Arzerra (ofatumumab) Injection for Leukemia Side Effects & Dosage

What is Arzerra (ofatumumab), and how does it work?

Generic drug: ofatumumab

Brand name: Arzerra

Arzerra (ofatumumab) Injection is a monoclonal antibody used to treat chronic lymphocytic leukemia. Arzerra is usually given after other medications have been tried without successful treatment of symptoms.

What are the side effects of Arzerra?

Common side effects of Arzerra include:

• nausea,
• vomiting,
• diarrhea,
• tiredness,
• swelling of hands/ankles/feet,
• trouble sleeping,
• skin rash, or
• cold symptoms such as stuffy nose, sneezing, and sore throat.

Arzerra decreases bone marrow function, an effect that may lead to a low number of blood cells such as red cells, white cells, and platelets. This side effect of Arzerra can cause anemia, decrease your body's ability to fight an infection, or cause easy bruising or bleeding. Tell your doctor if you have the following symptoms:

• easy bruising/bleeding,
• pale skin,
• unusual tiredness, or
• signs of infection (such as fever, chills, cough, persistent sore throat).

WARNING

HEPATITIS B VIRUS REACTIVATION AND PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

• Hepatitis B Virus (HBV) reactivation can occur in patients receiving CD20-directed cytolytic antibodies, including
  Arzerra,
  in some cases resulting in fulminant hepatitis, hepatic failure, and death.
• Progressive Multifocal Leukoencephalopathy (PML) resulting in death can occur in
  patients receiving CD20-directed cytolytic antibodies, including Arzerra.

What is the dosage for Arzerra?

Recommended Dosage Regimen

• Dilute and administer as an intravenous infusion according to the following schedules.
• Do not administer as an intravenous push or bolus or as a subcutaneous injection.
• Pre-medicate before each infusion.

Previously Untreated CLL:

The recommended dosage and schedule in combination with chlorambucil is:

• 300 mg on Day 1, followed 1 week later by 1,000 mg on Day 8 (Cycle 1), followed by
• 1,000 mg on Day 1 of subsequent 28-day cycles for a minimum of 3 cycles until best response or a maximum of 12 cycles.

Relapsed CLL:

The recommended dosage and schedule in combination with fludarabine and cyclophosphamide is:

• 300 mg on Day 1, followed 1 week later by 1,000 mg on Day 8 (Cycle 1), followed by
• 1,000 mg on Day 1 of subsequent 28-day cycles for a maximum of 6 cycles.

Extended Treatment In CLL:

The recommended dosage and schedule as single-agent extended treatment in CLL is:

• 300 mg on Day 1, followed by
• 1,000 mg 1 week later on Day 8, followed by
• 1,000 mg 7 weeks later and every 8 weeks thereafter for up to a maximum of 2 years.

Refractory CLL:

The recommended dosage and schedule is 12 doses administered as follows:

• 300 mg initial dose on Day 1, followed 1 week later by
• 2,000 mg weekly for 7 doses (Infusions 2 through 8), followed 4 weeks later by
• 2,000 mg every 4 weeks for 4 doses (Infusions 9 through 12).

Administration

Administer
Arzerra in an environment
where facilities to adequately monitor and treat infusion reactions are
available.

Prepare all doses in 1,000 mL of 0.9% Sodium Chloride
Injection, USP.

Previously Untreated CLL, Relapsed CLL, And Extended Treatment In CLL:

• For initial 300-mg dose: Initiate infusion at a rate of 3.6 mg/hour (12 mL/hour).
• For subsequent infusions of 1,000 mg: Initiate infusion at a rate of 25 mg/hour (25 mL/hour). Initiate infusion at a rate of 12 mg/hour if a Grade 3 or greater infusion-related adverse event was experienced during the previous infusion.

In the absence of an infusion-related adverse event, the rate of infusion may be increased every 30 minutes (Table 1). Do not exceed the infusion rates in Table 1.

Table 1. Infusion Rates for
Arzerra in Previously Untreated CLL, Relapsed CLL, and Extended Treatment in CLL

Interval After
Start of Infusion (min)Initial 300 mg Dose^a
(mL/hour)Subsequent Infusions^b
(mL/hour)0-30122531-60255061-905010091-120100200121-150200400151-180300400>180400400^a Initial 300 mg: median durations of infusions = 4.8 to 5.2 hours.
^b Subsequent infusions of 1,000 mg: median durations of infusions = 4.2 to 4.4 hours.

Refractory CLL:

• Infusion 1 (300-mg dose): Initiate infusion at a rate of 3.6 mg/hour (12 mL/hour).
• Infusion 2 (2,000-mg dose): Initiate infusion at a rate of 24 mg/hour (12 mL/hour).
• Infusions 3 through 12 (2,000-mg doses): Initiate infusion at a rate of 50 mg/hour (25 mL/hour).

