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Drug Safety-related Labeling Changes (SrLC)

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FULPHILA (BLA-761075)

(PEGFILGRASTIM-JMDB)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

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03/17/2021 (SUPPL-12)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.7 Thrombocytopenia

(Newly added subsection)

Thrombocytopenia has been reported in patients receiving pegfilgrastim. Monitor platelet counts.

5.10 Myelodysplastic Syndrome (MDS) and Acute Myeloid Leukemia (AML) in Patients with Breast and Lung Cancer

(Newly added subsection)

MDS and AML have been associated with the use of pegfilgrastim in conjunction with chemotherapy and/or radiotherapy in patients with breast and lung cancer. Monitor patients for signs and symptoms of MDS/AML in these settings.

6 Adverse Reactions

(Additions and/or revisions underlined)

The following clinically significant adverse reactions are discussed in greater detail in other sections of the labeling: 

  • Splenic Rupture [See Warnings and Precautions (5.1)]

  • Acute Respiratory Distress Syndrome [See Warnings and Precautions (5.2)]

  • Serious Allergic Reactions [See Warnings and Precautions (5.3)]

  • Use in Patients with Sickle Cell Disorders [See Warnings and Precautions (5.4)]

  • Glomerulonephritis [See Warnings and Precautions (5.5)]

  • Leukocytosis [See Warnings and Precautions (5.6)]

  • Thrombocytopenia [See Warnings and Precautions (5.7)]

  • Capillary Leak Syndrome [See Warnings and Precautions (5.8)]

  • Potential for Tumor Growth Stimulatory Effects on Malignant Cells [See Warnings and Precautions (5.9)]

  • Myelodysplastic syndrome [See Warnings and Precautions (5.10)]

  • Acute myeloid leukemia [See Warnings and Precautions (5.10)]

  • Aortitis [see Warnings and Precautions (5.11)]

6.3 Postmarketing Experience

(Additions and/or revisions underlined)

The following adverse reactions have been identified during post approval use of pegfilgrastim products. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. 

  • Splenic rupture and splenomegaly (enlarged spleen) [see Warnings and Precautions (5.1)]
  • Acute respiratory distress syndrome (ARDS) [see Warnings and Precautions (5.2)]
  • Allergic reactions/hypersensitivity, including anaphylaxis, skin rash, and urticaria, generalized erythema, and flushing [see Warnings and Precautions (5.3)]
  • Sickle cell crisis [see Warnings and Precautions (5.4)]
  • Glomerulonephritis [see Warnings and Precautions (5.5)]
  • Leukocytosis [see Warnings and Precautions (5.6)]
  • Thrombocytopenia [see Warnings and Precautions (5.7)]
  • Capillary Leak Syndrome [see Warnings and Precautions (5.8)]
  • Injection site reactions
  • Sweet’s syndrome, (acute febrile neutrophilic dermatosis), cutaneous vasculitis
  • Myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in patients with breast and lung cancer receiving chemotherapy and/or radiotherapy [see Warnings and Precautions (5.10)]

  • Aortitis [see Warnings and Precautions (5.11)]

  • Alveolar hemorrhage

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

17  PATIENT COUNSELING INFORMATION

(Additions and/or revisions underlined)

Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use).

Advise patients of the following risks and potential risks with Fulphila:

    • Splenic rupture and splenomegaly [see Warnings and Precautions (5.1)]

    • Acute Respiratory Distress Syndrome [see Warnings and Precautions (5.2)]

    • Serious allergic reactions [see Warnings and Precautions (5.3)]

    • Sickle cell crisis [see Warnings and Precautions (5.4)]

    • Glomerulonephritis [see Warnings and Precautions (5.5)]

    • Increased risk of Myelodysplastic Syndrome and/or Acute Myeloid Leukemia in patients with breast and lung cancer who receive pegfilgrastim in conjunction with chemotherapy and/or radiation therapy [see Warnings and Precautions (5.10)]

    • Capillary Leak Syndrome [see Warnings and Precautions (5.8)]

    • Aortitis [see Warnings and Precautions (5.11)]

05/29/2019 (SUPPL-4)

Approved Drug Label (PDF)

6 Adverse Reactions

6.3 Postmarketing Experience

(addition underlined)

 

  • Alveolar hemorrhage

03/21/2019 (SUPPL-1)

Approved Drug Label (PDF)

5 Warnings and Precautions

5.4 Use in Patients with Sickle Cell Disorders

Addition of the following sentence:

Discontinue Fulphila if sickle cell crisis occurs.

Newly added subsections:

5.9 Aortitis

Aortitis has been reported in patients receiving pegfilgrastim. It may occur as early as the first week after start of therapy. Manifestations may include generalized signs and symptoms such as fever, abdominal pain, malaise, back pain, and increased inflammatory markers (e.g., c-reactive protein and white blood cell count). Consider aortitis in patients who develop these signs and symptoms without known etiology. Discontinue Fulphila if aortitis is suspected.

5.10 Nuclear Imaging

Increased hematopoietic activity of the bone marrow in response to growth factor therapy has been associated with transient positive bone imaging changes. This should be considered when interpreting bone imaging results.

6 Adverse Reactions

Additions and/or revisions underlined:

The following clinically significant adverse reactions …

  • Aortitis

6.3 Postmarketing Experience

  • Aortitis

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

PATIENT COUNSELING INFORMATION

Addition of the following:

  • Aortitis