FLUARIX QUADRIVALENT 2019/2020- influenza virus vaccine suspension

FLUARIX QUADRIVALENT by

Drug Labeling and Warnings

FLUARIX QUADRIVALENT by is a Other medication manufactured, distributed, or labeled by GlaxoSmithKline Biologicals SA. Drug facts, warnings, and ingredients follow.

Drug Details [pdf]

  • 1 INDICATIONS AND USAGE

    FLUARIX QUADRIVALENT is indicated for active immunization for the prevention of disease caused by influenza A subtype viruses and type B viruses contained in the vaccine [see Description (11)]. FLUARIX QUADRIVALENT is approved for use in persons aged 6 months and older.

  • 2 DOSAGE AND ADMINISTRATION

    For intramuscular injection only.

    2.1 Dosage and Schedule

    The dose and schedule for FLUARIX QUADRIVALENT are presented in Table 1.

    Table 1. FLUARIX QUADRIVALENT: Dosing
    a One dose or 2 doses (0.5‑mL each) depending on vaccination history as per the annual Advisory Committee on Immunization Practices (ACIP) recommendation on prevention and control of seasonal influenza with vaccines. If 2 doses, administer each 0.5‑mL dose at least 4 weeks apart.

    Age

    Vaccination Status

    Dose and Schedule

    6 months through 8 years

    Not previously vaccinated with influenza vaccine

    Two doses (0.5‑mL each) at least 4 weeks apart

    Vaccinated with influenza vaccine in a previous season

    One or 2 dosesa (0.5‑mL each)

    9 years and older

    Not applicable

    One 0.5‑mL dose

    2.2 Administration Instructions

    Shake well before administration. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered.

    Attach a sterile needle to the prefilled syringe and administer intramuscularly.

    The preferred sites for intramuscular injection are the anterolateral thigh for children aged 6 through 11 months and the deltoid muscle of the upper arm for persons aged 12 months and older if muscle mass is adequate. Do not inject in the gluteal area or areas where there may be a major nerve trunk.

    Do not administer this product intravenously, intradermally, or subcutaneously.

  • 3 DOSAGE FORMS AND STRENGTHS

    FLUARIX QUADRIVALENT is a suspension for injection. Each 0.5‑mL dose is supplied in single-dose prefilled TIP‑LOK syringes.

  • 4 CONTRAINDICATIONS

    Do not administer FLUARIX QUADRIVALENT to anyone with a history of severe allergic reactions (e.g., anaphylaxis) to any component of the vaccine, including egg protein, or following a previous administration of any influenza vaccine [see Description (11)].

  • 5 WARNINGS AND PRECAUTIONS

    5.1 Guillain-Barré Syndrome

    If Guillain‑Barré syndrome (GBS) has occurred within 6 weeks of receipt of a prior influenza vaccine, the decision to give FLUARIX QUADRIVALENT should be based on careful consideration of the potential benefits and risks.

    The 1976 swine influenza vaccine was associated with an increased frequency of GBS. Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is inconclusive. If influenza vaccine does pose a risk, it is probably slightly more than 1 additional case/1 million persons vaccinated.

    5.2 Syncope

    Syncope (fainting) can occur in association with administration of injectable vaccines, including FLUARIX QUADRIVALENT. Syncope can be accompanied by transient neurological signs such as visual disturbance, paresthesia, and tonic-clonic limb movements. Procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope.

    5.3 Preventing and Managing Allergic Vaccine Reactions

    Prior to administration, the healthcare provider should review the immunization history for possible vaccine sensitivity and previous vaccination‑related adverse reactions. Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of FLUARIX QUADRIVALENT.

    5.4 Altered Immunocompetence

    If FLUARIX QUADRIVALENT is administered to immunosuppressed persons, including individuals receiving immunosuppressive therapy, the immune response may be lower than in immunocompetent persons.

    5.5 Limitations of Vaccine Effectiveness

    Vaccination with FLUARIX QUADRIVALENT may not protect all susceptible individuals.

    5.6 Persons at Risk of Bleeding

    As with other intramuscular injections, FLUARIX QUADRIVALENT should be given with caution in individuals with bleeding disorders, such as hemophilia or on anticoagulant therapy, to avoid the risk of hematoma following the injection.

  • 6 ADVERSE REACTIONS

    The safety experience with FLUARIX (trivalent influenza vaccine) is relevant to FLUARIX QUADRIVALENT because both vaccines are manufactured using the same process and have overlapping compositions [see Description (11)].

    6.1 Clinical Trials Experience

    Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. There is the possibility that broad use of FLUARIX QUADRIVALENT could reveal adverse reactions not observed in clinical trials.

    In adults who received FLUARIX QUADRIVALENT, the most common (≥10%) solicited local adverse reaction was pain (36%). The most common (≥10%) systemic adverse reactions were muscle aches (16%), headache (16%), and fatigue (16%).

    In children aged 6 through 35 months who received FLUARIX QUADRIVALENT, the most common (≥10%) solicited local adverse reactions were pain (17%) and redness (13%). The most common (≥10%) systemic adverse reactions were irritability (16%), loss of appetite (14%), and drowsiness (13%). In children aged 3 through 17 years who received FLUARIX QUADRIVALENT, solicited local adverse reactions were pain (44%), redness (23%), and swelling (19%). In children aged 3 through 5 years, the most common (≥10%) systemic adverse reactions were drowsiness (17%), irritability (17%), and loss of appetite (16%); in children aged 6 through 17 years, the most common systemic adverse reactions were fatigue (20%), muscle aches (18%), headache (16%), arthralgia (10%), and gastrointestinal symptoms (10%).

    FLUARIX QUADRIVALENT in Adults

    Trial 1 (NCT01204671) was a randomized, double-blind (2 arms) and open-label (one arm), active-controlled, safety, and immunogenicity trial. In this trial, subjects received FLUARIX QUADRIVALENT (n = 3,036) or one of 2 formulations of comparator trivalent influenza vaccine (FLUARIX; TIV-1, n = 1,010; or TIV-2, n = 610), each containing an influenza type B virus that corresponded to one of the 2 type B viruses in FLUARIX QUADRIVALENT (a type B virus of the Victoria lineage or a type B virus of the Yamagata lineage). The population was aged 18 years and older (mean age: 58 years) and 57% were female; 69% were white, 27% were Asian, and 4% were of other racial/ethnic groups. Solicited events were collected for 7 days (day of vaccination and the next 6 days). The frequencies of solicited adverse reactions are shown in Table 2.

    Table 2. FLUARIX QUADRIVALENT: Incidence of Solicited Local and Systemic Adverse Reactions within 7 Daysa of Vaccination in Adultsb (Total Vaccinated Cohort)
    Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available.
    n = Number of subjects with diary card completed.
    a Seven days included day of vaccination and the subsequent 6 days.
    b Trial 1: NCT01204671.
    c Contained the same composition as FLUARIX (trivalent formulation) manufactured for the 2010-2011 season and an additional influenza type B virus of Yamagata lineage.
    d Contained the same composition as FLUARIX manufactured for the 2010-2011 season (2 influenza A subtype viruses and an influenza type B virus of Victoria lineage).
    e Contained the same 2 influenza A subtype viruses as FLUARIX manufactured for the 2010-2011 season and an influenza type B virus of Yamagata lineage.
    f Grade 3 pain: Defined as significant pain at rest; prevented normal everyday activities.
      Grade 3 redness, swelling: Defined as >100 mm.
      Grade 3 muscle aches, headache, fatigue, arthralgia, gastrointestinal symptoms, shivering: Defined as prevented normal activity.
      Grade 3 fever: Defined as >102.2°F (39.0°C).
    g Gastrointestinal symptoms included nausea, vomiting, diarrhea, and/or abdominal pain.
    h Fever: Defined as ≥99.5°F (37.5°C).

