Efmoroctocog alfa is a fully recombinant factor VIII-Fc fusion protein (rFVIIIFc) with an extended half-life compared with conventional factor VIII (FVIII) preparations, including recombinant FVIII (rFVIII) products such as Moroctocog alfa^[1]. It is an antihemorrhagic agent used in replacement therapy for patients with haemophilia A (congenital factor VIII deficiency). It is suitable for all age groups. Haemophilia A is a rare bleeding disorder associated with a slow clotting process caused by the deficiency of factor VIII. Patients with this disorder are more susceptible to recurrent bleeding episodes and excessive bleeding following minor traumatic injuries or surgical procedures ^[1]. Prophylactic treatment may dramatically improve the management of severe haemophilia A in the future by reducing joint bleeding and other hemorrhages that cause chronic pain and disability to patients ^{[1, 2]}. Prophylaxis has also shown to reduce the formation of neutralizing anti-FVIII antibodies, or inhibitors ^[2].

Factor VIII is a blood coagulant factor involved in the intrinsic pathway to form fibrin, or a blood clot. Efmoroctocog alfa is a first commercially available rFVIII-Fc fusion protein (rFVIIIFc) where the conjugated molecule of rFVIII to polyethylene glycol is covalently fused to the dimeric Fc domain of human immunoglobulin G1, a long-lived plasma protein ^[Label]. The B domain of factor VIII is deleted. In animal models of haemophilia, efmoroctocog alfa demonstrated an approximately two-fold longer t½ than commercially available rFVIII products ^[1].

Other drug products with similar structure and function to Efmoroctocog alfa include Moroctocog alfa, which is produced by recombinant DNA technology and is identical in sequence to endogenously produced Factor VIII, but does not contain the B-domain, which has no known biological function, and Antihemophilic factor human, which is purified endogenous Factor VIII from human pooled blood and contains both A- and B-subunits.

It is commonly marketed as Elocta or Eloctate for intravenous injection. To date, no confirmed inhibitory autoantibodies were seen in previously treated patients included in clinical studies and treatment-emergent adverse events were generally consistent with those expected in the patient populations being studied ^[1]. The extended half-life of efmoroctocog alfa provides several clinical benefits for patients, including reduced frequency of injections required and improved adherence to prophylaxis ^[1].

Protein chemical formula

C₉₇₃₆H₁₄₈₆₃N₂₅₉₁O₂₈₅₅S₇₈

Protein average weight

220000.0 Da (Apparent, B-domain deleted)

Sequences

Not Available

Synonyms

Antihemophilic Factor (Recombinant BDD), FC Fusion Protein
Antihemophilic factor (recombinant, FC fusion protein)
Coagulation factor VIII recombinant immunoglubulin g1 fusion protein

Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End
Eloctate	Kit	5000 [iU]/3mL	Intravenous	Biogen	2014-07-14	Not applicable
Eloctate	Kit; Powder, for solution	1000 unit	Intravenous	Bioverativ Canada Inc	2016-01-15	Not applicable
Eloctate	Kit	6000 [iU]/3mL	Intravenous	Bioverativ Therapeutics Inc.	2017-09-06	Not applicable
Eloctate	Kit; Powder, for solution	250 unit	Intravenous	Bioverativ Canada Inc	2016-01-15	Not applicable
Eloctate	Kit	3000 [iU]/3mL	Intravenous	Biogen	2014-07-14	Not applicable
Eloctate	Kit	1500 [iU]/3mL	Intravenous	Biogen	2014-07-14	Not applicable
Eloctate	Kit	4000 [iU]/3mL	Intravenous	Bioverativ Therapeutics Inc.	2017-09-06	Not applicable
Eloctate	Kit	1500 [iU]/3mL	Intravenous	Bioverativ Therapeutics Inc.	2017-09-06	Not applicable
Eloctate	Kit	500 [iU]/3mL	Intravenous	Biogen	2014-07-14	Not applicable
Eloctate	Kit; Powder, for solution	1500 unit	Intravenous	Bioverativ Canada Inc	2016-01-15	Not applicable

Categories

Hemostatics

UNII

7PCM518YLR

CAS number

1270012-79-7

Pharmacology

Indication

Indicated for the treatment and prophylaxis of bleeding in patients with haemophilia A (congenital factor VIII deficiency) ^[Label].

