Identification

Summary

Human Rho(D) immune globulin is a solution of antibodies used to prevent isoimmunization of Rho(D) negative patients exposed to Rho(D) positive blood in pregnancy or transfusion.

Brand Names
Hyperrho, Micrhogam, Rhogam, Rhophylac, Winrho
Generic Name
Human Rho(D) immune globulin
DrugBank Accession Number
DB11597
Background

Human Rho(D) immune globulin is a medicine given by intramuscular or intravenous injection that is used to prevent the immunological condition known as Rh disease (or hemolytic disease of newborn). Rho (D) immune globulin is available as a sterile, lyophilized or liquid gamma globulin (IgG) fraction containing antibodies to the Rh0 (D) antigen (D antigen) under the name Rhophylac (IM/IV). Immune globullin was purified via ion-exchange chromatography method and prepared from pools of human plasma, where the donors are Rho (D)-negative donors who have been immunized with Rho(D)-positive RBCs. It was approved by FDA as treatment for suppression of rhesus (Rh) isoimmunization or chronic immune thrombocytopenic purpura (ITP) in adults.

Type
Biotech
Groups
Approved, Investigational
Biologic Classification
Protein Based Therapies
Polyclonal antibody (pAb)
Protein Chemical Formula
Not Available
Protein Average Weight
Not Available
Sequences
Not Available
Synonyms
  • Anti-D (RH) immunoglobulin (human)
  • Anti-D immunoglobulin
  • Anti-D immunoglobulins
  • Human anti-D immunoglobulin
  • IGG, Rho (D)
  • Immunoglobulin human anti-RH
  • Rh0(D) Immune Globulin Intravenous (Human)
  • Rho (D) immune globulin,human
  • Rho D immune globulin human
  • Rho(D) immune globulin (human)
  • Rho(D) immune globulin human
  • Rho(D) immune globulin IM human

Pharmacology

Indication

Indicated for suppression of rhesus (Rh) isoimmunization in nonsensitized Rho (D)-negative women with an Rh-incompatible pregnancy, or in Rho (D)-negative individuals transfused with Rh0(D)-positive red blood cells (RBCs) or blood components containing Rh0(D)-positive RBCs. Also indicated in Rh0(D)-positive, non-splenectomized adult patients with chronic immune thrombocytopenic purpura (ITP) to raise platelet counts.

Pharmacology
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Associated Conditions
Associated Therapies
Contraindications & Blackbox Warnings
Contraindications
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Pharmacodynamics

15000 international unit (IU) contains sufficient anti-Rho (D) to effectively suppress the immunizing potential of approximately 17mL of Rho (D) (D-positive) red blood cells 12. Human Rho(D) immune globulin therapy prevents immunization to Rho (D)-positive red blood cells (RBC) by inducing antibody-mediated immunosuppression (AMIS) effectively clearing Rho-positive RBCs by rapidly binding to them. This prevents Rho-negative mothers to produce alloantibodies to paternally inherited RhD antigen expressed on fetal erythrocytes and cause haemolytic diseases of the newborn. Rho immune globulin increase platelet counts and reduce bleeding in Rho-positive patients with ITP by inhibiting autoantibody-mediated platelet clearance.

Mechanism of action

The mechanism of action of Rho(D) immune globulin therapy is unclear. It is suggested that Rho immune globulin predominantly prevents the antibody response during incompatible pregnancy by accelerating the phagocytosis of RBC's and clearance from the circulation before the recognition by the immune system. IgG-opsonized RBCs may interact with activating IgG receptors (FcγRs) on effector cells and elicit phagocytosis via mononuclear phagocytic system, primarily by macrophages. IgG may also stimulate complement activation on the RBC surface, followed by RBC lysis or complement receptor-mediated phagocytosis but to smaller extent 4. Rho-specific IgG may inhibit the late stages of B cell activation by being internalized with Rho antigen by B cells, which alters the antigen processing and presentation. In response to the IgG-antigen complex formation, the immune globulin enhances the presentation of specific peptides and proliferation of epitope-specific T cells 4. Therapeutic efficacy of Rho (D) immune globulin in chronic immune thrombocytopenic purpura (ITP) may be explained by FcR blockade as well as the increase in the platelet count by substituting antibody-coated RBCs for antibodycoated platelets 2. In vitro studies of cytokine expression in human monocytes and granulocytes exposed to anti-D coated red blood cells have demonstrated enhanced secretion of interleukin 1 receptor antagonist resulting in down-regulation of FcγR mediated phagocytosis. Murine models show that RBC-specific antibodies can increase platelet counts by down-regulating FcγRIIIa on splenic macrophage, which is an opposing effect as predicted in intravenous Rho IgG 3.

