zymfentra

Important safety information

Serious injections, including invasive fungal infections: Avoid use of ZYMFENTRA in patients with an active infection. If infection develops during treatment, conduct a prompt and complete diagnostic workup appropriate for an immunocompromised patient and initiate antimicrobial therapy. If systemic illness develops in patients who reside or travel to regions where mycoses are endemic, consider empiric antifungal therapy. ( 5.1 ) Malignancies : The incidence of malignancies, including lymphoma, was greater in TNF blocker-treated patients than in controls. Consider the higher risk of hepatosplenic T-cell lymphoma (HSTCL) with combination therapy versus increased tisk of immunogenicity and hypersensitivity reactions with monotherapy. ( 5.2 ) Hepatitis B virus (HBV) reactivation: Test for HBV infection before starting ZYMFENTRA. Monitor HBV carriers during and several months after therapy for active HBV infection. If reactivation occurs, stop ZYMFENTRA and begin anti-viral therapy. ( 5.3 ) Hepatotoxicity: Severe hepatic reactions, some fatal or necessitating liver transplantation with infliximab products. Monitor hepatic enzymes and liver function tests every 3 to 4 months during treatment; investigate liver enzyme elevations and interrupt treatment if drug-induced liver injury is suspected. Instruct patients to seek immediate medical attention if symptoms develop. ( 5.4 ) Congestive heart failure (CHF) : New onset or worsening symptoms may occur. Avoid ZYMFENTRA in patients with CHF. Monitor for new or worsening symptoms if a decision is made to administer ZYMFENTRA. ( 5.5 ) Hematologic Reactions : Advise patients to seek immediate medical attention if signs and symtoms of cytopenia develop; consider stopping ZYMFENTRA if significant hematologic abnormalities devlop. ( 5.6 ) Hypersensitivity and Other Administration Reactions : Serious systemic hypersensitivity reactions including anaphylaxis; institute appropriate therapy and discontinue ZYMFENTRA. ( 4 , 5.7 ) Neurologic Reactions : Exacerbation or new onset CNS demyelinating disorders may occurs; consider discontinuation of ZYMFENTRA. ( 5.8 ) Risk of infection with concurrent administration of other biological products : Concurrent use with other immunosuppressive biological products may increase the risk of injection ( 5.9 ) Risk of additive immunosuppressive effects from prior biologic products : Consider the half-life and mode of action of prior biological products. ( 5.10 ) Autoimmunity : Formation of autoantibodies and development of lupus-like syndrome may occur; discontinue ZYMFENTRA if symptoms develop. ( 5.11 ) V accinations and Use of Live Vaccines/Therapeutic Infectious Agents: Prior to initiating ZYMFENTRA bring patients up to date with all vaccinations. Live vaccines or therapeutic infectious agents should not be given with ZYMFENTRA. A 6-month waiting period following birth is recommended before the administration of live vaccines to infants exposed in utero to infliximab products. ( 5.12 ) 5.1 Serious Infections Patients treated with ZYMFENTRA are at increased risk for developing serious infections involving various organ systems and sites that may lead to hospitalization or death. Opportunistic infections due to bacterial, mycobacterial, invasive fungal, viral, or parasitic organisms including aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, legionellosis, listeriosis, pneumocystosis, salmonellosis and tuberculosis have been reported with TNF blockers. Patients have frequently presented with disseminated rather than localized disease. Treatment with ZYMFENTRA should not be initiated in patients with an active infection, including clinically important localized infections.Patients greater than 65 years of age, patients with comorbid-conditions and/or patients taking concomitant immunosuppressants such as corticosteroids or methotrexate may be at greater risk of infection. The risks and benefits of treatment should be considered prior to initiating therapy in patients: with chronic or recurrent infection; who have been exposed to tuberculosis; with a history of an opportunistic infection; who have resided or traveled in areas of endemic tuberculosis or endemic mycoses, such as histoplasmosis, coccidioidomycosis, or blastomycosis; or with underlying conditions that may predispose them to infection. Tuberculosis Cases of reactivation of tuberculosis or new tuberculosis infections have been observed in patients receiving TNF-blockers, including patients who have previously received treatment for latent or active tuberculosis. Cases of active tuberculosis have also occurred in patients being treated with infliximab products during treatment for latent tuberculosis. Evaluate patients for tuberculosis risk factors and test for latent infection prior to initiating ZYMFENTRA and periodically during therapy. Treatment of latent tuberculosis infection prior to therapy with TNF blockers has been shown to reduce the risk of tuberculosis reactivation during therapy. Induration of 5 mm or greater with tuberculin skin testing should be considered a positive test result when assessing if treatment for latent tuberculosis is needed prior to initiating ZYMFENTRA even for patients previously vaccinated with Bacille Calmette-Guérin (BCG). Consider anti-tuberculosis therapy prior to initiation of ZYMFENTRA in patients with a past history of latent or active tuberculosis in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent tuberculosis but having risk factors for tuberculosis infection. Consultation with a physician with expertise in the treatment of tuberculosis is recommended to aid in the decision whether initiating anti-tuberculosis therapy is appropriate for an individual patient. Tuberculosis should be strongly considered in patients who develop a new infection during treatment with ZYMFENTRA especially in patients who have previously or recently traveled to countries with a high prevalence of tuberculosis, or who have had close contact with a person with active tuberculosis. Monitoring Closely monitor patients for the development of signs and symptoms of infection during and after treatment with ZYMFENTRA including the development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy. Tests for latent tuberculosis infection may also be falsely negative while on therapy with ZYMFENTRA. Discontinue ZYMFENTRA if a patient develops a serious infection or sepsis. A patient who develops a new infection during treatment with ZYMFENTRA should undergo prompt and complete diagnostic workup appropriate for an immunocompromised patient; and appropriate antimicrobial therapy should be initiated, and the patient should be closely monitored. Invasive Fungal Infections For patients who reside or travel in regions where mycoses are endemic, invasive fungal infection should be suspected if they develop a serious systemic illness. Appropriate empiric antifungal therapy should be considered while a diagnostic workup is being performed. Antigen and antibody testing for histoplasmosis may be negative in some patients with active infection. When feasible, the decision to administer empiric antifungal therapy in these patients should be made in consultation with a physician with expertise in the diagnosis and treatment of invasive fungal infections and should take into account both the risk for severe fungal infection and the risks of antifungal therapy. 5.2 Malignancies Malignancies, some fatal, have been reported among children, adolescents and young adults who received treatment with TNF blockers (initiation of therapy ≤ 18 years of age), including infliximab products. AApproximately half of these cases were lymphomas, including Hodgkin’s and non-Hodgkin’s lymphoma. The other cases represented a variety of malignancies, including rare malignancies that are usually…