Associated Conditions

Pharmacodynamics

In two multinational, open-label, noncomparative phase III trials involving previously treated pediatric and adult patients with severe haemophilia A, the clinical efficacy and safety of efmoroctocog alfa have been studied. The bleeding episodes were adequately controlled and bleeding rates were substantially reduced when efmoroctocog alfa has been used for individualized prophylaxis or treatment of bleeding ^[Label]. In adult patients receiving a single preoperative dose to maintain haemostasis during surgical procedures, the total dose on the day of surgery needed to maintain haemostasis ranged from 50.8 to 126.6 IU/kg ^[Label].

Mechanism of action

Factor VIII exists in a circulating protein complex consisting of two molecules via a non-covalent binding interaction; Factor VIII and von Willebrand factor. This complex remains inactive until the coagulation cascade is initiated, which activated factor VIII. Factor VIII is released from the protein complex upon activation and acts as a cofactor for factor IX-mediated conversion of factor X to activated factor X on phospholipid surfaces. Activated factor X is critical in converting prothrombin into thrombin and sequentially, thrombin converts fibrinogen to fibrin for the formation of a blood clot ^[Label].

Haemophilia A is a X-linked hereditary disorder of blood coagulation due to decreased levels of functional factor. The disorder can lead to various disabling complications including bleeding into joints, muscles or internal organs, either spontaneously or as a result of accidental or surgical trauma ^[Label]. Efmoroctocog alfa is a recombinant fusion protein comprised of a single molecule of B-domain deleted human coagulation factor VIII covalently linked to the Fc domain of human immunoglobulin G1. It acts as a replacement therapy to increase the plasma levels of factor VIII, thereby enabling a temporary correction of the factor deficiency and correction of the bleeding tendencies ^[Label].

Extended half-life of efmoroctocog alfa relative to endogenous factor VIII is explained by the Fc region binding to the neonatal Fc receptor expressed throughout life; the receptor is part of a naturally occurring pathway that protects immunoglobulins (and Fc fusion proteins) from lysosomal degradation by cycling them back into the circulation ^[Label].

Target	Actions	Organism
Avon Willebrand factor	binding	Human

Absorption

Following a single intravenous dose of 50 IU/kg in previously-treated adult patients with severe haemophilia A, mean peak plasma concentrations (Cmax) ranged from 108 to 131 IU/dL. Mean area under the FVIII activity time curve (AUC/Dose) ranged from 47.5 to 51.2 IUxh/dL per IU/kg. Mean AUC/Dose in adolescent patients 12 to 18 years of age ranged from 38.2 to 40.8 IUxh/dL per IU/kg. Mean AUC/Dose in pediatric patients < 12 years of age ranged from 25.9 to 38.4 IUxh/dL per IU/kg ^[Label].

Volume of distribution

Following a single intravenous dose of 50 IU/kg in previously-treated adult patients with severe haemophilia A, mean volume of distribution at steady state (Vss) ranged from 49.1 to 52.6 mL/kg. Mean Vss in adolescent patients 12 to 18 years of age ranged from 57.6 to 59.4mL/kg. Mean Vss in pediatric patients < 12 years of age ranged from 49.5 to 63.1 mL/kg ^[Label].

Protein binding

Like endogenous factor VIII, efmoroctocog alfa binds to von Willebrand factor in the circulation.

Metabolism

There are no detectable metabolites for efmoroctocog alfa. It is presumed to be metabolized via a same degradation pathway as endogenous factor VIII.

Route of elimination

Not Available

Half life

Following a single intravenous dose of 50 IU/kg in previously-treated adult patients with severe haemophilia A, mean half life (t1/2) ranged from 19 to 20.9 h. Mean t1/2 in adolescent patients 12 to 18 years of age ranged from 16 to 17.5 h. Mean t1/2 in pediatric patients < 12 years of age ranged from 12.3 to 15.9 h ^[Label].

Clearance

Following a single intravenous dose of 50 IU/kg in previously-treated adult patients with severe haemophilia A, mean clearance (CL) rate ranged from 1.95 to 2.11 mL/h/kg. Mean CL in adolescent patients 12 to 18 years of age ranged from 2.45 to 2.62 mL/h/kg. Mean t1/2 in pediatric patients < 12 years of age ranged from 2.61 to 3.86 mL/h/kg ^[Label].

