([coagulation factor IX (recombinant)])
The most serious adverse reactions are systemic hypersensitivity reactions, including bronchospastic reactions and/or hypotension and anaphylaxis and the development of high-titer inhibitors necessitating alternative treatments to factor IX replacement therapy.
The most common adverse reactions observed in clinical trials [frequency >5% of previously treated patients (PTPs) or previously untreated patients (PUPs)] were fever, cough, headaches, dizziness, nausea, injections site reaction, injection site pain and skin-related hypersensitivity reactions (e.g., rash, hives).
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.
During uncontrolled, open-label clinical trials with BeneFIX conducted in PTPs, 113 adverse reactions with known or unknown relation to BeneFIX therapy were reported among 38.5% (25 of 65) of subjects (with some subjects reporting more than one event) who received a total of 7,573 infusions. These adverse reactions are summarized in Table 2.
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Body System | Adverse Reaction | Number of Patients (%) |
Blood and lymphatic system disorders | Factor IX inhibition† | 1 (1.5%) |
Eye disorders | Blurred vision | 1 (1.5%) |
Gastrointestinal disorders | Nausea | 4 (6.2%) |
Vomiting | 1 (1.5%) | |
General disorders and administration site conditions | Injection site reaction | 5 (7.7%) |
Injection site pain | 4 (6.2%) | |
Fever | 2 (3.1%) | |
Infections and infestations | Cellulitis at IV site | 1 (1.5%) |
Phlebitis at IV site | 1 (1.5%) | |
Nervous system disorders | Headache | 7 (10.8%) |
Dizziness | 5 (7.7%) | |
Taste perversion (altered taste) | 3 (4.6%) | |
Shaking | 1 (1.5%) | |
Drowsiness | 1 (1.5%) | |
Renal and urinary disorders | Renal infarct‡ | 1 (1.5%) |
Respiratory, thoracic and mediastinal disorders | Dry cough | 1 (1.5%) |
Hypoxia | 1 (1.5%) | |
Chest tightness | 1 (1.5%) | |
Skin and subcutaneous disorders | Rash | 4 (6.2%) |
Hives | 2 (3.1%) | |
Vascular disorders | Flushing | 2 (3.1%) |
In the 63 PUPs, who received a total of 5,538 infusions, 10 adverse reactions were reported among 9.5% of the patients (6 out of 63) having known or unknown relationship to BeneFIX. These events are summarized in Table 3.
Body System | Adverse Reaction | Number of Patients (%) |
Blood and lymphatic system disorders | Factor IX inhibition† | 2 (3.2%) |
General disorders and administration site conditions | Injection site reaction | 1 (1.6%) |
Chills | 1 (1.6%) | |
Respiratory, thoracic and mediastinal disorders | Dyspnea (respiratory distress) | 2 (3.2%) |
Skin and subcutaneous disorders | Hives | 3 (4.8%) |
Rash | 1 (1.6%) | |
In a multi-center, prospective, open-label clinical trial with BeneFIX administered at 100 IU/kg once weekly, 25 PTPs (exposed to a factor IX containing product for ≥100 exposure days) were evaluated, with 25 subjects treated for approximately 52 weeks. Common (≥5%) adverse reactions were headache (36%), fever (20%), and cough (8%). No subject was withdrawn from the trial due to an adverse reaction. In the trial, no inhibitors were detected and no thrombotic events or anaphylactic reactions were reported.
Immunogenicity
In clinical trials with 65 PTPs (defined as having more than 50 exposure days), a low-titer inhibitor was observed in one patient. The inhibitor was transient, the patient continued on the trial and had normal factor IX recovery at the trial completion (approximately 15 months after inhibitor detection).
In clinical trials with pediatric PUPs, inhibitor development was observed in 2 out of 63 patients (3.2%), both were high-titer (>5 BU) inhibitors detected after 7 and 15 exposure days, respectively. Both patients were withdrawn from the trial.
In a clinical trial of 25 PTPs, with BeneFIX administered at 100 IU/kg once weekly, no inhibitors were detected.
The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors, including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to BeneFIX with the incidence of antibodies to other products may be misleading.
