Kenyan Health Patient Information Leaflet
CD20-directed Cytolytic Antibody [EPC], Endoglycosidase [EPC]
1 INDICATIONS AND USAGE RITUXAN HYCELA is a combination of rituximab, a CD20-directed cytolytic antibody, and hyaluronidase human, an endoglycosidase, indicated for the treatment of adult patients with: Follicular Lymphoma (FL) ( 1.1 ) Relapsed or refractory, follicular lymphoma as a single agent Previously untreated follicular lymphoma in combination with first line chemotherapy and, in patients achieving a complete or partial response to rituximab in combination with chemotherapy, as single-agent maintenance therapy Non-progressing (including stable disease), follicular lymphoma as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy Diffuse Large B-cell Lymphoma (DLBCL) ( 1.2 ) Previously untreated diffuse large B-cell lymphoma in combination with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or other anthracycline-based chemotherapy regimens Chronic Lymphocytic Leukemia (CLL) ( 1.3 ) Previously untreated and previously treated CLL in combination with fludarabine and cyclophosphamide (FC) Limitations of Use: Initiate treatment with RITUXAN HYCELA only after patients have received at least one full dose of a rituximab product by intravenous infusion. ( 1.4 , 2.1 , 5.4 ). RITUXAN HYCELA is not indicated for the treatment of non-malignant conditions. ( 1.4 ) 1.1 Follicular Lymphoma (FL) RITUXAN HYCELA is indicated for the treatment of adult patients with: Relapsed or refractory, follicular lymphoma as a single agent. Previously untreated follicular lymphoma in combination with first line chemotherapy and, in patients achieving a complete or partial response to rituximab in combination with chemotherapy, as single-agent maintenance therapy. Non-progressing (including stable disease), follicular lymphoma as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy. 1.2 Diffuse Large B-Cell Lymphoma (DLBCL) RITUXAN HYCELA is indicated for the treatment of adult patients with previously untreated diffuse large B-cell lymphoma in combination with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or other anthracycline-based chemotherapy regimens. 1.3 Chronic Lymphocytic Leukemia (CLL) RITUXAN HYCELA is indicated, in combination with fludarabine and cyclophosphamide (FC), for the treatment of adult patients with previously untreated and previously treated CLL. 1.4 Limitations of Use Initiate treatment with RITUXAN HYCELA only after patients have received at least one full dose of a rituximab product by intravenous infusion [see Dosage and Administration (2.1) and Warnings and Precautions (5.4) ]. RITUXAN HYCELA is not indicated for the treatment of non-malignant conditions.
( 2.1 ) All patients must receive at least one full dose of a rituximab product by intravenous infusion before receiving RITUXAN HYCELA by subcutaneous injection ( 2.1 ). FL/DLBCL: Administer 1,400 mg/23,400 Units (1,400 mg rituximab and 23,400 Units hyaluronidase human) subcutaneously according to recommended schedule ( 2.2 , 2.3 ). CLL: Administer 1,600 mg/26,800 Units (1,600 mg rituximab and 26,800 Units hyaluronidase human) subcutaneously according to recommended schedule ( 2.4 ). Premedicate with acetaminophen and antihistamine before each dose; in addition, consider premedication with glucocorticoids ( 2.5 , 5.4 ) Administer specified volume into subcutaneous tissue of abdomen: ( 2.6 ) 11.7 mL from 1,400 mg/23,400 Units vial over approximately 5 minutes. 