    Adverse Reaction

    Trivalent Influenza Vaccine (TIV)

    FLUARIX QUADRIVALENTc

    n = 3,011-3,015

    %

    TIV-1

    (B Victoria)d

    n = 1,003

    %

    TIV-2

    (B Yamagata)e

    n = 607

    %

    Any

    Grade 3f

    Any

    Grade 3f

    Any

    Grade 3f

    Local

    Pain

    36

    0.8

    37

    1

    31

    0.5

    Redness

    2

    0

    2

    0

    2

    0

    Swelling

    2

    0

    2

    0

    1

    0

    Systemic

    Muscle aches

    16

    0.5

    19

    0.8

    16

    0.5

    Headache

    16

    0.9

    16

    0.8

    13

    0.7

    Fatigue

    16

    0.7

    18

    0.6

    15

    0.5

    Arthralgia

    8

    0.5

    10

    0.7

    9

    0.3

    Gastrointestinal symptomsg

    7

    0.4

    7

    0.2

    6

    0.3

    Shivering

    4

    0.4

    5

    0.3

    4

    0.2

    Feverh

    2

    0

    1

    0

    2

    0

    Unsolicited events occurring within 21 days of vaccination (Day 0 to 20) were reported in 13%, 14%, and 15% of subjects who received FLUARIX QUADRIVALENT, TIV-1, or TIV-2, respectively. The unsolicited adverse reactions that occurred most frequently (≥0.1% for FLUARIX QUADRIVALENT) included dizziness, injection site hematoma, injection site pruritus, and rash. Serious adverse events occurring within 21 days of vaccination were reported in 0.5%, 0.6%, and 0.2% of subjects who received FLUARIX QUADRIVALENT, TIV-1, or TIV-2, respectively.

    FLUARIX QUADRIVALENT in Children

    Trial 7 (NCT01439360) was a randomized, observer-blind, non-influenza vaccine-controlled trial evaluating the efficacy of FLUARIX QUADRIVALENT. In this trial, subjects aged 6 through 35 months received FLUARIX QUADRIVALENT (n = 6,006) or a control vaccine (n = 6,012). The comparator was pneumococcal 13-valent conjugate vaccine [Diphtheria CRM197 Protein] (Wyeth Pharmaceuticals, Inc.) in children younger than 12 months, HAVRIX (Hepatitis A Vaccine) in children 12 months and older with a history of influenza vaccination, or HAVRIX (Dose 1) and a varicella vaccine (U.S. Licensed Manufactured by Merck & Co., Inc. or Non-U.S. Licensed Manufactured by GlaxoSmithKline Biologicals) (Dose 2) in those with no history of influenza vaccination. Subjects were aged 6 through 35 months, and one child aged 43 months (mean age: 22 months); 51% were male; 27% were white, 45% were Asian, and 28% were of other racial/ethnic groups. Children aged 12 months and older with no history of influenza vaccination and children younger than 12 months received 2 doses of FLUARIX QUADRIVALENT or the control vaccine approximately 28 days apart. Children aged 12 months and older with a history of influenza vaccination received one dose. Solicited local adverse reactions and systemic adverse events were collected using diary cards for 7 days (day of vaccination and the next 6 days). The incidences of solicited adverse reactions are shown in Table 3.

    Table 3. FLUARIX QUADRIVALENT: Incidence of Solicited Local and Systemic Adverse Reactions within 7 Daysa after First Vaccination in Children Aged 6 through 35 Monthsb (Total Vaccinated Cohort)
    Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available.
    n = Number of subjects with diary card completed.
    a Seven days included day of vaccination and the subsequent 6 days.
    b Trial 7: NCT01439360.
    c Children younger than 12 months: pneumococcal 13-valent conjugate vaccine [Diphtheria CRM197 Protein] (Wyeth Pharmaceuticals, Inc.).
    d Children 12 months and older: HAVRIX (Hepatitis A Vaccine) for those with a history of influenza vaccination; or HAVRIX (Dose 1) and a varicella vaccine (U.S. Licensed Manufactured by Merck & Co., Inc. or Non-U.S. Licensed Manufactured by GlaxoSmithKline Biologicals) (Dose 2) for those with no history of influenza vaccination.
    e Grade 3 pain: Defined as cried when limb was moved/spontaneously painful.
      Grade 3 swelling, redness: Defined as >50 mm.
      Grade 3 irritability: Defined as crying that could not be comforted/prevented normal activity.
      Grade 3 loss of appetite: Defined as not eating at all.
      Grade 3 drowsiness: Defined as prevented normal activity.
      Grade 3 fever: Defined as >102.2°F (39.0°C).
    f Fever: Defined as ≥100.4°F (38.0°C).

    Adverse Reaction

    FLUARIX QUADRIVALENT

    %

    Non-Influenza Active Comparatorc,d

    %

    Any

    Grade 3e

    Any

    Grade 3e

    Local

    n = 5,899

    n = 5,896

    Pain

    17

    0.4

    18

    0.5

    Redness

    13

    0

    14

    0

    Swelling

    8

    0

    9

    0

    Systemic

    n = 5,898

    n = 5,896

    Irritability

    16

    0.7

    18

    1

    Loss of appetite

    14

    1

    15

    1

    Drowsiness

    13

    0.7

    14

    0.9

    Feverf

    6

    1

    7

    1

    In children who received a second dose of FLUARIX QUADRIVALENT or the Non-Influenza Active Comparator vaccine, the incidences of solicited adverse reactions following the second dose were generally lower than those observed after the first dose.

    Unsolicited adverse events occurring within 28 days of vaccination were reported in 44% and 45% of subjects who received FLUARIX QUADRIVALENT (n = 6,006) and the comparator vaccine (n = 6,012), respectively. Serious adverse events (SAEs) occurring during the study period (6 to 8 months) were reported in 3.6% of subjects who received FLUARIX QUADRIVALENT and in 3.3% of subjects who received the comparator vaccine.

    Trial 2 (NCT01196988) was a randomized, double-blind, active-controlled, safety, and immunogenicity trial. In this trial, subjects received FLUARIX QUADRIVALENT (n = 915) or one of 2 formulations of comparator trivalent influenza vaccine (FLUARIX; TIV-1, n = 912; or TIV-2, n = 911), each containing an influenza type B virus that corresponded to one of the 2 type B viruses in FLUARIX QUADRIVALENT (a type B virus of the Victoria lineage or a type B virus of the Yamagata lineage). Subjects were aged 3 through 17 years and 52% were male; 56% were white, 29% were Asian, 12% were black, and 3% were of other racial/ethnic groups. Children aged 3 through 8 years with no history of influenza vaccination received 2 doses approximately 28 days apart. Children aged 3 through 8 years with a history of influenza vaccination and children aged 9 years and older received one dose. Solicited local adverse reactions and systemic adverse events were collected using diary cards for 7 days (day of vaccination and the next 6 days). The frequencies of solicited adverse reactions are shown in Table 4.

    Table 4. FLUARIX QUADRIVALENT: Incidence of Solicited Local and Systemic Adverse Reactions within 7 Daysa after First Vaccination in Children Aged 3 through 17 Yearsb (Total Vaccinated Cohort)
    Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available.
    n = Number of subjects with diary card completed.
    a Seven days included day of vaccination and the subsequent 6 days.
    b Trial 2: NCT01196988.
    c Contained the same composition as FLUARIX (trivalent formulation) manufactured for the 2010-2011 season and an additional influenza type B virus of Yamagata lineage.
    d Contained the same composition as FLUARIX manufactured for the 2010-2011 season (2 influenza A subtype viruses and an influenza type B virus of Victoria lineage).
    e Contained the same 2 influenza A subtype viruses as FLUARIX manufactured for the 2010-2011 season and an influenza type B virus of Yamagata lineage.
    f Grade 3 pain: Defined as cried when limb was moved/spontaneously painful (children ˂6 years), or significant pain at rest, prevented normal everyday activities (children ≥6 years).
      Grade 3 redness, swelling: Defined as >50 mm.
      Grade 3 drowsiness: Defined as prevented normal activity.
      Grade 3 irritability: Defined as crying that could not be comforted/prevented normal activity.
      Grade 3 loss of appetite: Defined as not eating at all.
      Grade 3 fever: Defined as >102.2°F (39.0°C).
      Grade 3 fatigue, muscle aches, headache, arthralgia, gastrointestinal symptoms, shivering: Defined as prevented normal activity.
    g Percentage of subjects with any pain by age subgroup: 39%, 38%, and 37% for FLUARIX QUADRIVALENT, TIV-1, and TIV-2, respectively, in children aged 3 through 8 years and 52%, 50%, and 46% for FLUARIX QUADRIVALENT, TIV-1, and TIV-2, respectively, in children aged 9 through 17 years.
    h Fever: Defined as ≥99.5°F (37.5°C).
    i Gastrointestinal symptoms included nausea, vomiting, diarrhea, and/or abdominal pain.