TargetActionsOrganism
ARhesus blood group D antigen
antibody
Humans
Absorption

In patients undergoing therapy for Rh isoimmunization suppression, Rho(D) immune globulin titers were detected in all women up to at least 9 weeks following either intravenous or intramuscular administration. Following intravenous administration of a single 1500 IU (300 mcg) dose, peak serum levels of Rh0(D) immune globulin ranged from 62 to 84 ng/mL after first day. The levels ranged from 7 to 46 ng/mL and were achieved between 2 and 7 days following intramuscular injection. The absolute bioavailability achieved following IM administration is 69%.

Volume of distribution

A single dose of 300ug Rho(D) Immune Globulin through intramuscular injection displays a Vd of 8.59L 13.

Protein binding

Not Available

Metabolism

Rho (D) immune globulin is expected to undergo nonspecific catabolism.

Route of elimination

Human immune globulin and the fragments can be detected in feces and urine.

Half-life

The half life is 16 ± 4 days following IV administration and 18 ± 5 days following IM administration.

Clearance

Mean systemic clearance following IV administration is 0.20 ±0.03 mL/min. Mean apparent clearance following IM administration is 0.29 ± 0.12 mL/min.

Adverse Effects
Adverseeffects
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Toxicity

Most serious adverse reactions in patients with ITP include intravascular hemolysis, anemia, acute renal insufficiency, and death. In patients treated for Rh isoimmunization suppression, common adverse effects include nausea, dizziness, headache, pain at injection site and malaise. Common adverse effects in patients with ITP include chills, pyrexia, mild extravascular hemolysis and headache.

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
AbciximabThe risk or severity of adverse effects can be increased when Abciximab is combined with Human Rho(D) immune globulin.
AdalimumabThe risk or severity of adverse effects can be increased when Adalimumab is combined with Human Rho(D) immune globulin.
AducanumabThe risk or severity of adverse effects can be increased when Human Rho(D) immune globulin is combined with Aducanumab.
AlemtuzumabThe risk or severity of adverse effects can be increased when Alemtuzumab is combined with Human Rho(D) immune globulin.
AlirocumabThe risk or severity of adverse effects can be increased when Alirocumab is combined with Human Rho(D) immune globulin.
AmivantamabThe risk or severity of adverse effects can be increased when Human Rho(D) immune globulin is combined with Amivantamab.
AnifrolumabThe risk or severity of adverse effects can be increased when Human Rho(D) immune globulin is combined with Anifrolumab.
AnsuvimabThe risk or severity of adverse effects can be increased when Human Rho(D) immune globulin is combined with Ansuvimab.
Anthrax immune globulin humanThe risk or severity of adverse effects can be increased when Anthrax immune globulin human is combined with Human Rho(D) immune globulin.
Antilymphocyte immunoglobulin (horse)The risk or severity of adverse effects can be increased when Antilymphocyte immunoglobulin (horse) is combined with Human Rho(D) immune globulin.
Interactions
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Food Interactions
No interactions found.

Products

Products2
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dosage, form, labeller, route of administration, and marketing period.
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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
Hyp Rho D Inj 16.5%Liquid16.5 %IntramuscularCutter Med & Biol, Division Of Miles Canada Ltd.1979-12-311998-09-25Canada flag
Hyperrho S/d Full DoseSolution1500 [iU]/1IntramuscularGRIFOLS USA, LLC1996-08-14Not applicableUS flag
Hyperrho S/d Mini-doseSolution250 [iU]/1IntramuscularGRIFOLS USA, LLC1996-08-14Not applicableUS flag
MICRhoGAM Ultra-Filtered PLUSInjection, solution50 ug/1IntramuscularKedrion Biopharma Inc2007-03-09Not applicableUS flag
RhoGAM Ultra-Filtered PLUSInjection, solution300 ug/1IntramuscularKedrion Biopharma Inc2007-03-09Not applicableUS flag
RhophylacSolution1500 [iU]/2mLIntramuscular; IntravenousCsl Behring Ag2009-01-06Not applicableUS flag
WinrhoLiquid5000 [iU]/1mLIntramuscular; IntravenousAptevo Biotherapeutics Llc2016-07-01Not applicableUS flag
WinrhoLiquid2500 [iU]/1mLIntramuscular; IntravenousAptevo Biotherapeutics Llc2016-07-01Not applicableUS flag
WinrhoLiquid15000 [iU]/1mLIntramuscular; IntravenousAptevo Biotherapeutics Llc2016-07-01Not applicableUS flag
WinrhoLiquid1500 [iU]/1mLIntramuscular; IntravenousAptevo Biotherapeutics Llc2016-07-01Not applicableUS flag
Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing EndRegionImage
Winrho Sd Kit InjHuman Rho(D) immune globulin (120 mcg / kit) + Sodium chloride (0.9 % / kit)KitIntramuscular; IntravenousRh Pharmaceuticals Inc.1993-12-311997-07-22Canada flag
Winrho Sd Kit Inj.Human Rho(D) immune globulin (300 mcg / kit) + Sodium chloride (.9 % / kit)KitIntramuscular; IntravenousRh Pharmaceuticals Inc.1993-12-311997-07-22Canada flag
Unapproved/Other Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing EndRegionImage
WIN RHO SDF 300 MCG FLAKON, 1 ADETHuman Rho(D) immune globulin (300 mcg)Injection, solutionIntramuscular; IntravenousRA İLAÇ SAN.VE TİC. A.Ş.2020-08-14Not applicableTurkey flag

