KEDRAB by is a Other medication manufactured, distributed, or labeled by Kedrion Biopharma Inc., Kamada Ltd.. Drug facts, warnings, and ingredients follow.
KEDRAB is a human rabies immunoglobulin (HRIG) indicated for passive, transient post-exposure prophylaxis of rabies infection, when given immediately after contact with a rabid or possibly rabid animal. KEDRAB should be administered concurrently with a full course of rabies vaccine (1).
The most frequent adverse events in subjects treated with KEDRAB in clinical trials were injection site pain, headache, muscle pain, and upper respiratory tract infection (6).
To report SUSPECTED ADVERSE REACTIONS, contact Kedrion Biopharma Inc. Customer Service (1-855-353-7466) in the United States. Outside of the United States, the company distributing these products should be contacted. Voluntary reporting of adverse reactions may also be made to the FDA through MedWatch at 1-800-FDA-1088 or on the Internet at www.fda.gov/medwatch. or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
See 17 for PATIENT COUNSELING INFORMATION.
Revised: 8/2017
KEDRAB is a human rabies immunoglobulin (HRIG) indicated for passive, transient post-exposure prophylaxis (PEP) of rabies infection, when given immediately after contact with a rabid or possibly rabid animal. KEDRAB should be administered concurrently with a full course of rabies vaccine.
Local Treatment of Wounds prior to KEDRAB Administration
The World Health Organization (WHO) and the U.S. Public Health Service Advisory Committee on Immunization Practices (ACIP) have outlined recommendations for passive and active immunization after exposure to an animal suspected of having rabies.1,2,3 Immediate and thorough cleansing of all bite wounds and scratches with soap and water is an important component of post-exposure prophylaxis (PEP). A virucidal agent (e.g., povidone-iodine solution) should be used to irrigate the wounds.
Tetanus prophylaxis and measures to control bacterial infection should be given if medically indicated.
Post-exposure prophylaxis consists of a single dose of KEDRAB and a full course of rabies vaccine. The recommended dose of KEDRAB is 20 IU/kg body weight, given at the time of the first vaccine dose. KEDRAB and the first dose of rabies vaccine should be given as soon as possible after exposure, as delays are potentially lethal. However, should a delay occur, KEDRAB should be administered at any time up to and including seven days after the first dose of vaccine. The rabies vaccine should be given according to the manufacturer's instructions.
No more than the recommended dose of KEDRAB should be given because KEDRAB partially suppresses active antibody production following vaccination. For the same reason, additional doses of KEDRAB should not be given, even if the antibody response to vaccination is delayed.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. If either of these conditions exists, DO NOT use KEDRAB; discard the vial.
Further Information on Rabies Post-Exposure Prophylaxis
Consult local or state public health officials if questions arise about the need for rabies prophylaxis.
KEDRAB is supplied in single-use vials containing 2 mL or 10 mL of ready-to-use solution with a nominal potency of 150 IU/mL.
The 2-mL vial contains a total of 300 IU and the 10-mL vial contains a total of 1,500 IU. The final product is assayed with human rabies immunoglobulin reference standard that is calibrated against the WHO International Standard.
Despite these measures, KEDRAB administration can still potentially transmit infectious diseases. There is also the possibility that unknown infectious agents may be present in KEDRAB.
Any infection considered to have possibly been transmitted by this product should be reported by the physician or other healthcare provider to Kedrion Biopharma Inc. Customer Service (1-855-353-7466) or FDA at 1-800-FDA-1088.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates of adverse reactions in clinical trials of another drug and may not reflect the rates observed in clinical practice.
KEDRAB was evaluated in three single-center, controlled clinical trials. Subjects in the clinical studies of KEDRAB were healthy adults, primarily white and ranged in age from 18 to 72 years. A total of 160 subjects were treated in these three studies, including 91 subjects who received single intramuscular doses of KEDRAB (20 IU/kg) with or without rabies vaccine.
Table 1 summarizes adverse events (assessed by the investigator as related or unrelated to study treatment) occurring in >3% of subjects in the clinical trials of KEDRAB. The most frequent adverse events in the KEDRAB group (>6%) were injection site pain, headache, muscle pain, and upper respiratory tract infection (Table 1).