     

     

    Trivalent Influenza Vaccine (TIV)

    FLUARIX QUADRIVALENTc

    % 

    TIV-1

    (B Victoria)d

    %

    TIV-2

    (B Yamagata)e

    %

     

    Any

    Grade 3f

    Any

    Grade 3f

    Any

    Grade 3f

    Adverse Reaction

    Aged 3 through 17 Years

    Local

    n = 903

    n = 901

    n = 905

    Paing

    44

    2

    42

    2

    40

    0.8

    Redness

    23

    1

    21

    0.2

    21

    0.7

    Swelling

    19

    0.8

    17

    1

    15

    0.2

    Aged 3 through 5 Years

    Systemic

    n = 291

    n = 314

    n = 279

    Drowsiness

    17

    1

    12

    0.3

    14

    0.7

    Irritability

    17

    0.7

    13

    0.3

    14

    0.7

    Loss of appetite

    16

    0.3

    8

    0

    10

    0.7

    Feverh

    9

    0.3

    9

    0.3

    8

    1

    Aged 6 through 17 Years

    Systemic

    n = 613

    n = 588

    n = 626

    Fatigue

    20

    2

    19

    1

    16

    0.5

    Muscle aches

    18

    0.7

    16

    1

    16

    0.5

    Headache

    16

    1

    19

    0.7

    15

    0.6

    Arthralgia

    10

    0.3

    9

    0.7

    7

    0.2

    Gastrointestinal symptomsi

    10

    1

    10

    0.7

    7

    0.3

    Shivering

    6

    0.5

    4

    0.5

    5

    0

    Feverh

    6

    1

    9

    0.5

    6

    0.3

    In children who received a second dose of FLUARIX QUADRIVALENT, TIV-1, or TIV-2, the incidences of adverse reactions following the second dose were generally lower than those observed after the first dose.

    Unsolicited adverse events occurring within 28 days of any vaccination were reported in 31%, 33%, and 34% of subjects who received FLUARIX QUADRIVALENT, TIV-1, or TIV-2, respectively. The unsolicited adverse reactions that occurred most frequently (≥0.1% for FLUARIX QUADRIVALENT) included injection site pruritus and rash. Serious adverse events occurring within 28 days of any vaccination were reported in 0.1%, 0.1%, and 0.1% of subjects who received FLUARIX QUADRIVALENT, TIV-1, or TIV-2, respectively.

    FLUARIX (Trivalent Formulation)

    FLUARIX has been administered to 10,317 adults aged 18 through 64 years, 606 subjects aged 65 years and older, and 2,115 children aged 6 months through 17 years in clinical trials. The incidence of solicited adverse reactions in each age-group is shown in Tables 5 and 6.

    Table 5. FLUARIX (Trivalent Formulation): Incidence of Solicited Local and Systemic Adverse Reactions within 4 Daysa of Vaccination in Adults (Total Vaccinated Cohort)
    Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available.
    n = Number of subjects with diary card completed.
    a Four days included day of vaccination and the subsequent 3 days.
    b Trial 3 was a randomized, double-blind, placebo-controlled, safety, and immunogenicity trial (NCT00100399).
    c Trial 4 was a randomized, single-blind, active-controlled, safety, and immunogenicity trial (NCT00197288). The active control was FLUZONE, a U.S.-licensed trivalent, inactivated influenza vaccine (Sanofi Pasteur Inc.).
    d Grade 3 pain, muscle aches, fatigue, headache, arthralgia, shivering: Defined as prevented normal activity.
      Grade 3 redness, swelling: Defined as >50 mm.
      Grade 3 fever: Defined as >102.2°F (39.0°C).
    e Fever: Defined as ≥100.4°F (38.0°C) in Trial 3, and ≥99.5°F (37.5°C) in Trial 4.

    Adverse Reaction

    Trial 3b

    Trial 4c

    Aged 18 through 64 Years

    Aged 65 Years and Older

    FLUARIX

    n = 760

    %

    Placebo

    n = 192

    %

    FLUARIX

    n = 601-602

    %

    Comparator

    n = 596

    %

    Any

    Grade 3d

    Any

    Grade 3d

    Any

    Grade 3d

    Any

    Grade 3d

    Local

    Pain

    55

    0.1

    12

    0

    19

    0

    18

    0

    Redness

    18

    0

    10

    0

    11

    0.2

    13

    0.7

    Swelling

    9

    0.1

    6

    0

    6

    0

    9

    0.7

    Systemic

    Muscle aches

    23

    0.4

    12

    0.5

    7

    0.3

    7

    0

    Fatigue

    20

    0.4

    18

    1

    9

    0.3

    10

    0.7

    Headache

    19

    0.1

    21

    1

    8

    0.3

    8

    0.3

    Arthralgia

    6

    0.1

    6

    0.5

    6

    0.5

    5

    0.2

    Shivering

    3

    0.1

    3

    0

    2

    0.2

    2

    0

    Fevere

    2

    0

    2

    0

    2

    0

    0.5

    0
    Table 6. FLUARIX (Trivalent Formulation): Incidence of Solicited Local and Systemic Adverse Reactions within 4 Daysa of First Vaccination in Children Aged 3 through 17 Yearsb (Total Vaccinated Cohort)
    Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available.
    n = Number of subjects with diary card completed.
    a Four days included day of vaccination and the subsequent 3 days.
    b Trial 6 was a single-blind, active-controlled, safety, and immunogenicity U.S. trial (NCT00383123). The active control was FLUZONE, a U.S.-licensed trivalent, inactivated influenza vaccine (Sanofi Pasteur Inc.).
    c Grade 3 pain, irritability, loss of appetite, drowsiness, muscle aches, fatigue, headache, arthralgia, shivering: Defined as prevented normal activity.
      Grade 3 swelling, redness: Defined as >50 mm.
      Grade 3 fever: Defined as >102.2°F (39.0°C).
    d Fever: Defined as ≥99.5°F (37.5°C).

    Adverse Reaction

    Aged 3 through 4 Years

    Aged 5 through 17 Years

    FLUARIX

    n = 350

    %

    Comparator

    n = 341

    %

    FLUARIX

    n = 1,348

    %

    Comparator

    n = 451

    %

    Any

    Grade 3c

    Any

    Grade 3c

    Any

    Grade 3c

    Any

    Grade 3c

    Local

    Pain

    35

    2

    38

    1

    56

    0.8

    56

    0.7

    Redness

    23

    0.3

    20

    0

    18

    1

    16

    0.7

    Swelling

    14

    0

    13

    0

    14

    2

    13

    0.7

    Systemic

    Irritability

    21

    0.9

    22

    0

    –

    –

    –

    –

    Loss of appetite

    13

    0.9

    15

    0.9

    –

    –

    –

    –

    Drowsiness

    13

    0.6

    20

    0.9

    –

    –

    –

    –

    Feverd

    7

    1

    8

    2

    4

    0.3

    3

    0.2

    Muscle aches

    –

    –

    –

    –

    29

    0.4

    29

    0.4

    Fatigue

    –

    –

    –

    –

    20

    1.

    19

    1

    Headache

    –

    –

    –

    –

    15

    0.5

    16

    0.9

    Arthralgia

    –

    –

    –

    –

    6

    0.1

    6

    0.2

    Shivering

    –

    –

    –

    –

    3

    0.1

    4

    0.2

    In children who received a second dose of FLUARIX or the comparator vaccine, the incidences of adverse reactions following the second dose were similar to those observed after the first dose.

    Serious Adverse Reactions: In the 4 clinical trials in adults (N = 10,923), there was a single case of anaphylaxis within one day following administration of FLUARIX (<0.01%).