Thromboembolic complications
All subjects participating in the PTP, PUP and surgery trials were monitored for clinical evidence of thrombosis. No thrombotic complications were reported in PUPs or surgery subjects. One PTP subject experienced a renal infarct (see Table 2). Laboratory studies of thrombogenicity (fibrinopeptide A and prothrombin fragment 1 + 2) were obtained in 41 PTPs and 7 surgery subjects prior to infusion and up to 24 hours following infusion. The results of these studies were inconclusive. Out of 29 PTP subjects noted to have elevated fibrinopeptide A levels post-infusion of BeneFIX, 22 also had elevated levels at baseline. Surgery subjects showed no evidence of significant increase in coagulation activation.
The following post-marketing adverse reactions have been reported for BeneFIX: inadequate factor IX recovery, inadequate therapeutic response, inhibitor development [see Clinical Pharmacology (12)], anaphylaxis [see Warnings and Precautions (5.1)], angioedema, dyspnea, hypotension, and thrombosis.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
There have been post-marketing reports of thrombotic events, including life-threatening SVC syndrome in critically ill neonates, while receiving continuous-infusion BeneFIX through a central venous catheter. Cases of peripheral thrombophlebitis and DVT have also been reported. In some, BeneFIX was administered via continuous infusion, which is not an approved method of administration [see Dosage and Administration (2)]. The safety and efficacy of BeneFIX administration by continuous infusion have not been established [see Warnings and Precautions (5.2)].
Patient Information
BeneFIX® / BEN-uh-fiks/
[Coagulation Factor IX (Recombinant)]
Please read this Patient Leaflet carefully before using BeneFIX and each time you get a refill. There may be new information. This Patient Leaflet does not take the place of talking with your doctor about your medical condition or your treatment.
What is BeneFIX?
BeneFIX is an injectable medicine that is used to help control and prevent bleeding in people with hemophilia B. Hemophilia B is also called congenital factor IX deficiency or Christmas disease.
BeneFIX is NOT used to treat hemophilia A.
What should I tell my doctor before using BeneFIX?
Tell your doctor and pharmacist about all of the medicines you take, including all prescription and non-prescription medicines, such as over-the-counter medicines, supplements, or herbal medicines.
Tell your doctor about all of your medical conditions, including if you:
How should I infuse BeneFIX?
The initial administrations of BeneFIX should be administered under proper medical supervision, where proper medical care for severe allergic reactions could be provided.
See the step-by-step instructions for infusing BeneFIX at the end of this leaflet. You should always follow the specific instructions given by your doctor. The steps listed below are general guidelines for using BeneFIX. If you are unsure of the procedures, please call your doctor or pharmacist before using.
Call your doctor right away if bleeding is not controlled after using BeneFIX.
Your doctor will prescribe the dose that you should take.
Your doctor may need to test your blood from time to time.
BeneFIX should not be administered by continuous infusion.
What if I take too much BeneFIX?
Call your doctor if you take too much BeneFIX.
What are the possible side effects of BeneFIX?
Allergic reactions may occur with BeneFIX. Call your doctor or get emergency treatment right away if you have any of the following symptoms:
Your body can also make antibodies, called "inhibitors," against BeneFIX, which may stop BeneFIX from working properly.
Some common side effects of BeneFIX are fever, cough, nausea, injection site reaction, injection site pain, headache, dizziness and rash.
BeneFIX may increase the risk of thromboembolism (abnormal blood clots) in your body if you have risk factors for developing blood clots, including an indwelling venous catheter through which BeneFIX is given by continuous infusion. There have been reports of severe blood clotting events, including life-threatening blood clots in critically ill neonates, while receiving continuous-infusion BeneFIX through a central venous catheter. The safety and efficacy of BeneFIX administration by continuous infusion have not been established.
These are not all the possible side effects of BeneFIX.
Tell your doctor about any side effect that bothers you or that does not go away.
How should I store BeneFIX?
DO NOT FREEZE BeneFIX kit.
BeneFIX kit can be stored at room temperature (below 86°F) or under refrigeration.
Throw away any unused BeneFIX and diluent after the expiration date indicated on the label.
Freezing should be avoided to prevent damage to the pre-filled diluent syringe.
BeneFIX does not contain a preservative. After reconstituting BeneFIX, you can store it at room temperature for up to 3 hours. If you have not used it in 3 hours, throw it away.
Do not use BeneFIX if the reconstituted solution is not clear and colorless.
What else should I know about BeneFIX?
Medicines are sometimes prescribed for purposes other than those listed here. Do not use BeneFIX for a condition for which it was not prescribed. Do not share BeneFIX with other people, even if they have the same symptoms that you have.
This Patient Leaflet summarizes the most important information about BeneFIX. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about BeneFIX that was written for healthcare professionals.
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