Data are presented as number of subjects (% of subjects) |
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KEDRAB
N = 91 | Comparator HRIG
N = 84 | Saline Placebo + Vaccine
N = 8 |
|
Injection site pain | 30 (33) | 26 (31) | 2 (25) |
Headache | 14 (15) | 11 (13) | 3 (38) |
Muscle pain | 8 (9) | 6 (7) | 0 (0) |
Upper respiratory tract infection | 8 (9) | 8 (10) | 0 (0) |
Joint pain | 5 (6) | 0 (0) | 1 (13) |
Dizziness | 5 (6) | 3 (4) | 0 (0) |
Fatigue | 5 (6) | 2 (2) | 0 (0) |
Abdominal pain | 4 (4) | 1 (1) | 0 (0) |
Blood in urine | 4 (4) | 2 (2) | 0 (0) |
Nausea | 4 (4) | 3 (4) | 0 (0) |
Feeling faint | 4 (4) | 1 (1) | 0 (0) |
Bruising | 3 (3) | 1 (1) | 0 (0) |
Sunburn | 3 (3) | 0 (0) | 0 (0) |
White blood cells in urine | 3 (3) | 4 (5) | 0 (0) |
Less common adverse events were joint pain, dizziness, fatigue, abdominal pain, blood in urine, nausea, feeling faint, bruising, sunburn, and white blood cells in urine.
Risk Summary
KEDRAB has not been studied in pregnant women. Therefore, the risk of major birth defects and miscarriage in pregnant women who are exposed to KEDRAB is unknown. Animal developmental or reproduction toxicity studies have not been conducted with KEDRAB. It is not known whether KEDRAB can cause harm to the fetus when administered to a pregnant woman or whether KEDRAB can affect reproductive capacity. In the U.S. general population, the estimated background of major birth defects occurs in 2-4% of the general population and miscarriage occurs in 15-20% of clinically recognized pregnancies.
Risk Summary
There is no information regarding the presence of KEDRAB in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for KEDRAB and any potential adverse effects on the breastfed infant from KEDRAB or from the underlying maternal condition.
The safety and effectiveness of KEDRAB in the pediatric population have not been established.
Clinical studies of KEDRAB did not include sufficient numbers of subjects aged 65 years and over to determine whether they respond differently from younger subjects. Clinical experience with HRIG products has not identified differences in effectiveness between elderly and younger patients (ACIP)1.
KEDRAB is a sterile, non-pyrogenic aqueous solution of anti-rabies immunoglobulin (≥95% protein as IgG). The product is stabilized with 0.3 M glycine and has a pH of 5.5 ± 0.5. It does not contain preservatives and the vial stopper is not made with natural rubber latex. KEDRAB is a clear to opalescent liquid.
KEDRAB is prepared from human plasma from donors hyper-immunized with rabies vaccine. Individual plasma units are tested using FDA-licensed serologic assays for hepatitis B surface antigen (HBsAg) and for antibodies to hepatitis C virus (HCV) and human immunodeficiency virus types 1 and 2 (HIV-1/2), as well as by FDA-licensed Nucleic Acid Testing (NAT) for hepatitis B virus (HBV), HCV and HIV-1. Each plasma unit must be non-reactive (negative) in all tests. Plasma is also tested by in-process NAT procedures for HAV and parvovirus B19. Each plasma unit must be non-reactive to HAV, while the limit in the manufacturing pool is set not to exceed 104 IU per mL for parvovirus B19.
To reduce the risk of viral transmission further, the manufacturing process for KEDRAB includes three steps specifically designed to remove or inactivate viruses. The first of these is solvent/detergent (S/D) treatment with a mixture of tri-(n-butyl) phosphate (TnBP) and Octynoxol 9, which inactivates enveloped viral agents such as HIV, HBV and HCV. The second and third are heat-treatment (pasteurization) steps, which can inactivate both enveloped and non–enveloped viruses, and a nanofiltration (NF) step which removes viruses on the basis of size. The effectiveness of the S/D treatment, pasteurization and nanofiltration procedures for reducing viral content has been assessed using a series of viruses with a range of physico-chemical characteristics. The results of the viral challenge studies are summarized in Table 2.