    FLUARIX QUADRIVALENT Concomitant Administration with Zoster Vaccine Recombinant, Adjuvanted (SHINGRIX)

    In an open-label, randomized trial (NCT 01954251), adults aged 50 years and older (median 63 years, range 50 to 92 years) received FLUARIX QUADRIVALENT and SHINGRIX at Month 0 and SHINGRIX at Month 2 (n = 413), or FLUARIX QUADRIVALENT at Month 0 and SHINGRIX at Months 2 and 4 (n = 415). Information about solicited local and systemic adverse reactions was collected using diary cards for 7 days (day of vaccination and the next 6 days). The rates of the solicited, systemic adverse reactions of fatigue, headache, myalgia, shivering, and fever (≥37.5oC) reported in subjects receiving FLUARIX QUADRIVALENT and SHINGRIX concomitantly were similar to those observed with SHINGRIX alone, and higher than when FLUARIX QUADRIVALENT was given alone.

    6.2 Postmarketing Experience

    Beyond those events reported above in the clinical trials for FLUARIX QUADRIVALENT or FLUARIX, the following adverse reactions have been identified during post-approval use of FLUARIX QUADRIVALENT or FLUARIX (trivalent influenza vaccine). 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 the vaccine.

    Blood and Lymphatic System Disorders

    Lymphadenopathy.

    Cardiac Disorders

    Tachycardia.

    Ear and Labyrinth Disorders

    Vertigo.

    Eye Disorders

    Conjunctivitis, eye irritation, eye pain, eye redness, eye swelling, eyelid swelling.

    Gastrointestinal Disorders

    Abdominal pain or discomfort, swelling of the mouth, throat, and/or tongue.

    General Disorders and Administration Site Conditions

    Asthenia, chest pain, influenza-like illness, feeling hot, injection site mass, injection site reaction, injection site warmth, body aches.

    Immune System Disorders

    Anaphylactic reaction including shock, anaphylactoid reaction, hypersensitivity, serum sickness.

    Infections and Infestations

    Injection site abscess, injection site cellulitis, pharyngitis, rhinitis, tonsillitis.

    Nervous System Disorders

    Convulsion, encephalomyelitis, facial palsy, facial paresis, Guillain-Barré syndrome, hypoesthesia, myelitis, neuritis, neuropathy, paresthesia, syncope.

    Respiratory, Thoracic, and Mediastinal Disorders

    Asthma, bronchospasm, dyspnea, respiratory distress, stridor.

    Skin and Subcutaneous Tissue Disorders

    Angioedema, erythema, erythema multiforme, facial swelling, pruritus, Stevens-Johnson syndrome, sweating, urticaria.

    Vascular Disorders

    Henoch-Schönlein purpura, vasculitis.

  • 7 DRUG INTERACTIONS

    7.1 Concomitant Vaccine Administration

    In an open-label trial (NCT 01954251), FLUARIX QUADRIVALENT was administered concomitantly with Zoster Vaccine Recombinant, Adjuvanted (SHINGRIX) [see Adverse Reactions (6.1), Clinical Studies (14.4)].

    7.2 Immunosuppressive Therapies

    Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater-than-physiologic doses), may reduce the immune response to FLUARIX QUADRIVALENT.

  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Pregnancy Exposure Registry

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to FLUARIX QUADRIVALENT during pregnancy. Healthcare providers are encouraged to register women by calling 1-888-452-9622.

    Risk Summary

    All pregnancies have a risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

    There are insufficient data on FLUARIX QUADRIVALENT in pregnant women to inform vaccine-associated risks.

    A developmental toxicity study was performed in female rats administered FLUARIX QUADRIVALENT prior to mating and during gestation and lactation periods. The total dose was 0.2 mL at each occasion (a single human dose is 0.5 mL). This study revealed no adverse effects on fetal or pre-weaning development due to FLUARIX QUADRIVALENT (see Data).

    Clinical Considerations

    Disease-Associated Maternal and/or Embryo/Fetal Risk: Pregnant women infected with seasonal influenza are at increased risk of severe illness associated with influenza infection compared with non-pregnant women. Pregnant women with influenza may be at increased risk for adverse pregnancy outcomes, including preterm labor and delivery.

    Data

    Animal Data: In a developmental toxicity study, female rats were administered FLUARIX QUADRIVALENT by intramuscular injection 4 and 2 weeks prior to mating, on Gestation Days 3, 8, 11, and 15, and on Lactation Day 7. The total dose was 0.2 mL at each occasion (a single human dose is 0.5 mL). No adverse effects on pre-weaning development up to Postnatal Day 25 were observed. There were no vaccine-related fetal malformations or variations.

    8.2 Lactation

    Risk Summary

    It is not known whether FLUARIX QUADRIVALENT is excreted in human milk. Data are not available to assess the effects of FLUARIX QUADRIVALENT on the breastfed infant or on milk production/excretion. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for FLUARIX QUADRIVALENT and any potential adverse effects on the breastfed child from FLUARIX QUADRIVALENT or from the underlying maternal condition. For preventive vaccines, the underlying maternal condition is susceptibility to disease prevented by the vaccine.

    8.4 Pediatric Use

    Safety and effectiveness of FLUARIX QUADRIVALENT in children younger than 6 months have not been established.

    Safety and effectiveness of FLUARIX QUADRIVALENT in individuals aged 6 months through 17 years have been established [see Adverse Reactions (6.1), Clinical Studies (14.3)].

    8.5 Geriatric Use

    In a randomized, double-blind (2 arms) and open-label (one arm), active-controlled trial, immunogenicity and safety were evaluated in a cohort of subjects aged 65 years and older who received FLUARIX QUADRIVALENT (n = 1,517); 469 of these subjects were aged 75 years and older. In subjects aged 65 years and older, the geometric mean antibody titers (GMTs) post-vaccination and seroconversion rates were lower than in younger subjects (aged 18 through 64 years) and the frequencies of solicited and unsolicited adverse reactions were generally lower than in younger subjects.

  • 11 DESCRIPTION

    FLUARIX QUADRIVALENT, Influenza Vaccine, for intramuscular injection, is a sterile, colorless, and slightly opalescent suspension. FLUARIX QUADRIVALENT is prepared from influenza viruses propagated in embryonated chicken eggs. Each of the influenza viruses is produced and purified separately. After harvesting the virus-containing fluids, each influenza virus is concentrated and purified by zonal centrifugation using a linear sucrose density gradient solution containing detergent to disrupt the viruses. Following dilution, the vaccine is further purified by diafiltration. Each influenza virus solution is inactivated by the consecutive effects of sodium deoxycholate and formaldehyde leading to the production of a “split virus.” Each split inactivated virus is then suspended in sodium phosphate-buffered isotonic sodium chloride solution. Each vaccine is formulated from the split inactivated virus solutions.

    FLUARIX QUADRIVALENT has been standardized according to U.S. Public Health Service (USPHS) requirements for the 2019‑2020 influenza season and is formulated to contain 60 micrograms (mcg) hemagglutinin (HA) per 0.5‑mL dose, in the recommended ratio of 15 mcg HA of each of the following 4 influenza virus strains (2 A strains and 2 B strains): A/Brisbane/02/2018 (H1N1) pdm09 (IVR-190), A/Kansas/14/2017 (H3N2) NYMC X-327, B/Maryland/15/2016 NYMC BX-69A (a B/Colorado/06/2017-like virus), and B/Phuket/3073/2013.

    FLUARIX QUADRIVALENT is formulated without preservatives. FLUARIX QUADRIVALENT does not contain thimerosal. Each 0.5‑mL dose also contains octoxynol-10 (TRITON X-100) ≤0.115 mg, α-tocopheryl hydrogen succinate ≤0.135 mg, and polysorbate 80 (Tween 80) ≤0.550 mg. Each dose may also contain residual amounts of hydrocortisone ≤0.0015 mcg, gentamicin sulfate ≤0.15 mcg, ovalbumin ≤0.050 mcg, formaldehyde ≤5 mcg, and sodium deoxycholate ≤65 mcg from the manufacturing process.

    The tip caps and plungers of the prefilled syringes of FLUARIX QUADRIVALENT are not made with natural rubber latex.

