmbH, Immunology, Industriestraße 67, 1220, Vienna, Austria
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17
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Ammann EM, Jones MP, Link BK, Carnahan RM, Winiecki SK, Torner JC, McDowell BD, Fireman BH, Chrischilles EA. Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy. Blood 2016; 127:200-7. [PMID: 26443622 PMCID: PMC4713161 DOI: 10.1182/blood-2015-05-647552] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/02/2015] [Indexed: 01/25/2023] Open
Abstract
In patients with hypogammaglobulinemia secondary to chronic lymphocytic leukemia (CLL) or multiple myeloma (MM), intravenous immune globulin (IVIg) may be administered to reduce the risk of infection. Since 2013, IVIg products have carried a boxed safety warning about the risk of thromboembolic events (TEEs), with TEEs reported in 0.5% to 15% of patients treated with IVIg. In this retrospective cohort study of older patients with CLL or MM identified from the Surveillance, Epidemiology, and End Results-Medicare Linked Database, we assessed rates of clinically serious TEEs in 2724 new users of IVIg and a propensity-matched comparison group of 8035 nonusers. For the primary end point, arterial TEE, we observed a transient increased risk of TEE during the day of an IVIg infusion and the day afterward (hazard ration = 3.40; 95% confidence interval [CI]: 1.25, 9.25); this risk declined over the remainder of the 30-day treatment cycle. When considered in terms of absolute risk averaged over a 1-year treatment period, the increase in risk attributable to IVIg was estimated to be 0.7% (95% CI: -0.2%, 2.0%) compared with a baseline risk of 1.8% for the arterial TEE end point. A statistically nonsignificant risk increase of 0.3% (95% CI: -0.4%, 1.5%) compared with a baseline risk of 1.1% was observed for the venous TEE end point. Further research is needed to establish the generalizability of these results to patients receiving higher doses of IVIg for other indications.
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Affiliation(s)
| | - Michael P Jones
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Brian K Link
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA
| | | | - Scott K Winiecki
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation & Research, US Food and Drug Administration, Silver Spring, MD
| | | | - Bradley D McDowell
- Population Research Core, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA; and
| | - Bruce H Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Elizabeth A Chrischilles
- Department of Epidemiology and Population Research Core, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA; and
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18
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19
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Bonilla FA, Khan DA, Ballas ZK, Chinen J, Frank MM, Hsu JT, Keller M, Kobrynski LJ, Komarow HD, Mazer B, Nelson RP, Orange JS, Routes JM, Shearer WT, Sorensen RU, Verbsky JW, Bernstein DI, Blessing-Moore J, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller D, Spector SL, Tilles S, Wallace D. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol 2015; 136:1186-205.e1-78. [PMID: 26371839 DOI: 10.1016/j.jaci.2015.04.049] [Citation(s) in RCA: 400] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/18/2015] [Accepted: 04/23/2015] [Indexed: 02/07/2023]
Abstract
The American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) have jointly accepted responsibility for establishing the "Practice parameter for the diagnosis and management of primary immunodeficiency." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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20
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Parunov LA, Surov SS, Tucker E, Ovanesov MV. The effect of corn trypsin inhibitor and inhibiting antibodies for FXIa and FXIIa on coagulation of plasma and whole blood: comment. J Thromb Haemost 2015; 13:1527-30. [PMID: 26094623 DOI: 10.1111/jth.13028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L A Parunov
- Office of Blood Research and Review, CBER, US Food and Drug Administration, Silver Spring, MD, USA
| | - S S Surov
- Office of Blood Research and Review, CBER, US Food and Drug Administration, Silver Spring, MD, USA
| | - E Tucker
- Oregon Health and Science University, Portland, OR, USA
| | - M V Ovanesov
- Office of Blood Research and Review, CBER, US Food and Drug Administration, Silver Spring, MD, USA
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21
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Farrugia A, Quinti I. Manufacture of immunoglobulin products for patients with primary antibody deficiencies - the effect of processing conditions on product safety and efficacy. Front Immunol 2014; 5:665. [PMID: 25566269 PMCID: PMC4274962 DOI: 10.3389/fimmu.2014.00665] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/10/2014] [Indexed: 01/28/2023] Open