In the absence of an infusion-related adverse event, the rate of infusion may be increased every 30 minutes (Table 2). Do not exceed the infusion rates in Table 2.

Table 2. Infusion Rates for
Arzerra in Refractory CLL

Interval after Start of Infusion (min)Infusions 1 and 2^a
(mL/hour)Subsequent Infusions ^b 
(mL/hour)0-30122531-60255061-905010091-120100200>120200400^a Infusions 1 and 2 (300 mg and 2,000 mg): median duration of infusions = 6.8 hours.
^b Subsequent infusions of 2,000 mg: median durations of infusions = 4.2 to 4.4 hours.

Infusion Rate Dose Modification For Infusion Reactions

• Interrupt infusion for infusion reactions of any severity. Treatment can be resumed at the discretion of the treating physician. The following infusion rate modifications can be used as a guide.
• If the infusion reaction resolves or remains less than or equal to Grade 2, resume infusion with the following modifications according to the initial Grade of the infusion reaction.
  • Grade 1 or 2: Infuse at one-half of the previous infusion rate.
  • Grade 3 or 4: Infuse at a rate of 12 mL/hour.
• After resuming the infusion, the infusion rate may be increased according to Tables 1 and 2 above, based on patient tolerance.
• Consider permanent discontinuation of
  Arzerra if the severity of the infusion reaction does not resolve to less than or equal to Grade 2 despite adequate clinical intervention.
• Permanently discontinue therapy for patients who develop an anaphylactic reaction to
  Arzerra.

Premedication

Patients should receive all of the following premedication agents 30 minutes to 2 hours prior to each infusion of
Arzerra. See Table 3 for pre-medication schedule prior to each infusion.

Table 3. Premedication Schedule for Arzerra

Previously Untreated CLL, Relapsed CLL or Extended Treatment in CLLRefractory CLLInfusion Number1 and 23 and beyond^a1, 2, and 93 to 810 to 12Intravenous corticosteroid (prednisolone or equivalent)50 mg0-50 mg^b100 mg0-100 mg^b50-100 mg^cOral acetaminophen1,000 mgOral or intravenous antihistamineDiphenhydramine 50 mg or cetirizine 10 mg (or quivalent)^a Up to 13 infusions in previously untreated CLL; up to 7 infusions in relapsed CLL, up to 14 infusions in extended treatment in CLL.
^b Corticosteroid may be reduced or omitted for subsequent infusions if a Grade 3 or greater infusion-related adverse event did not occur with the preceding infusion(s).
^c Prednisolone may be given at reduced dose of 50 mg to 100 mg (or equivalent) if a Grade 3 or greater infusion-related adverse event did not occur with Infusion 9.

Preparation And Administration

• Do not shake product.
• Inspect parenteral drug products visually for particulate matter and discoloration prior to administration.
  Arzerra should be a clear to opalescent, colorless solution. The solution should not be used if discolored or cloudy, or if foreign particulate matter is present.

Preparation Of Solution:

• 300-mg dose: Withdraw and discard 15 mL from a 1,000-mL bag of 0.9% Sodium Chloride Injection, USP. Withdraw 5 mL from each of 3 single-use 100-mg vials of
  Arzerra and add to the bag. Mix diluted solution by gentle inversion.
• 1,000-mg dose: Withdraw and discard 50 mL from a 1,000-mL bag of 0.9% Sodium Chloride Injection, USP. Withdraw 50 mL from 1 single-use 1,000-mg vial of
  Arzerra and add to the bag. Mix diluted solution by gentle inversion.
• 2,000-mg dose: Withdraw and discard 100 mL from a 1,000-mL bag of 0.9% Sodium Chloride Injection, USP. Withdraw 50 mL from each of 2 single-use 1,000-mg vials of
  Arzerra and add to the bag. Mix diluted solution by gentle inversion.
• Store diluted solution between 2° to 8°C (36° to 46°F).
• No incompatibilities between
  Arzerra and polyvinylchloride or polyolefin bags and administration sets have been observed.

Administration Instructions:

• Do not mix
  Arzerra with, or administer as an infusion with other medicinal products.
• Administer using an infusion pump and an administration set.
• Flush the intravenous line with 0.9% Sodium Chloride Injection, USP before and after each dose.
• Start infusion within 12 hours of preparation.
• Discard prepared solution after 24 hours.

What drugs interact with Arzerra?

No Information Provided

Is Arzerra safe to use while pregnant or breastfeeding?

• Arzerra may cause fetal B-cell depletion based on findings from animal studies and the drug’s mechanism of action.
• There are no data on Arzerra use in pregnant women to inform a drug-associated risk. However, there are clinical considerations.
• There is no information regarding the presence of Arzerra in human milk, the effects on the breastfed infant, or the effects on milk production.
• Human IgG is known to be present in human milk. Published data suggest that antibodies in breast milk do not enter the neonatal and infant circulations in substantial amounts.