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    Influenza illness and its complications follow infection with influenza viruses. Global surveillance of influenza identifies yearly antigenic variants. Since 1977, antigenic variants of influenza A (H1N1 and H3N2) viruses and influenza B viruses have been in global circulation.

    Public health authorities give annual influenza vaccine composition recommendations. Inactivated influenza vaccines are standardized to contain the hemagglutinins of influenza viruses representing the virus types or subtypes likely to circulate in the United States during the influenza season. Two influenza type B virus lineages (Victoria and Yamagata) are of public health importance because they have co-circulated since 2001. FLUARIX (trivalent influenza vaccine) contains 2 influenza A subtype viruses and one influenza type B virus.

    Specific levels of hemagglutination-inhibition (HI) antibody titer post-vaccination with inactivated influenza virus vaccines have not been correlated with protection from influenza illness but the HI antibody titers have been used as a measure of vaccine activity. In some human challenge studies, HI antibody titers of ≥1:40 have been associated with protection from influenza illness in up to 50% of subjects.1,2 Antibody against one influenza virus type or subtype confers little or no protection against another virus. Furthermore, antibody to one antigenic variant of influenza virus might not protect against a new antigenic variant of the same type or subtype. Frequent development of antigenic variants through antigenic drift is the virological basis for seasonal epidemics and the reason for the usual replacement of one or more influenza viruses in each year’s influenza vaccine.

    Annual revaccination is recommended because immunity declines during the year after vaccination, and because circulating strains of influenza virus change from year to year.

  • 13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

    FLUARIX QUADRIVALENT has not been evaluated for carcinogenic or mutagenic potential or male infertility in animals. Vaccination of female rats with FLUARIX QUADRIVALENT had no effect on fertility [see Use in Specific Populations (8.1)].

  • 14 CLINICAL STUDIES

    14.1 Efficacy against Influenza

    The efficacy experience with FLUARIX is relevant to FLUARIX QUADRIVALENT because both vaccines are manufactured using the same process and have overlapping compositions [see Description (11)].

    The efficacy of FLUARIX was evaluated in a randomized, double-blind, placebo-controlled trial conducted in 2 European countries during the 2006-2007 influenza season. Efficacy of FLUARIX, containing A/New Caledonia/20/1999 (H1N1), A/Wisconsin/67/2005 (H3N2), and B/Malaysia/2506/2004 influenza virus strains, was defined as the prevention of culture-confirmed influenza A and/or B cases, for vaccine antigenically matched strains, compared with placebo. Healthy subjects aged 18 through 64 years (mean age: 40 years) were randomized (2:1) to receive FLUARIX (n = 5,103) or placebo (n = 2,549) and monitored for influenza-like illnesses (ILI) starting 2 weeks post-vaccination and lasting for approximately 7 months. In the overall population, 60% of subjects were female and 99.9% were white. Culture-confirmed influenza was assessed by active and passive surveillance of ILI. Influenza-like illness was defined as at least one general symptom (fever ≥100°F and/or myalgia) and at least one respiratory symptom (cough and/or sore throat). After an episode of ILI, nose and throat swab samples were collected for analysis; attack rates and vaccine efficacy were calculated (Table 7).

    Table 7. FLUARIX (Trivalent Formulation): Attack Rates and Vaccine Efficacy against Culture-Confirmed Influenza A and/or B in Adults (Total Vaccinated Cohort)
    a There were no vaccine matched culture-confirmed cases of A/New Caledonia/20/1999 (H1N1) or B/Malaysia/2506/2004 influenza virus strains with FLUARIX or placebo.
    b Vaccine efficacy for FLUARIX exceeded a pre-defined threshold of 35% for the lower limit of the 2-sided 95% Confidence Interval (CI).
    c Of the 22 additional cases, 18 were unmatched and 4 were untyped; 15 of the 22 cases were A (H3N2) (11 cases with FLUARIX and 4 cases with placebo).

    Attack Rates (n/N)

    Vaccine Efficacy

    N

    n

    %

    %

    Lower Limit

    Upper Limit

    Antigenically Matched Strainsa

    FLUARIX

    5,103

    49

    1.0

    66.9b

    51.9

    77.4

    Placebo

    2,549

    74

    2.9

    –

    –

    –

    All Culture-Confirmed Influenza (Matched, Unmatched, and Untyped)c

    FLUARIX

    5,103

    63

    1.2

    61.6b

    46.0

    72.8

    Placebo

    2,549

    82

    3.2

    –

    –

    –

    In a post-hoc exploratory analysis by age, vaccine efficacy (against culture-confirmed influenza A and/or B cases, for vaccine antigenically matched strains) in subjects aged 18 through 49 years was 73.4% (95% CI: 59.3, 82.8) (number of influenza cases: FLUARIX [n = 35/3,602] and placebo [n = 66/1,810]). In subjects aged 50 through 64 years, vaccine efficacy was 13.8% (95% CI: ‑137.0, 66.3) (number of influenza cases: FLUARIX [n = 14/1,501] and placebo [n = 8/739]). As the trial lacked statistical power to evaluate efficacy within age subgroups, the clinical significance of these results is unknown.

    The efficacy of FLUARIX QUADRIVALENT was evaluated in Trial 7, a randomized, observer-blind, non-influenza vaccine-controlled trial conducted in 13 countries in Asia, Europe, and Central America during the 2011-2012 and 2012-2013 Northern Hemisphere influenza seasons, and from 2012 to 2014 during influenza seasons in subtropical countries. Healthy subjects aged 6 through 35 months (mean age: 22 months) were randomized (1:1) to receive FLUARIX QUADRIVALENT (n = 6,006) or a non-influenza control vaccine (n = 6,012). In the overall population, 51% were male; 27% were white, 45% were Asian, and 28% were of other racial/ethnic groups. Children aged 12 months and older with no history of influenza vaccination and children younger than 12 months received 2 doses of FLUARIX QUADRIVALENT or the Non-Influenza Active Comparator vaccine approximately 28 days apart. Children aged 12 months and older with a history of influenza vaccination received one dose.

    The influenza virus strain composition of FLUARIX QUADRIVALENT administered in each of the 5 study cohorts followed the World Health Organization (WHO) recommendations (which included 2nd B strain from 2012 onwards) for each influenza season associated with a particular cohort.

    Efficacy of FLUARIX QUADRIVALENT was assessed for the prevention of reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed influenza A and/or B disease, due to any seasonal influenza strain, compared with non-influenza control vaccines. Influenza disease included episodes of influenza-like illness (ILI, i.e., fever ≥100.4°F with any of the following: cough, runny nose, nasal congestion, or breathing difficulty) or a consequence of influenza virus infection (acute otitis media or lower respiratory illnesses). Among subjects with RT-PCR-positive influenza A and/or B disease, subjects were further prospectively classified based on the presence of adverse outcomes associated with influenza infection: fever >102.2°F, physician-diagnosed acute otitis media, physician-diagnosed lower respiratory tract illness, physician-diagnosed serious extra-pulmonary complications, hospitalization in the intensive care unit, or supplemental oxygen required for more than 8 hours. Subjects were monitored for influenza disease by passive and active surveillance starting 2 weeks post-vaccination and lasting for approximately 6 months. After an episode of ILI, lower respiratory illness, or acute otitis media, nasal swabs were collected and tested for influenza A and/or B by RT-PCR. All RT-PCR-positive specimens were further tested in cell culture and by antigenic characterization to determine whether the viral strains matched those in the vaccine. Vaccine efficacy for subjects with RT-PCR confirmed and culture-confirmed vaccine matching strains (According-to-Protocol (ATP) cohort for efficacy – time to event) is presented in Table 8.