Abstract
Early preparations of immunoglobulin (Ig) manufactured from human plasma by ethanol (Cohn) fractionation were limited in their usefulness for substitution therapy in patients with primary antibody deficiencies (PAD), as Ig aggregates formed during manufacture resulted in severe systemic reactions in patients when given intravenously. Developments in manufacturing technology obviated this problem through the capacity to produce concentrated solutions of intact monomeric Ig, revolutionizing PAD treatment and improving patient life expectancy and quality of life. As the need for Ig has grown, manufacturers have refined further manufacturing technologies to improve yield from plasma and produce therapies, which are easier and less expensive to deliver. This has led to the substitution, partly or wholly, of ethanol precipitation by other techniques such as chromatography, and has also stimulated the production of highly concentrated solutions capable of rapid infusion. Ig products have been associated, since their inception, with certain adverse events, including infectious disease transmission, hemolysis, and thromboembolism. The introduction of standardized manufacturing processes and dedicated pathogen elimination steps has removed the risk of infectious disease, and the focus of attention has shifted to other problems, which appear to have increased over the past 5 years. These include hemolysis and thromboembolism, both the cause for substantial concern and the subject of recent regulatory scrutiny and actions. We review the development of manufacturing technology and the emerging evidence that changes for the optimization of yield and convenience has contributed to the recent incidents in certain adverse events. Industry measures under development will be discussed in terms of their potential to improve safety and optimize care for patients with PAD.
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Affiliation(s)
- Albert Farrugia
- Faculty of Medicine and Surgery, Department of Surgery, Centre for Orthopaedic Research, University of Western Australia, Perth, WA, Australia
- College of Medicine, Biology and Environment, Australian National University, Acton, ACT, Australia
- Plasma Protein Therapeutics Association, Annapolis, MD, USA
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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22
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Berg R, Schiff R. Thromboembolic events associated with immune globulin preparations: spontaneous pharmacovigilance data versus claims-based data. Transfusion 2014; 54:3255-7. [DOI: 10.1111/trf.12910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Roger Berg
- Global Pharmacovigilance; Baxter Innovations GmbH; Vienna Austria
| | - Richard Schiff
- Clinical Affairs; Baxter Healthcare Corp.; Westlake Village CA
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23
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Germishuizen WA, Gyure DC, Stubbings D, Burnouf T. Quantifying the thrombogenic potential of human plasma-derived immunoglobulin products. Biologicals 2014; 42:260-70. [PMID: 25096922 DOI: 10.1016/j.biologicals.2014.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/24/2014] [Accepted: 04/29/2014] [Indexed: 12/27/2022] Open
Abstract
Polyvalent immunoglobulin G (IgG) products obtained by fractionation of human plasma are used to treat a broad range of conditions, including immunodeficiency syndromes and autoimmune, inflammatory, and infectious diseases. Recent incidences of increased thromboembolic events (TEEs) associated with intravenous (IV) IgG (IVIG) led to recalls of some products and increased regulatory oversight of manufacturing processes in order to ensure that products are essentially free of procoagulant/thrombogenic plasma protein contaminants. Laboratory investigations have now identified activated factor XI (FXIa) as the likely causative agent of IVIG-related TEEs. Quantification of the thrombogenic potential is becoming a requirement made to fractionators (a) to validate the capacity of IVIG and subcutaneous IgG manufacturing processes to remove procoagulant contaminants and (b) to establish the safety of the final products. However, in the absence of a recommended test by the main regulatory authorities, several analytical approaches have been evaluated by fractionators, regulators, and university groups. This review focuses on the scientific rationale, merits, and applications of several analytical methods of quantifying the thrombogenic potential of IgG products and intermediates to meet the latest regulatory requirements.
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Affiliation(s)
| | - D C Gyure
- National Bioproducts Institute, Pinetown, South Africa
| | - D Stubbings
- National Bioproducts Institute, Pinetown, South Africa
| | - T Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan.
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