Abbreviations: BVDV: bovine viral diarrhea virus; EMCV: encephalomyocarditis virus; HIV-1: human immunodeficiency virus 1; HRIG: human rabies immune globulin; PPV: Porcine parvovirus; PRV: Pseudorabies virus; S/D: solvent/detergent; WNV: West Nile Virus |
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Process Step | Enveloped Viruses | Non-enveloped Viruses | ||||
HIV-1 | BVDV | PRV | WNV | EMCV | PPV | |
S/D treatment | >4.99 | >5.70 | >4.38 | >5.46 | Not tested | Not tested |
Heat treatment | >6.21 | >5.67 | Not tested | >6.33 | 3.30 | Not tested |
Nanofiltration | Not tested | Not tested | >6.58 | Not tested | >7.66 | 3.41 |
Global Log10 Reduction Factor | >11.20 | >11.37 | >10.96 | >11.79 | >10.96 | 3.41 |
Rabies is a zoonotic disease caused by RNA viruses in the family Rhabdoviridae, genus Lyssavirus. Virus is typically present in the saliva of rabid mammals and is transmitted primarily through a bite. KEDRAB is infiltrated into the inoculation site (i.e., at the beginning of anti-rabies PEP) to previously unvaccinated persons, to provide immediate passive rabies virus neutralizing antibody protection until the patient's immune system responds to vaccination by actively producing antibodies.
A protective threshold for rabies virus neutralizing activity (RVNA) has never been established. However, the WHO has generally accepted a RVNA of at least 0.5 IU/mL measured 14 days after initiation of PEP as protective. By comparison, the ACIP recommends complete neutralization of rabies virus at a 1:5 serum dilution by a rapid fluorescent focus inhibition test (RFFIT) from 1 to 2 weeks after prophylaxis; this corresponds to RVNA ~0.1-0.2 IU/mL. In support of these recommendations, there has been almost no documented clinical disease when the current rabies PEP regimen is administered appropriately (ACIP) 1.
KEDRAB has the potential to attenuate the patient's immune response to rabies vaccine. This was evaluated in a double-blind, randomized study where 16 healthy subjects were administered either KEDRAB (20 IU/kg IM) or saline placebo followed by three doses of a rabies vaccine (Table 3). Lower RVNA levels were seen in the KEDRAB + vaccine group compared to the placebo + vaccine group at all time-points beginning on Day 14, confirming that KEDRAB interferes with the host immune response to rabies vaccine.
A randomized, single-dose, two-period, two-treatment, two-sequence, double-blind, crossover study assessed the pharmacokinetics of KEDRAB. Twenty-six healthy volunteer subjects were randomized to receive a single IM injection of 20 IU/kg HRIG on two separate occasions (KEDRAB or Comparator HRIG). Subjects received the second treatment (A or B) following the 42-day test period and a 21-day washout period. Single dose IM injection of KEDRAB resulted in maximum plasma RVNA levels of 0.25 IU/mL. The median Tmax was 7 days (range: 3 – 14 days). The elimination half-life was approximately 17.9 days. A statistical analysis of the pharmacokinetic parameters showed that KEDRAB was not bioequivalent to the Comparator HRIG (Table 3).
Abbreviations: AUC: area under the concentration-time curve; Cmax: maximum concentration; inf: infinity; IU: international units; mL: milliliter; PK: Pharmacokinetic; RVNA: rabies virus neutralizing antibody |
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Parameter | Units | Geometric LS Mean Values | Test/Reference
(%) | 90% Confidence
Interval (%) |
|
KEDRAB | Comparator HRIG | ||||
Cmax | IU/mL | 0.24 | 0.30 | 81.71 | 75.34-88.62 |
AUC0-last | Day*IU/mL | 5.08 | 6.17 | 82.35 | 77.39-87.63 |
AUC0-inf | Day*IU/mL | 6.64 | 7.86 | 84.44 | 78.63-90.68 |
A plot of plasma rabies virus neutralizing antibody titer concentration versus time (Figure 1) demonstrated that, in both treatment groups, plasma rabies virus neutralizing antibody concentrations declined in a biphasic manner after the absorption phase was complete.