13.4 mL from 1,600 mg/26,800 Units vial over approximately 7 minutes. Observe 15 minutes following administration 2.1 Important Dosing Information RITUXAN HYCELA is for subcutaneous use only. RITUXAN HYCELA should only be administered by a healthcare professional with appropriate medical support to manage severe reactions that can be fatal if they occur. All patients must first receive at least one full dose of a rituximab product by intravenous infusion without experiencing severe adverse reactions before starting treatment with RITUXAN HYCELA. If patients are not able to receive one full dose by intravenous infusion, they should continue subsequent cycles with a rituximab product by intravenous infusion and not switch to RITUXAN HYCELA until a full intravenous dose is successfully administered [see Warnings and Precautions (5.4) ]. Refer to the prescribing information for a rituximab product for intravenous infusion for additional information. Premedicate before each dose of RITUXAN HYCELA [see Dosage and Administration (2.5) ] . Dose reductions of RITUXAN HYCELA are not recommended. When RITUXAN HYCELA is given in combination with chemotherapy dose, reduce the chemotherapeutic drugs to manage adverse reactions. 2.2 Recommended Dosage for Follicular Lymphoma (FL) All patients must receive at least one full dose of a rituximab product by intravenous infusion before starting treatment with RITUXAN HYCELA [see Dosage and Administration (2.1) and Warnings and Precautions (5.4) ]. Premedicate before each dose [see Dosage and Administration (2.5) ]. The recommended dose is RITUXAN HYCELA 1,400 mg/23,400 Units (1,400 mg rituximab and 23,400 Units hyaluronidase human) subcutaneously at a fixed dose irrespective of patient's body surface area according to the following schedules: Relapsed or Refractory, Follicular Lymphoma Administer once weekly for 3 or 7 weeks following a full dose of a rituximab product by intravenous infusion at week 1 (i.e., 4 or 8 weeks in total). Retreatment for Relapsed or Refractory, Follicular Lymphoma Administer once weekly for 3 weeks following a full dose of a rituximab product by intravenous infusion at week 1 (i.e., 4 weeks in total). Previously Untreated, Follicular Lymphoma Administer on Day 1 of Cycles 2–8 of chemotherapy (every 21 days), for up to 7 cycles following a full dose of a rituximab product by intravenous infusion on Day 1 of Cycle 1 of chemotherapy (i.e., up to 8 cycles in total). In patients with complete or partial response, initiate RITUXAN HYCELA maintenance treatment 8 weeks following completion of RITUXAN HYCELA in combination with chemotherapy. Administer RITUXAN HYCELA as a single-agent every 8 weeks for 12 doses. Non-progressing, Follicular Lymphoma after first line CVP chemotherapy Following completion of 6–8 cycles of CVP chemotherapy and a full dose of a rituximab product by intravenous infusion at week 1, administer once weekly for 3 weeks (i.e., 4 weeks in total) at 6 month intervals to a maximum of 16 doses. 2.3 Recommended Dosage for Diffuse Large B-Cell Lymphoma (DLBCL) All patients must receive at least one full dose of a rituximab product by intravenous infusion in combination with CHOP chemotherapy before starting treatment with RITUXAN HYCELA [see Dosage and Administration (2.1) and Warnings and Precautions (5.4) ]. Premedicate before each dose [see Dosage and Administration (2.5) ]. The recommended dose for DLBCL is RITUXAN HYCELA 1,400 mg/23,400 Units (1,400 mg rituximab and 23,400 Units hyaluronidase human) at a fixed dose irrespective of patient's body surface area in combination with CHOP chemotherapy. Administer RITUXAN HYCELA 1,400 mg/23,400 Units on Day 1 of Cycles 2–8 of CHOP chemotherapy for up to 7 cycles following a full dose of a rituximab product by intravenous infusion at Day 1, Cycle 1 of CHOP chemotherapy (i.e., up to 6–8 cycles in total). 