    Table 8. Attack Rates and Vaccine Efficacy against Influenza A and/or B in Children Aged 6 through 35 Monthsa (ATP Cohort for Efficacy – Time to Event)
    ATP = According‑to‑Protocol; RT-PCR = Reverse Transcriptase Polymerase Chain Reaction.
    a Trial 7: NCT01439360.
    b Number of subjects in the ATP cohort for efficacy – time to event, which included subjects who met all eligibility criteria, who were followed for efficacy and complied with the study protocol until the influenza-like episode.
    c Number of subjects who reported at least one case in the reporting period.
    d Vaccine efficacy for FLUARIX QUADRIVALENT met the pre-defined criterion for the lower limit of the 2-sided 97.5% CI (>15% for all influenza).
    e Children younger than 12 months: pneumococcal 13-valent conjugate vaccine [Diphtheria CRM197 Protein] (Wyeth Pharmaceuticals, Inc.).
    f Children 12 months and older: HAVRIX (Hepatitis A Vaccine) for those with a history of influenza vaccination; or HAVRIX (Dose 1) and a varicella vaccine (U.S. Licensed Manufactured by Merck & Co., Inc. or Non-U.S. Licensed Manufactured by GlaxoSmithKline Biologicals) (Dose 2) for those with no history of influenza vaccination.
    g Vaccine efficacy for FLUARIX QUADRIVALENT met the pre-defined criterion of >10% for the lower limit of the 2-sided 95% CI.
    h Vaccine efficacy for FLUARIX QUADRIVALENT met the pre-defined criterion of >15% for the lower limit of the 2-sided 95% CI.

    Nb

    nc

    Attack Rates (n/N)

    Vaccine Efficacy

    %

    %

    Lower Limit

    Upper Limit

    All RT-PCR-Confirmed Influenza

    FLUARIX QUADRIVALENT

    5,707

    344

    6.03

    49.8

    41.8d

    56.8

    Non-Influenza Comparatore,f

    5,697

    662

    11.62

    -

    -

    -

    All Culture-Confirmed Influenza

    FLUARIX QUADRIVALENT

    5,707

    303

    5.31

    51.2

    44.1g

    57.6

    Non-Influenza Comparatore,f

    5,697

    602

    10.57

    -

    -

    -

    All Antigenically Matched Culture-Confirmed Influenza

    FLUARIX QUADRIVALENT

    5,707

    88

    1.54

    60.1

    49.1h

    69.0

    Non-Influenza Comparatore,f

    5,697

    216

    3.79

    -

    -

    -

    The vaccine efficacy against RT-PCR-confirmed influenza associated with adverse outcomes was 64.6% (97.5% CI 53.2%, 73.5%). The vaccine efficacy against RT-PCR-confirmed influenza associated with adverse outcomes due to A/H1N1, A/H3N2, B/Victoria, and B/Yamagata was 71.4% (95% CI 48.5%, 85.2%), 51.3% (95% CI 32.7%, 65.2%), 86.7% (95% CI 52.8%, 97.9%), and 68.9% (95% CI 50.6%, 81.2%), respectively.

    For RT-PCR-confirmed influenza cases associated with adverse outcomes, the incidence of the specified adverse outcomes is presented in Table 9.

    Table 9. Incidence of Adverse Outcomes Associated with RT-PCR-Positive Influenza in Children Aged 6 through 35 Monthsa (ATP Cohort for Efficacy- Time to Event)b
    ATP = According‑to‑Protocol; RT-PCR = Reverse transcriptase polymerase chain reaction.
    a Trial 7: NCT01439360.
    b Number of subjects in the ATP cohort for efficacy – time to event, which included subjects who met all eligibility criteria, who were followed for efficacy and complied with the study protocol until the influenza-like episode.
    c Children younger than 12 months: pneumococcal 13-valent conjugate vaccine [Diphtheria CRM197 Protein] (Wyeth Pharmaceuticals, Inc.).
    d Children 12 months and older: HAVRIX (Hepatitis A Vaccine) for those with a history of influenza vaccination; or HAVRIX (Dose 1) and a varicella vaccine (U.S. Licensed Manufactured by Merck & Co., Inc. or Non-U.S. Licensed Manufactured by GlaxoSmithKline Biologicals) (Dose 2) for those with no history of influenza vaccination.
    e Subjects who experienced more than one adverse outcome, each outcome was counted in the respective category.
    f Number of subjects with at least one event in a given category.
    g Analyses considered AOM cases confirmed by otoscopy.
    h Pneumonia, lower respiratory tract infection, bronchiolitis, bronchitis, or croup infection as per final diagnosis by physician.
    i Includes myositis, encephalitis or other neurologic condition including seizure, myocarditis/pericarditis or other serious medical condition as per final diagnosis by physician.

    Influenza-Associated Symptome

    FLUARIX QUADRIVALENT

    n = 5,707

    Non-Influenza Active Comparatorc,d

    n = 5,697

    Number of Events

    Number of Subjectsf

    %

    Number of Events

    Number of Subjectsf

    %

    Fever >102.2°F/39°C

    62

    61

    1.1

    184

    183

    3.2

    Acute otitis media (AOM)g

    5

    5

    0.1

    15

    15

    0.3

    Physician-diagnosed lower respiratory tract illnessh

    28

    28

    0.5

    62

    61

    1.1

    Physician-diagnosed serious extra-pulmonary complicationsi

    2

    2

    0

    3

    3

    0.1

    Hospitalization in the intensive care unit

    0

    0

    0

    0

    0

    0

    Supplemental oxygen required for more than 8 hours

    0

    0

    0

    0

    0

    0

    14.2 Immunological Evaluation of FLUARIX QUADRIVALENT in Adults

    Trial 1 was a randomized, double-blind (2 arms) and open-label (one arm), active-controlled, safety, immunogenicity, and non-inferiority trial. In this trial, subjects received FLUARIX QUADRIVALENT (n = 1,809) or one of 2 formulations of comparator trivalent influenza vaccine (FLUARIX, TIV-1, n = 608 or TIV-2, n = 534), each containing an influenza type B virus that corresponded to one of the 2 type B viruses in FLUARIX QUADRIVALENT (a type B virus of the Victoria lineage or a type B virus of the Yamagata lineage). Subjects aged 18 years and older (mean age: 58 years) were evaluated for immune responses to each of the vaccine antigens 21 days following vaccination. In the overall population, 57% of subjects were female; 69% were white, 27% were Asian, and 4% were of other racial/ethnic groups.

    The immunogenicity endpoints were GMTs of serum HI antibodies adjusted for baseline, and the percentage of subjects who achieved seroconversion, defined as a pre-vaccination HI titer of <1:10 with a post-vaccination titer ≥1:40 or at least a 4‑fold increase in serum HI antibody titer over baseline to ≥1:40 following vaccination, performed on the According-to-Protocol (ATP) cohort for whom immunogenicity assay results were available after vaccination. FLUARIX QUADRIVALENT was non‑inferior to both TIVs based on adjusted GMTs (upper limit of the 2‑sided 95% CI for the GMT ratio [TIV/FLUARIX QUADRIVALENT] ≤1.5) and seroconversion rates (upper limit of the 2‑sided 95% CI on difference of the TIV minus FLUARIX QUADRIVALENT ≤10%). The antibody response to influenza B strains contained in FLUARIX QUADRIVALENT was higher than the antibody response after vaccination with a TIV containing an influenza B strain from a different lineage. There was no evidence that the addition of the second B strain resulted in immune interference to other strains included in the vaccine (Table 10).

    Table 10. FLUARIX QUADRIVALENT: Immune Responses to Each Antigen 21 Days after Vaccination in Adults (ATP Cohort for Immunogenicity)
    ATP = According‑to‑protocol; CI = Confidence Interval.
    ATP cohort for immunogenicity included subjects for whom assay results were available after vaccination for at least one trial vaccine antigen.
    a Contained the same composition as FLUARIX (trivalent formulation) manufactured for the 2010-2011 season and an additional influenza type B virus of Yamagata lineage.
    b Contained the same composition as FLUARIX manufactured for the 2010-2011 season (2 influenza A subtype viruses and an influenza type B virus of Victoria lineage).
    c Contained the same 2 influenza A subtype viruses as FLUARIX manufactured for the 2010-2011 season and an influenza type B virus of Yamagata lineage.
    d Seroconversion defined as a pre-vaccination HI titer of <1:10 with a post-vaccination titer ≥1:40 or at least a 4-fold increase in serum titers of HI antibodies to ≥1:40.