Figure 1: Plasma HRIG Concentrations [Mean (±SD)] at Scheduled PK Sampling Days (Semi-log Scale), Phase 2/3 Study, Pharmacokinetic Analysis
Additionally, a prospective, randomized, double-blind, non-inferiority, study evaluated the pharmacokinetics, safety and effectiveness of simulated post-exposure prophylaxis with KEDRAB with co-administration of active rabies vaccine in 118 healthy subjects. Subjects were randomized into two treatment groups (59 per treatment group) to receive intramuscular KEDRAB or comparator HRIG at a dose of 20 IU/kg on Day 0, and rabies vaccine on Days 0, 3, 7, 14 and 28. The peak plasma RVNA was 71.9 IU/mL and 53.9 IU/mL for KEDRAB and comparator HRIG respectively. For both treatment groups, the median Tmax was 14 days (range: 14 – 49 days). The half-lives were 48.6 hours and 52.7 hours for KEDRAB and comparator HRIG respectively.
Bioequivalent assessment showed that KEDRAB was not bioequivalent to the comparator HRIG when co-administered with a five-dose rabies vaccine regimen (Table 4). Furthermore, the RVNA on Day 3 was lower in the KEDRAB with rabies vaccine group relative to the Comparator HRIG with vaccine group (0.188±0.051 vs 0.229±0.054, P=0.0005). However, these pharmacokinetic differences are not expected to affect clinical outcomes.
Abbreviations: AUC: area under the concentration-time curve; Cmax: maximum concentration; inf: infinity; IU: international units; mL: milliliter; RVNA: rabies virus neutralizing antibody |
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Parameter | Units | Geometric LS Mean Values | Test/Reference
(%) | 90% Confidence
Interval (%) |
|
KEDRAB (Test)
| Comparator HRIG
(Reference) |
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Cmax | IU/mL | 44.87 | 36.02 | 124.59 | 90.62-171.28 |
AUC0-last | Day*IU/mL | 1741.40 | 1686.03 | 103.28 | 79.03-134.98 |
AUC0-inf | Day*IU/mL | 2045.87 | 1916.90 | 106.73 | 80.48-141.54 |
Please see Clinical Studies (14) section for clinical efficacy.
The efficacy of KEDRAB administered concurrently with rabies vaccine was studied in a single-center, randomized, comparator HRIG-controlled clinical study. Study subjects were healthy adults 18 to 72 years of age who were without significant acute or chronic illness. A total of 118 subjects (59 per treatment group) received intramuscular KEDRAB or comparator HRIG at a dose of 20 IU/kg on Day 0, and rabies vaccine on Days 0, 3, 7, 14 and 28. The mean age of study subjects was 45 years; subjects were, predominantly white (93%), and 64% were women. The efficacy variable was RVNA, as assessed by RFFIT, on Day 14. Efficacy analyses were performed on the As-Treated Population, which comprised the 116 study subjects who received KEDRAB or comparator HRIG and at least 3 of the 5 doses of rabies vaccine before Day 14.
Efficacy, considered when RVNA titer is 0.5 IU/mL or higher on Day 14 (as established by the WHO), was met by 56/57 subjects (98.2%) in the KEDRAB group and 59/59 subjects in the comparator HRIG group (Table 5). The lower limit of the 90% CI was greater than the pre-specified non-inferiority margin of -10%; thus, KEDRAB was non-inferior to comparator HRIG.
a 'Pa' and 'Pb' are the proportion of participants with IgG antibody titer ≥0.5 IU/mL on Day 14 in Groups A and B, respectively. Group A = KEDRAB +Rabies Vaccine, Group B = Control HyperRAB®+Rabies Vaccine. |
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b based on Farrington-Manning score statistic. |
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Abbreviations: CI: confidence interval; HRIG: human rabies immune globulin; IU: international units; mL: milliliter |
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KEDRAB with Rabies Vaccine
(N=57) | Comparator HRIG with Rabies Vaccine
(N=59) |
|
Rabies virus neutralizing antibody titer ≥0.5 IU/mL, n (%) | 56 (98.2) | 59 (100) |
Exact 95% CI for proportion (%) | (90.6, 100) | (93.9, 100) |
Difference (Pa-Pb)a (%) | -1.8 | |
Exact 90% CI for differenceb (%) | (-8.1, 3.0) |
Additional efficacy analyses included pharmacokinetics [see Clinical Pharmacology (12)].