Toxicity

Based on the findings from acute and repeated dose toxicity studies, efmoroctocog alfa displays no special hazard for humans. Studies to assess the genotoxicity, carcinogenicity, toxicity to reproduction or embryo-foetal development of efmoroctocog alfa have not been conducted. In a placental transfer study, efmoroctocog alfa has been shown to cross the placenta in small amounts in mice ^[Label].

Affected organisms

Not Available

Pathways

Not Available

Pharmacogenomic Effects/ADRs

Not Available

Interactions

Drug Interactions: Not Available
Food Interactions: Not Available

References

General References

Frampton JE: Efmoroctocog Alfa: A Review in Haemophilia A. Drugs. 2016 Sep;76(13):1281-1291. doi: 10.1007/s40265-016-0622-z. [PubMed:27487799]
Tiede A: Half-life extended factor VIII for the treatment of hemophilia A. J Thromb Haemost. 2015 Jun;13 Suppl 1:S176-9. doi: 10.1111/jth.12929. [PubMed:26149020]

External Links

PubChem Substance: 347911217

AHFS Codes

20:28.16 — Hemostatics

FDA label

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Clinical Trials

Clinical Trials

Phase	Status	Purpose	Conditions	Count
0	Recruiting	Treatment	Hemophilia / Menstrual Flow Excessive	1
1	Completed	Treatment	Severe Hemophilia A	1
2	Not Yet Recruiting	Treatment	Severe Hemophilia A	1
2	Recruiting	Treatment	Hemophilia	1
3	Completed	Treatment	Hemophilia A	2
4	Recruiting	Treatment	Hemophilia A	1
4	Recruiting	Treatment	Hemophilia A / Hemophilia A With Inhibitors	1
Not Available	Recruiting	Not Available	Hemophilia	1
Not Available	Recruiting	Not Available	Hemophilia A	1
Not Available	Terminated	Not Available	Hemophilia A / Hereditary factor IX deficiency	1

Pharmacoeconomics

Manufacturers

Not Available

Packagers

Not Available

Dosage forms

Form	Route	Strength
Kit	Intravenous	1000 [iU]/3mL
Kit	Intravenous	1500 [iU]/3mL
Kit	Intravenous	2000 [iU]/3mL
Kit	Intravenous	250 [iU]/3mL
Kit	Intravenous	3000 [iU]/3mL
Kit	Intravenous	4000 [iU]/3mL
Kit	Intravenous	500 [iU]/3mL
Kit	Intravenous	5000 [iU]/3mL
Kit	Intravenous	6000 [iU]/3mL
Kit	Intravenous	750 [iU]/3mL
Kit; powder, for solution	Intravenous	1000 unit
Kit; powder, for solution	Intravenous	1500 unit
Kit; powder, for solution	Intravenous	2000 unit
Kit; powder, for solution	Intravenous	250 unit
Kit; powder, for solution	Intravenous	3000 unit
Kit; powder, for solution	Intravenous	500 unit
Kit; powder, for solution	Intravenous	750 unit

Prices

Not Available

Patents

Not Available

Properties

State: Solid
Experimental Properties: Not Available

Taxonomy

Description: Not Available
Kingdom: Organic Compounds
Super Class: Organic Acids
Class: Carboxylic Acids and Derivatives
Sub Class: Amino Acids, Peptides, and Analogues
Direct Parent: Peptides
Alternative Parents: Not Available
Substituents: Not Available
Molecular Framework: Not Available
External Descriptors: Not Available

Targets

Details1. von Willebrand factor

Kind: Protein
Organism: Human
Pharmacological action: Yes
Actions: Binding

General Function: Protein n-terminus binding
Specific Function: Important in the maintenance of hemostasis, it promotes adhesion of platelets to the sites of vascular injury by forming a molecular bridge between sub-endothelial collagen matrix and platelet-surf...
Gene Name: VWF
Uniprot ID: P04275
Uniprot Name: von Willebrand factor
Molecular Weight: 309261.83 Da

Drug created on June 24, 2016 13:15 / Updated on October 16, 2018 08:43