NESP INJECTION PLASTIC SYRINGE 20 μG/0.5 ML [SIN14740P]

Product Info

NESP INJECTION PLASTIC SYRINGE 20 μG/0.5 ML

[SIN14740P]

Indication

INDICATIONS
NESP® is indicated for the treatment of anaemia associated with chronic renal failure (CRF).
NESP® is also indicated for the treatment of anaemia and reduction of transfusion requirements in patients with non-myeloid malignancies where anaemia develops as a result of concomitantly administered chemotherapy.

NESP® is also indicated for anaemia with myelodysplastic syndrome. The efficacy and safety of NESP® have not been established in patients who are in the intermediate-2 or high risk categories under the International Prognostic Scoring System (IPSS). Patients indicated for NESP® should be selected based on a full knowledge of the description in the “CLINICAL TRIAL” section – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information, including serum erythropoietin concentration in patients enrolled in clinical studies, as well as adequate understanding of the efficacy and safety of NESP® and reference to the academic guidelines and other relevant updates.

Dosing

DOSAGE AND ADMINISTRATION
For CRF Patients and Patients with Non-Myeloid Malignancies Receiving Chemotherapy
Use the lowest dose of NESP® that will gradually increase the haemoglobin concentration to approach a target of not more than 12 g/dL; the rate of haemoglobin increase should not exceed 1 g/dL in any 2-week period.

Rapid increases in haemoglobin concentrations or the use of erythropoietins in subjects with normal haemoglobin concentrations, may result in an increased risk of thrombotic adverse events (see PRECAUTIONS-Cardiovascular and Thrombotic Events/Increased Mortality – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

CRF Patients
NESP® can be administered either SC or IV.

The dose should be started and titrated slowly (e.g. once every 4 weeks) based on individual haemoglobin levels. The haemoglobin target, regardless of the treatment population should not exceed 12 g/dL. (see Dose Adjustment in CRF patients). Clinical studies have shown interpatient response to be variable. If a patient fails to respond or maintain a response, other aetiologies should be considered and evaluated (see PRECAUTIONS: General – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information). Haemoglobin levels should be monitored frequently until stable. Thereafter, haemoglobin levels can be monitored less frequently. In clinical studies that were used for approval of darbepoetin alfa in patients with chronic renal failure, haemoglobin levels were measured every 1 to 2 weeks.

Dosing instructions are provided for two phases treatment: correction of anaemia and maintenance of the target haemoglobin level. Instructions for dose adjustment and for conversion from recombinant human erythropoietin (r-HuEPO) to NESP® are also provided.

Correction of Anaemia
The initial NESP® dosage by SC or IV administration is 0.45 mcg/kg body weight, as a single injection once weekly. If the increase in haemoglobin is inadequate (less than 1 g/dL in 4 weeks) and iron stores are adequate (see PRECAUTIONS: General – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information), the dose of NESP® may be increased by approximately 25%. Further increases may be made at 4-week intervals, until the desired response is attained.

Maintenance of Haemoglobin Concentration
In patients on dialysis and not on dialysis, NESP® may be dosed weekly or once every 2 weeks at the titrated dose to maintain the target haemoglobin.

If a dose adjustment is required to maintain a target haemoglobin, the individual dose may be adjusted at 4-week intervals until the appropriate haemoglobin level is achieved (see Dose Adjustment in CRF Patients).

After any dose adjustment the haemoglobin should be monitored every 1 to 2 weeks until stable and less frequently thereafter. Dose changes in the maintenance phase of treatment should not be made more frequently than every 2 weeks.

When changing the route of administration the same dose should be used and the haemoglobin monitored so that the appropriate NESP® dose adjustments can be made to keep the haemoglobin at a target not to exceed 12 g/dL. Data from 809 patients receiving darbepoetin alfa in Australian and European clinical studies were analysed to assess the dose required to maintain haemoglobin; no difference was observed between the average weekly dose administered via the IV and SC routes of injection.

Dose Adjustment in CRF Patients
The dose should be adjusted for each patient to achieve and maintain a target haemoglobin not to exceed 12 g/dL. Dose adjustment instructions should be followed to achieve and maintain a target haemoglobin or in response to an excessive rate of rise of haemoglobin.