The KEDRAB manufacturing process includes three valid and effective viral elimination steps. In addition, the process allows the removal of thrombogenic activity.
Inform patients that KEDRAB is made from human plasma and may contain infectious agents that can cause disease (e.g., viruses and, theoretically, the CJD agent). Explain that the risk of KEDRAB transmitting an infectious agent has been reduced by screening the plasma donors, by testing the donated plasma for certain virus infections, and by a process demonstrated to inactivate and/or remove certain viruses during manufacturing [see Warnings and Precautions (5.7)]. Inform patients of symptoms of a possible viral infection, including headache, fever, nausea, vomiting, weakness, malaise, diarrhea, or, in the case of hepatitis, jaundice.
Distributed by:
Kedrion Biopharma Inc.
Parker Plaza, 400 Kelby St.
Fort Lee, NJ 07024
United States
Manufactured by:
Kamada Ltd.
Beit Kama
MP Negev 8532500
Israel
US License No. 1826
Principal Display Panel – 2mL Carton Label
NDC-76125-150-02
KEDRAB
Rabies Immune Globulin (Human)
150 IU/mL
For wound infiltration and intramuscular
use. Do not administer intravenously.
Store at 2-8 °C (36-46 °F). Do not freeze.
Single use vial. Discard any unused
contents.
Preservative Free, Latex Free, Sterile,
Pyrogen Free.
The patient and physician should discuss
the risks and benefits of this product.
Rx only
2 mL
KAMADA
KEDRION
BIOPHARMA
Principal Display Panel – 2mL Vial Label
NDC-76125-150-03
KEDRAB Rabies Immune Globulin (Human) 150 IU/ml
For wound infiltration and intramuscular use. Do not administer intravenously.
See package insert for dosage information. Single use vial.
Store at 2-8 °C (36-46 °F). Do not freeze. Rx only
Distributed by: Kedrion Biopharma Inc.
Parker Plaza, 400 Kelby St, Fort Lee, NJ 07024 United States
Manufactured by: Kamada Ltd. Beit Kama MP Negev 8532500 Israel
U.S. License No. 1826
2mL
Principal Display Panel – 10mL Carton Label
NDC-76125-150-10
KEDRAB
Rabies Immune Globulin (Human)
150 IU/mL
For wound infiltration and intramuscular
use. Do not administer intravenously.
Store at 2-8 °C (36-46 °F). Do not freeze.
Single use vial. Discard any unused
contents.
Preservative Free, Latex Free, Sterile,
Pyrogen Free.
The patient and physician should discuss
the risks and benefits of this product.
Rx only
10 mL
KAMADA
KEDRION
BIOPHARMA
Principal Display Panel – 10mL Vial Label
NDC-76125-150-11
KEDRAB Rabies Immune Globulin (Human) 150 IU/ml
For wound infiltration and intramuscular use. Do not administer intravenously.
See package insert for dosage information. Single use vial.
Store at 2-8 °C (36-46 °F). Do not freeze. Rx only
Distributed by: Kedrion Biopharma Inc.
Parker Plaza, 400 Kelby St, Fort Lee, NJ 07024 United States
Manufactured by: Kamada Ltd. Beit Kama MP Negev 8532500 Israel
U.S. License No. 1826
10mL
KEDRAB
human rabies virus immune globulin injection, solution |
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Labeler - Kedrion Biopharma Inc. (078622209) |
Registrant - Kamada Ltd. (600251631) |
Establishment | |||
Name | Address | ID/FEI | Business Operations |
---|---|---|---|
Kamada Ltd. | 649062486 | MANUFACTURE, LABEL, PACK, ANALYSIS |
Mark Image Registration | Serial | Company Trademark Application Date |
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KEDRAB 87636954 5623863 Live/Registered |
Kamada Ltd. 2017-10-06 |
KEDRAB 86173344 not registered Dead/Abandoned |
Kamada Ltd. 2014-01-23 |