2.4 Recommended Dosage for Chronic Lymphocytic Leukemia (CLL) All patients must receive at least one full dose of a rituximab product by intravenous infusion in combination with FC chemotherapy before starting treatment with RITUXAN HYCELA [see Dosage and Administration (2.1) and Warnings and Precautions (5.4) ]. Premedicate before each dose [see Dosage and Administration (2.5) ]. The recommended dose for CLL is RITUXAN HYCELA 1,600 mg/26,800 Units (1,600 mg rituximab and 26,800 Units hyaluronidase human) in combination with FC chemotherapy, at a fixed dose, irrespective of patient's body surface area. Administer RITUXAN HYCELA 1,600 mg/26,800 Units on Day 1 of Cycles 2–6 (every 28 days) for a total of 5 cycles following a full intravenous dose at Day 1, Cycle 1 (i.e., 6 cycles in total). 2.5 Recommended Premedication and Prophylactic Medications Premedicate with acetaminophen and an antihistamine before each dose of RITUXAN HYCELA. Premedication with a glucocorticoid should also be considered [see Dosage and Administration (2.2 , 2.3 , 2.4) ] . Provide prophylaxis for Pneumocystis jiroveci pneumonia (PCP) and herpes virus infections for patients with CLL during treatment and for up to 12 months following treatment as appropriate [see Warnings and Precautions (5.6) ]. 2.6 Preparation and Administration To prevent medication errors, check the vial labels to ensure that the drug being prepared and administered is RITUXAN HYCELA for subcutaneous use. Do not administer RITUXAN HYCELA intravenously . RITUXAN HYCELA is ready to use. Preparation Use a sterile needle and syringe to prepare RITUXAN HYCELA. RITUXAN HYCELA is compatible with polypropylene and polycarbonate syringe material and stainless steel transfer and injection needles. Using a 20 mL syringe, withdraw the required volume from the vial with a narrow (e.g., 25–30 gauge) needle of any length. Label the syringe with the provided peel-off label. Change the needle to a 1/2" to 5/8" long, narrow gauge needle (e.g., 25–30 gauge) immediately prior to subcutaneous administration to avoid needle clogging. Visually inspect for particulate matter and discoloration prior to administration. RITUXAN HYCELA should be a clear to opalescent and colorless to yellowish liquid. Do not use if particulates or discoloration is present. Administration Inject RITUXAN HYCELA into the subcutaneous tissue of the abdomen over approximately 5–7 minutes. Never inject into areas where the skin is red, bruised, tender or hard, or areas where there are moles or scars. No data are available on performing the injection at other sites of the body. Inject 11.7 mL of RITUXAN HYCELA 1,400 mg/23,400 Units vial (1,400 mg rituximab and 23,400 Units hyaluronidase human) subcutaneously into the abdomen over approximately 5 minutes. Inject 13.4 mL of RITUXAN HYCELA 1,600 mg/26,800 Units vial (1,600 mg rituximab and 26,800 Units hyaluronidase human) subcutaneously into the abdomen over approximately 7 minutes. If administration of RITUXAN HYCELA is interrupted, continue administering at the same site, or at a different site, but restricted to the abdomen. Observe patients for at least 15 minutes following RITUXAN HYCELA administration [see Warnings and Precautions (5.4) ]. During treatment with RITUXAN HYCELA, do not administer other medications for subcutaneous use at the same sites as RITUXAN HYCELA. Storage Use immediately. If not used immediately store refrigerated at 2°C to 8°C (36°F to 46°F) up to 48 hours and subsequently for 8 hours at room temperature up to 30°C (86°F) in diffuse light.
labeling: Mucocutaneous reactions [see Warnings and Precautions (5.1) ] Hepatitis B reactivation including fulminant hepatitis [see Warnings and Precautions (5.2) ] Progressive multifocal leukoencephalopathy [see Warnings and Precautions (5.3) ] Hypersensitivity and other administration reactions [see Warnings and Precautions (5.4) ] Tumor lysis syndrome [see Warnings and Precautions (5.5) ] Infections [see Warnings and Precautions (5.6) ] Cardiac arrhythmias [see Warnings and Precautions (5.7) ] Renal toxicity [see Warnings and Precautions (5.8) ] Bowel obstruction and perforation [see Warnings and Precautions (5.9) ] Most common adverse reactions (incidence of ≥ 20%) are: ( 6.1 ) FL: infections, neutropenia, nausea, constipation, cough, and fatigue DLBCL: infections, neutropenia, alopecia, nausea, and anemia CLL: infections, neutropenia, nausea, thrombocytopenia, pyrexia, vomiting, and injection site erythema To report SUSPECTED ADVERSE REACTIONS, contact Genentech at 1-888-835-2555 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The data described below reflect exposure to RITUXAN HYCELA in 892 patients in four controlled trials with exposures ranging from a single injection up to 27 months of treatment. The population included 382 patients with follicular lymphoma (FL), 369 patients with diffuse large B-cell lymphoma (DLBCL), and 141 patients with chronic lymphocytic leukemia (CLL). The median age was 60 years (range: 18–85 years, 53% were male, and 84% were White. In the SABRINA study patients with FL received a full dose of a rituximab product by intravenous infusion, followed by RITUXAN HYCELA (1,400 mg rituximab/23,400 Units hyaluronidase human), in combination with chemotherapy for up to 7 doses (i.e., total of 8 doses in combination with chemotherapy), or as monotherapy for up to 12 doses (maintenance treatment). In the MabEase study patients with DLBCL received a full dose of a rituximab product by intravenous infusion, followed by RITUXAN HYCELA (1,400 mg rituximab/23,400 Units hyaluronidase human), given in combination with chemotherapy for up to 7 doses (i.e., up to a total of 8 doses). In the SAWYER study patients with CLL on part 2 received a full dose of a rituximab product by intravenous infusion, followed by RITUXAN HYCELA (1,600 mg rituximab/26,800 Units hyaluronidase human) for up to 5 doses, in combination with fludarabine and cyclophosphamide (i.e., total of 6 doses). The most common adverse reactions (≥ 20%) of RITUXAN HYCELA observed in patients with FL on the SABRINA study were: infections, neutropenia, nausea, constipation, cough, and fatigue. The most common adverse reactions (≥ 20%) of RITUXAN HYCELA observed in patients with DLBCL on the MabEase study were: infections, neutropenia, alopecia, nausea, and anemia. The most common adverse reactions (≥ 20%) of RITUXAN HYCELA observed in patients with CLL on part 2 of the SAWYER study were: infections, neutropenia, nausea, thrombocytopenia, pyrexia, vomiting, and injection site erythema. Administration-related reactions (ARRs) Administration-related reactions (ARRs) with RITUXAN HYCELA were defined as all the adverse reactions related to the administration of RITUXAN HYCELA within the 24 hours post injection. The incidence of ARRs with RITUXAN HYCELA was 34% in FL/DLBCL in combination with chemotherapy with injection site erythema (5%), chills (3%), dyspnea, erythema, flushing, injection site pain, nausea, pruritus, pyrexia, rash, and throat irritation (2% each) being the most common ARRs. The incidence of ARRs in FL maintenance setting was 20%. The most common ARRs were injection site erythema (7%), erythema (4%), injection site pain/edema, myalgia, and rash (2% each). The incidence of ARRs with RITUXAN HYCELA in CLL was 44%. With the exception of Local Cutaneous Reactions, the incidence and profile of adverse reactions reported for RITUXAN HYCELA were comparable with those for rituximab. The overall incidence of adverse reactions for intravenous rituximab versus RITUXAN HYCELA in combination with chemotherapy for FL/DLBCL was 93% versus 95% (BSA ≤ 1.73 m 2 ), 89% versus 93% (1.73 < BSA ≤ 1.92 m 2 ), and 94% versus 94% (BSA > 1.92 m 2 ). The overall incidence of adverse reactions for rituximab versus RITUXAN HYCELA in CLL was 89% versus 100% (BSA ≤ 1.81 m 2 ), 97% versus 88% (1.82 < BSA ≤ 1.99 m 2 ), and 88% versus 93% (BSA > 2.00 m 2 ). Summary of Clinical Trial Experience in Follicular Lymphoma (FL) The data in Table 1 were obtained in the SABRINA study, a two-stage randomized, controlled study in patients with previously untreated