    Geometric Mean Antibody Titer

    FLUARIX QUADRIVALENTa

    Trivalent Influenza Vaccine (TIV)

    TIV-1

    (B Victoria)b

    TIV-2

    (B Yamagata)c

    n = 1,809

    (95% CI)

    n = 608

    (95% CI)

    n = 534

    (95% CI)

    A/California/7/2009 (H1N1)

    201.1

    (188.1, 215.1)

    218.4

    (194.2, 245.6)

    213.0

    (187.6, 241.9)

    A/Victoria/210/2009 (H3N2)

    314.7

    (296.8, 333.6)

    298.2

    (268.4, 331.3)

    340.4

    (304.3, 380.9)

    B/Brisbane/60/2008 (Victoria lineage)

    404.6

    (386.6, 423.4)

    393.8

    (362.7, 427.6)

    258.5

    (234.6, 284.8)

    B/Brisbane/3/2007 (Yamagata lineage)

    601.8

    (573.3, 631.6)

    386.6

    (351.5, 425.3)

    582.5

    (534.6, 634.7)

    Seroconversiond

    n = 1,801

    %

    (95% CI)

    n = 605

    %

    (95% CI)

    n = 530

    %

    (95% CI)

    A/California/7/2009 (H1N1)

    77.5

    (75.5, 79.4)

    77.2

    (73.6, 80.5)

    80.2

    (76.5, 83.5)

    A/Victoria/210/2009 (H3N2)

    71.5

    (69.3, 73.5)

    65.8

    (61.9, 69.6)

    70.0

    (65.9, 73.9)

    B/Brisbane/60/2008 (Victoria lineage)

    58.1

    (55.8, 60.4)

    55.4

    (51.3, 59.4)

    47.5

    (43.2, 51.9)

    B/Brisbane/3/2007 (Yamagata lineage)

    61.7

    (59.5, 64.0)

    45.6

    (41.6, 49.7)

    59.1

    (54.7, 63.3)

    14.3 Immunological Evaluation of FLUARIX QUADRIVALENT in Children

    Trial 7 was a randomized, observer-blind, non-influenza vaccine-controlled trial evaluating the efficacy of FLUARIX QUADRIVALENT. In this trial, subjects aged 6 through 35 months received FLUARIX QUADRIVALENT (n = 6,006) or a non-influenza control vaccine (n = 6,012). Immune responses to each of the vaccine antigens were evaluated in sera 28 days following 1 or 2 doses in a subgroup of subjects (n = 753 for FLUARIX QUADRIVALENT, n = 579 for control in the ATP cohort for immunogenicity).

    Immunogenicity endpoints (GMTs and the percentage of subjects who achieved seroconversion) were analyzed based on the ATP cohort for whom immunogenicity assay results were available after vaccination. Antibody responses for all 4 influenza strains are presented in Table 11.

    Table 11. FLUARIX QUADRIVALENT: Immune Responses to Each Antigen 28 Days after Last Vaccination in Children Aged 6 through 35 Monthsa (ATP Cohort for Immunogenicity)
    ATP = According‑to‑protocol; CI = Confidence Interval.
    ATP cohort for immunogenicity included subjects for whom assay results were available after vaccination for at least one trial vaccine antigen.
    a Trial 7: NCT01439360.
    b Children younger than 12 months: pneumococcal 13-valent conjugate vaccine [Diphtheria CRM197 Protein] (Wyeth Pharmaceuticals, Inc.).
    c Children 12 months and older: HAVRIX (Hepatitis A Vaccine) for those with a history of influenza vaccination; or HAVRIX (Dose 1) and a varicella vaccine (U.S. Licensed Manufactured by Merck & Co., Inc. or Non-U.S. Licensed Manufactured by GlaxoSmithKline Biologicals) (Dose 2) for those with no history of influenza vaccination.
    d Seroconversion defined as a pre-vaccination HI titer of <1:10 with a post-vaccination titer ≥1:40 or at least a 4-fold increase in serum titers of HI antibodies to ≥1:40.

    Geometric Mean Antibody Titer

    FLUARIX QUADRIVALENT

    Non-Influenza Active Comparatorb,c

    n = 750-753

    (95% CI)

    n = 578-579

    (95% CI)

    A (H1N1)

    165.3

    (148.6, 183.8)

    12.6

    (11.1, 14.3)

    A (H3N2)

    132.1

    (119.1, 146.5)

    14.7

    (12.9, 16.7)

    B (Victoria lineage)

    92.6

    (82.3, 104.1)

    9.2

    (8.4, 10.1)

    B (Yamagata lineage)

    121.4

    (110.1, 133.8)

    7.6

    (7.0, 8.3)

    Seroconversiond

    n = 742-746

    %

    (95% CI)

    n = 566-568

    %

    (95% CI)

    A (H1N1)

    80.2

    (77.2, 83.0)

    3.5

    (2.2, 5.4)

    A (H3N2)

    68.8

    (65.3, 72.1)

    4.2

    (2.7, 6.2)

    B (Victoria lineage)

    69.3

    (65.8, 72.6)

    0.9

    (0.3, 2.0)

    B (Yamagata lineage)

    81.2

    (78.2, 84.0)

    2.3

    (1.2, 3.9)

    Trial 2 was a randomized, double-blind, active-controlled, safety, immunogenicity, and non-inferiority trial. In this trial, subjects received FLUARIX QUADRIVALENT (n = 791) or one of 2 formulations of comparator trivalent influenza vaccine (FLUARIX; TIV-1, n = 819; or TIV-2, n = 801), each containing an influenza type B virus that corresponded to one of the 2 type B viruses in FLUARIX QUADRIVALENT (a type B virus of the Victoria lineage or a type B virus of the Yamagata lineage). In children aged 3 through 17 years, immune responses to each of the vaccine antigens were evaluated in sera 28 days following 1 or 2 doses. In the overall population, 52% of subjects were male; 56% were white, 29% were Asian, 12% were black, and 3% were of other racial/ethnic groups.

    The immunogenicity endpoints were GMTs adjusted for baseline, and the percentage of subjects who achieved seroconversion, defined as a pre-vaccination HI titer of <1:10 with a post-vaccination titer ≥1:40 or at least a 4‑fold increase in serum HI titer over baseline to ≥1:40, following vaccination, performed on the ATP cohort for whom immunogenicity assay results were available after vaccination. FLUARIX QUADRIVALENT was non-inferior to both TIVs based on adjusted GMTs (upper limit of the 2‑sided 95% CI for the GMT ratio [TIV/FLUARIX QUADRIVALENT] ≤1.5) and seroconversion rates (upper limit of the 2‑sided 95% CI on difference of the TIV minus FLUARIX QUADRIVALENT ≤10%). The antibody response to influenza B strains contained in FLUARIX QUADRIVALENT was higher than the antibody response after vaccination with a TIV containing an influenza B strain from a different lineage. There was no evidence that the addition of the second B strain resulted in immune interference to other strains included in the vaccine (Table 12).

    Table 12. FLUARIX QUADRIVALENT: Immune Responses to Each Antigen 28 Days after Last Vaccination in Children Aged 3 through 17 Years (ATP Cohort for Immunogenicity)
    ATP = According‑to‑protocol; CI = Confidence Interval.
    ATP cohort for immunogenicity included subjects for whom assay results were available after vaccination for at least one trial vaccine antigen.
    a Contained the same composition as FLUARIX (trivalent formulation) manufactured for the 2010-2011 season and an additional influenza type B virus of Yamagata lineage.
    b Contained the same composition as FLUARIX manufactured for the 2010-2011 season (2 influenza A subtype viruses and an influenza type B virus of Victoria lineage).
    c Contained the same 2 influenza A subtype viruses as FLUARIX manufactured for the 2010-2011 season and an influenza B virus of Yamagata lineage.
    d Seroconversion defined as a pre-vaccination HI titer of <1:10 with a post-vaccination titer ≥1:40 or at least a 4-fold increase in serum titers of HI antibodies to ≥1:40.