If the haemoglobin is increasing and approaching 12 g/dL, the dose should be reduced by approximately 25%. If after a dose reduction, haemoglobin continues to increase, the dose should be temporarily withheld until the haemoglobin begins to decrease, at which point, therapy should be reinstated at a dose approximately 25% below the previous dose.

If the rise in haemoglobin is more than 1 g/dL in 2 weeks, reduce the dose by 25%.
Haemoglobin levels should be monitored every 1 to 2 weeks until stable and less frequently thereafter.

Conversion from Recombinant Human Erythropoietin to NESP®
Due to its longer serum half-life, NESP® can be administered less frequently than r-HuEPO. Clinical experience has shown that patients receiving r-HuEPO 2 or 3 times weekly may change to once weekly NESP®. Those receiving r-HuEPO once weekly may change to NESP® administered once every 2 weeks.

The substitution of NESP® for r-HuEPO should be based on the patient's r-HuEPO dose at the time of substitution, and the same route of administration should be used. The initial SC dose of NESP® (mcg/week) can be determined by dividing the total weekly SC dose of r-HuEPO (units/week) by 200, while the initial IV dose can be determined by dividing the total weekly IV dose of r-HuEPO (units/week) by 240. Because of individual variability, doses should be titrated as described above to maintain the haemoglobin at the desired concentration.

Patients with Non-Myeloid Malignancies Receiving Chemotherapy
Treatment should not be commenced unless haemoglobin falls below 10 – 11 g/dL. The recommended initial dose is 2.25 mcg/kg given once weekly as a single SC injection.

The aim of treatment is to increase haemoglobin concentration to a target not to exceed 12 g/dL and to reduce the requirement for blood transfusions. The therapy should be continued for approximately 4 weeks after the end of chemotherapy or until haemoglobin concentrations approach 12 g/dL.

Dose Adjustment-Cancer Patients
If the haemoglobin approaches 12 g/dL, the dose should be reduced by approximately 25% to 50%. If the haemoglobin exceeds 12 g/dL, doses should be temporarily withheld until the haemoglobin decreases to approximately 11 g/dL, at which point therapy should be re-initiated at 25% to 50% below the previous dose.

For patients receiving darbepoetin alfa on a weekly basis if the increase in haemoglobin is inadequate (less than 1 g/dL after approximately 1 month of therapy) or if the response is not satisfactory in terms of reducing red blood cell transfusion requirements, the dose should be doubled to 4.5 mcg/kg given once weekly.

Anaemia with Myelodysplastic Syndrome
The usual dose of NESP® in adults is 240 mcg as darbepoetin alfa (genetical recombination), to be administered as a single subcutaneous injection once weekly. The dose should be decreased in view of the degree of anaemic symptoms and the patient's age.

The efficacy and safety of NESP® in combination with other antitumour agents have not been established.

If cases such as excessive haemopoiesis occur (the haemoglobin concentration exceeds approximately 11 g/dL) and dose reduction is required, the dose should be reduced by approximately 50%. If after dose reduction, the haemoglobin concentration falls (below approximately 9 g/dL) and dose increase is required, the dose should be increased approximately twofold. The dose should not exceed 240 mcg as a single injection.

If the desired improvement in anaemia is not obtained or anaemia is aggravated after administration of NESP®, change to another treatment should be considered. The necessity of continued administration of NESP® should be assessed at approximately 16 weeks after the initiation of administration. (See CLINICAL TRIAL – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Preparation and Administration of NESP®
Do not take out the syringe from its pillow package before administration.
Before using NESP® Syringe, remove the Tip Cap. Attach an appropriate needle, etc., if necessary, and then administer the drug.
Do not shake NESP®. Prolonged vigorous shaking may denature any protein, rendering it biologically inactive.
Parenteral drug products should be inspected visually for particulate matter and discolouration prior to administration. Do not use any products exhibiting particulate matter or discolouration.
Do not dilute or administer NESP® in conjunction with other drug solutions.
NESP® contains no antimicrobial agent. NESP® is for single use in one patient only. Discard any residue.

Contraindications

CONTRAINDICATIONS
NESP® is contraindicated in patients with:

1. Uncontrolled hypertension.

2. Known sensitivity to products derived from mammalian cells.

3. Known hypersensitivity to darbepoetin alfa or any of the excipients found in NESP®.