FL. The study compared patients receiving RITUXAN HYCELA (1,400 mg rituximab/23,400 Units hyaluronidase human; n=197) with patients receiving a rituximab product by intravenous infusion (375 mg/m 2 ; n=210), both in combination with CHOP or CVP followed by maintenance treatment with RITUXAN HYCELA or a rituximab product by intravenous infusion. The majority of patients completed all 8 cycles of combination treatment with chemotherapy (91% RITUXAN HYCELA vs. 90% rituximab). In addition, 69% of patients in each of the treatment groups completed all 20 cycles of combination plus maintenance treatment. In both RITUXAN HYCELA and rituximab groups, patients experienced similar median duration of exposure (27.1 months for each arm). Across the two stages, the overall demographics and baseline characteristics were balanced between the treatment groups. However, there were more female patients (53%) randomized in the study than male patients (47%) and a higher proportion of females were randomized to receive RITUXAN HYCELA (59% female) compared with the rituximab group (48%). The treatment groups in the combined Stage 1 and 2 population were otherwise balanced in regard to baseline demographics, characterized by a median age of 57 years (56.0 years [range 28–85 years] for RITUXAN HYCELA and 57 years [range 28–86 years] for rituximab) and median BSA of 1.83 m 2 (1.80 and 1.84 m 2 for RITUXAN HYCELA and rituximab, respectively). The incidence of all adverse reactions was 96% for RITUXAN HYCELA vs. 95% for rituximab ( Table 1 ). Grade 3–4 adverse reactions were reported in 55% of patients receiving RITUXAN HYCELA vs. 53% in patients receiving rituximab. Serious adverse reactions were reported in 37% of patients receiving RITUXAN HYCELA vs. 34% of patients receiving rituximab. The most common adverse reactions (occurring in ≥ 20% of patients in any arm) were infections, neutropenia, nausea, constipation, cough, and fatigue. A total of 36 patients died, including 14/197 patients (7%) who received RITUXAN HYCELA and 22/210 patients (10%) who received rituximab. Of these 36 patients, 19 patients (7 patients RITUXAN HYCELA [4%] vs. 12 patients rituximab [6%]) died due to adverse reactions and 13 patients (6 patients RITUXAN HYCELA [3%] vs. 7 patients rituximab [3%]) died due to disease progression. The incidence of administration-related reactions (ARRs) due to the subcutaneous route of administration associated with RITUXAN HYCELA was assessed in combination with chemotherapy and during maintenance. Thirty patients (15%) experienced an ARR during the first administration of RITUXAN HYCELA (Cycle 2). Incidence of ARRs generally decreased at subsequent cycles with 18 patients (9%) reporting ARR at Cycle 3, 13 patients (7%) at Cycle 4, 11 patients (6%) at Cycles 5 and 6, 12 patients (7%) at Cycle 7, and 8 patients (4%) at Cycle 8. During RITUXAN HYCELA monotherapy in the maintenance setting the incidence of ARRs at each cycle was ≤ 7% and was observed in 24 patients (14%) overall. Grade 1–2 ARRs constituted 96% of the overall ARRs. Grade 3 ARRs were reported during the first administration of RITUXAN HYCELA at Cycle 2 by 2 patients. Of the reported ARRs, local cutaneous reactions with RITUXAN HYCELA were reported in 32 patients. These events resolved within a median of 2 days from the onset (range 1 to 37 days). Majority of these reactions were Grade 1 and 2 and were observed in 31 patients (16%). Table 1: Incidence of Adverse Reactions in ≥ 5% of Patients with Previously Untreated Follicular Lymphoma Receiving RITUXAN HYCELA or Rituximab in Combination with CHOP or CVP and as Monotherapy for Maintenance Treatment Body System/Adverse Reactions RITUXAN HYCELA (n=197) Rituximab (n=210) All Grades % Grade 3–4 % All Grades % Grade 3–4 % Gastrointestinal Disorders Nausea 31 0 22 0 Constipation 25 0 26 < 1 Diarrhea 18 2 16 < 1 Abdominal Pain 