    Geometric Mean Antibody Titer

    FLUARIX QUADRIVALENTa

    Trivalent Influenza Vaccine (TIV)

    TIV-1

    (B Victoria)b

    TIV-2

    (B Yamagata)c

    n = 791

    (95% CI)

    n = 818

    (95% CI)

    n = 801

    (95% CI)

    A/California/7/2009 (H1N1)

    386.2

    (357.3, 417.4)

    433.2

    (401.0, 468.0)

    422.3

    (390.5, 456.5)

    A/Victoria/210/2009 (H3N2)

    228.8

    (215.0, 243.4)

    227.3

    (213.3, 242.3)

    234.0

    (219.1, 249.9)

    B/Brisbane/60/2008 (Victoria lineage)

    244.2

    (227.5, 262.1)

    245.6

    (229.2, 263.2)

    88.4

    (81.5, 95.8)

    B/Brisbane/3/2007 (Yamagata lineage)

    569.6

    (533.6, 608.1)

    224.7

    (207.9, 242.9)

    643.3

    (603.2, 686.1)

    Seroconversiond

    n = 790

    %

    (95% CI)

    n = 818

    %

    (95% CI)

    n = 800

    %

    (95% CI)

    A/California/7/2009 (H1N1)

    91.4

    (89.2, 93.3)

    89.9

    (87.6, 91.8)

    91.6

    (89.5, 93.5)

    A/Victoria/210/2009 (H3N2)

    72.3

    (69.0, 75.4)

    70.7

    (67.4, 73.8)

    71.9

    (68.6, 75.0)

    B/Brisbane/60/2008 (Victoria lineage)

    70.0

    (66.7, 73.2)

    68.5

    (65.2, 71.6)

    29.6

    (26.5, 32.9)

    B/Brisbane/3/2007 (Yamagata lineage)

    72.5

    (69.3, 75.6)

    37.0

    (33.7, 40.5)

    70.8

    (67.5, 73.9)

    14.4 FLUARIX QUADRIVALENT Concomitant Administration with Zoster Vaccine Recombinant, Adjuvanted (SHINGRIX)

    In an open-label, randomized clinical trial (NCT 01954251) in adults aged 50 years and older, there was no evidence for interference in antibody responses (HI antibodies and anti-gE antibodies) to FLUARIX QUADRIVALENT or the coadministered vaccine, SHINGRIX [see Adverse Reactions (6.1)].

  • 15 REFERENCES

    • 1. Hannoun C, Megas F, Piercy J. Immunogenicity and protective efficacy of influenza vaccination. Virus Res. 2004;103:133-138.
    • 2. Hobson D, Curry RL, Beare AS, et al. The role of serum haemagglutination-inhibiting antibody in protection against challenge infection with influenza A2 and B viruses. J Hyg Camb. 1972;70:767-777.
  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    NDC: 58160-896-41 Syringe in Package of 10: NDC: 58160-896-52

    Store refrigerated between 2º and 8ºC (36º and 46ºF). Do not freeze. Discard if the vaccine has been frozen. Store in the original package to protect from light.

  • 17 PATIENT COUNSELING INFORMATION

    Provide the following information to the vaccine recipient or guardian:

    • Inform of the potential benefits and risks of immunization with FLUARIX QUADRIVALENT.
    • Educate regarding potential side effects, emphasizing that: (1) FLUARIX QUADRIVALENT contains non‑infectious killed viruses and cannot cause influenza and (2) FLUARIX QUADRIVALENT is intended to provide protection against illness due to influenza viruses only and cannot provide protection against all respiratory illness.
    • Encourage women exposed to FLUARIX QUADRIVALENT during pregnancy to enroll in the pregnancy registry [see Use in Specific Populations (8.1)].
    • Give the Vaccine Information Statements, which are required by the National Childhood Vaccine Injury Act of 1986 prior to each immunization. These materials are available free of charge at the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines).
    • Instruct that annual revaccination is recommended.

    FLUARIX, HAVRIX, and TIP-LOK are trademarks owned by or licensed to the GSK group of companies. The other brands listed are trademarks owned by or licensed to their respective owners and are not owned by or licensed to the GSK group of companies. The makers of these brands are not affiliated with and do not endorse the GSK group of companies or its products.

    Manufactured by GlaxoSmithKline Biologicals, Dresden, Germany,

    a branch of SmithKline Beecham Pharma GmbH & Co. KG, Munich, Germany

    Licensed by GlaxoSmithKline Biologicals, Rixensart, Belgium, U.S. License 1617

    Distributed by GlaxoSmithKline, Research Triangle Park, NC 27709

    ©2020 GSK group of companies or its licensor.

    FLQ:14PI

  • PRINCIPAL DISPLAY PANEL

    PRINCIPAL DISPLAY PANEL

    NDC: 58160-896-52

    FLUARIX QUADRIVALENT

    Influenza Vaccine

    2019/2020 Formula

    Rx only

    For 6 Months of Age and Older

    10 Disposable Single-Dose Prefilled Tip-Lok Syringes each containing one 0.5 mL dose

    TIP-LOK syringes are compatible with LUER-LOK needles

    NEEDLES NOT INCLUDED

    ©2019 GSK group of companies or its licensor.

    Rev. 4/19

    497261

    Fluarix Quadrivalent 2019-2020 10 count carton
  • INGREDIENTS AND APPEARANCE
    FLUARIX QUADRIVALENT  2019/2020
    influenza virus vaccine suspension
    Product Information
    Product TypeVACCINEItem Code (Source)NDC: 58160-896
    Route of AdministrationINTRAMUSCULAR
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    INFLUENZA A VIRUS A/BRISBANE/02/2018 IVR-190 (H1N1) ANTIGEN (FORMALDEHYDE INACTIVATED) (UNII: XW4JB03TI5) (INFLUENZA A VIRUS A/BRISBANE/02/2018 IVR-190 (H1N1) HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED) - UNII:92XE6GHC89) INFLUENZA A VIRUS A/BRISBANE/02/2018 IVR-190 (H1N1) HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED)15 ug  in 0.5 mL
    INFLUENZA A VIRUS A/KANSAS/14/2017 X-327 (H3N2) ANTIGEN (FORMALDEHYDE INACTIVATED) (UNII: 3NZW5ND3D6) (INFLUENZA A VIRUS A/KANSAS/14/2017 X-327 (H3N2) HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED) - UNII:K329YCD1N9) INFLUENZA A VIRUS A/KANSAS/14/2017 X-327 (H3N2) HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED)15 ug  in 0.5 mL
    INFLUENZA B VIRUS B/MARYLAND/15/2016 BX-69A ANTIGEN (FORMALDEHYDE INACTIVATED) (UNII: M691J375MM) (INFLUENZA B VIRUS B/MARYLAND/15/2016 BX-69A HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED) - UNII:U2L42S6PLV) INFLUENZA B VIRUS B/MARYLAND/15/2016 BX-69A HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED)15 ug  in 0.5 mL
    INFLUENZA B VIRUS B/PHUKET/3073/2013 ANTIGEN (FORMALDEHYDE INACTIVATED) (UNII: B93BQX9789) (INFLUENZA B VIRUS B/PHUKET/3073/2013 HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED) - UNII:9HB0XUS9TM) INFLUENZA B VIRUS B/PHUKET/3073/2013 HEMAGGLUTININ ANTIGEN (FORMALDEHYDE INACTIVATED)15 ug  in 0.5 mL
    Inactive Ingredients
    Ingredient NameStrength
    OCTOXYNOL-9 (UNII: 7JPC6Y25QS)  
    .ALPHA.-TOCOPHEROL SUCCINATE, D- (UNII: LU4B53JYVE)  
    POLYSORBATE 80 (UNII: 6OZP39ZG8H)  
    POTASSIUM CHLORIDE (UNII: 660YQ98I10)  
    SODIUM CHLORIDE (UNII: 451W47IQ8X)  
    MAGNESIUM CHLORIDE (UNII: 02F3473H9O)  
    SODIUM PHOSPHATE, DIBASIC, DODECAHYDRATE (UNII: E1W4N241FO)  
    POTASSIUM PHOSPHATE, MONOBASIC (UNII: 4J9FJ0HL51)  
    WATER (UNII: 059QF0KO0R)  
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC: 58160-896-5210 in 1 CARTON
    1NDC: 58160-896-410.5 mL in 1 SYRINGE; Type 2: Prefilled Drug Delivery Device/System (syringe, patch, etc.)
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    BLABLA12512707/02/201906/30/2020
    Labeler - GlaxoSmithKline Biologicals SA (372748392)
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