14 0 12 < 1 Vomiting 14 0 12 < 1 Dyspepsia 8 0 7 0 Stomatitis 6 0 5 0 Abdominal Pain Upper 5 0 5 0 General Disorders and Administration Site Conditions Fatigue 20 0 18 < 1 Asthenia 17 1 13 0 Pyrexia 15 < 1 16 < 1 Injection Site Erythema 13 0 0 0 Injection Site Pain 8 0 0 0 Chills 8 0 9 0 Chest Pain 6 1 3 0 Edema Peripheral 5 < 1 6 0 Mucosal Inflammation 5 1 6 < 1 Influenza Like Illness 3 0 6 0 Infections Upper Respiratory Tract Infection 15 < 1 10 0 Pneumonia 11 5 4 2 Nasopharyngitis 10 0 10 0 Bronchitis 8 < 1 8 < 1 Urinary Tract Infection 8 1 14 < 1 Sinusitis 7 < 1 4 0 Conjunctivitis 5 0 5 0 Influenza 4 0 6 < 1 Blood and Lymphatic System Disorders Neutropenia 32 26 27 21 Anemia 15 5 13 0 Febrile Neutropenia 8 7 6 6 Leukopenia 6 4 11 2 Musculoskeletal and Connective Tissue Disorders Arthralgia 13 < 1 10 0 Bone Pain 10 < 1 8 0 Pain In Extremity 10 0 5 0 Back Pain 9 < 1 12 < 1 Muscle Spasms 8 0 3 0 Myalgia 8 0 5 0 Nervous System Disorders Paresthesia 16 0 12 0 Headache 13 0 9 0 Neuropathy Peripheral 12 2 14 < 1 Dizziness 7 0 7 0 Skin and Subcutaneous Tissue Disorders Alopecia 14 < 1 10 < 1 Pruritus 10 0 12 < 1 Rash 10 0 7 0 Erythema 9 0 5 0 Respiratory, Thoracic and Mediastinal Disorders Cough 23 0 13 < 1 Dyspnea 11 1 8 2 Oropharyngeal Pain 9 0 8 0 Psychiatric Disorders Insomnia 9 0 9 0 Vascular Disorders Hypertension 6 1 6 0 Summary of Clinical Trial Experience in Diffuse Large B-Cell Lymphoma (DLBCL) The data in Table 2 were obtained in the MabEASE study, a comparative, randomized, parallel-group, multicenter study to investigate the efficacy of RITUXAN HYCELA (1,400 mg rituximab and 23,400 Units hyaluronidase human; n=369) versus 375 mg/m 2 a rituximab product by intravenous infusion (n=203) both in combination with CHOP (R-CHOP) in previously untreated patients with CD20-positive DLBCL. Eighty two percent of patients receiving RITUXAN HYCELA or rituximab completed all 8 cycles of study treatment. In both RITUXAN HYCELA and rituximab treatment groups, patients experienced 4.9 months median duration of rituximab exposure in each arm. The demographic characteristics were balanced. Most patients were White (79%) and 54% were male. The median was 64 years and median BSA was 1.83 m 2 . The incidences of adverse reactions of any grade (RITUXAN HYCELA [94%] vs. rituximab [92%]) ( Table 2 ), Grade 3–4 adverse reactions (RITUXAN HYCELA [63%] vs. rituximab [57%]), and serious adverse reactions (RITUXAN HYCELA [42%] vs. rituximab [37%]) were generally comparable between the two treatment groups. The common adverse reactions (occurring in ≥ 20% of patients in any treatment group) were neutropenia, alopecia, nausea, and anemia. A total of 91 patients (16%) died, including 58/369 patients (16%) in RITUXAN HYCELA and 33/203 patients (16%) in rituximab. Of these patients, 44 patients (29 patients RITUXAN HYCELA [8%] vs. 15 patients rituximab [7%]) died due to adverse reactions and 35 patients (22 patients RITUXAN HYCELA [6%] vs. 13 patients rituximab [6%]) died due to disease progression. Pneumonia (4 patients RITUXAN HYCELA vs. 1 patient rituximab), septic shock (2 patients RITUXAN HYCELA vs. 3 patients rituximab), and cardiac arrest (1 patient…
16 HOW SUPPLIED/STORAGE AND HANDLING RITUXAN HYCELA (rituximab and hyaluronidase human) injection, for subcutaneous use is supplied as a sterile preservative-free liquid solution in a single-dose vial. The following configurations are available: Individually packaged single-dose vials: RITUXAN HYCELA 1,400 mg/23,400 Units (NDC 50242-108-01) providing 1,400 mg rituximab and 23,400 Units hyaluronidase human per 11.7 mL RITUXAN HYCELA 1,600 mg/26,800 Units (NDC 50242-109-01) providing 1,600 mg rituximab and 26,800 Units hyaluronidase human per 13.4 mL Storage Store RITUXAN HYCELA vials in the refrigerator at 2°C to 8°C (36°F to 46°F) in the original carton to protect from light. Do not freeze.