Categories

ATC Codes
J06BB01 — Anti-d (rh) immunoglobulin
Drug Categories
Chemical TaxonomyProvided by Classyfire
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
Affected organisms
Not Available

Chemical Identifiers

UNII
48W7181FLP
CAS number
Not Available

References

General References
  1. Cheung E, Liebman HA: Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia. Biologics. 2009;3:57-62. Epub 2009 Jul 13. [Article]
  2. Bussel JB, Graziano JN, Kimberly RP, Pahwa S, Aledort LM: Intravenous anti-D treatment of immune thrombocytopenic purpura: analysis of efficacy, toxicity, and mechanism of effect. Blood. 1991 May 1;77(9):1884-93. [Article]
  3. Crowther CA, Keirse MJ: Anti-D administration in pregnancy for preventing rhesus alloimmunisation. Cochrane Database Syst Rev. 2000;(2):CD000020. [Article]
  4. Brinc D, Lazarus AH: Mechanisms of anti-D action in the prevention of hemolytic disease of the fetus and newborn. Hematology Am Soc Hematol Educ Program. 2009:185-91. doi: 10.1182/asheducation-2009.1.185. [Article]
  5. Brinc D, Le-Tien H, Crow AR, Freedman J, Lazarus AH: IgG-mediated immunosuppression is not dependent on erythrocyte clearance or immunological evasion: implications for the mechanism of action of anti-D in the prevention of haemolytic disease of the newborn? Br J Haematol. 2007 Oct;139(2):275-9. [Article]
  6. Bichler J, Schondorfer G, Pabst G, Andresen I: Pharmacokinetics of anti-D IgG in pregnant RhD-negative women. BJOG. 2003 Jan;110(1):39-45. [Article]
  7. Poortmans JR, Jeanloz RW: Urinary excretion of immunoglobulins and their subunits in human subjects before and after exercise. Med Sci Sports Exerc. 1993 Feb;25(2):171-8. [Article]
  8. Haneberg B, Endresen C: Fragments of immunoglobulins in human faeces. Acta Pathol Microbiol Scand C. 1976 Feb;84(1):31-6. [Article]
  9. Haneberg B, Aarskog D: Human faecal immunoglobulins in healthy infants and children, and in some with diseases affecting the intestinal tract or the immune system. Clin Exp Immunol. 1975 Nov;22(2):210-22. [Article]
  10. Arend WP, Silverblatt FJ: Serum disappearance and catabolism of homologous immunoglobulin fragments in rats. Clin Exp Immunol. 1975 Dec;22(3):502-13. [Article]
  11. Rhophylac Summary of Basis for Approval [Link]
  12. WinRho Product information [Link]
  13. RhoGam (Rho(D) Immune Globulin intramuscular injection) product information [Link]
PubChem Substance
347911208
RxNav
1789837
Wikipedia
Rho(D)_immune_globulin
FDA label
Download (513 KB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
4TerminatedTreatmentHepatitis C Virus (HCV) Infection / Human Immunodeficiency Virus (HIV) Infections / Thrombocytopenia1
2CompletedNot AvailableHealthy Subjects (HS)1
1CompletedTreatmentHealthy Subjects (HS)1
Not AvailableCompletedTreatmentDengue Fever1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Powder, for solutionIntravenous
LiquidIntramuscular16.5 %
InjectionIntramuscular; Intravenous
SolutionIntramuscular1500 [iU]/1
InjectionIntramuscular1500 IU/dose
SolutionIntramuscular250 [iU]/1
Injection, powder, for solutionIntramuscular1250 U.I./2ML
Injection, solutionIntramuscular1500 UI/2ML
Injection, powder, for solutionIntramuscular200 MCG
Injection, solutionIntramuscular100 mcg/2ml
Injection, solutionIntramuscular300 MCG/2ML
Injection, powder, for solutionIntramuscular300 mcg
Injection, powder, lyophilized, for solutionIntramuscular
Injection, solutionIntramuscular50 ug/1
Injection, powder, for solutionIntramuscular
Injection, solutionIntramuscular
Injection, solutionParenteral625 IU/ml
Injection, solutionIntramuscular300 ug/1
Injection, solution
SolutionIntramuscular; Intravenous1500 [iU]/2mL
Injection, solutionIntramuscular; Intravenous
SolutionIntramuscular; Intravenous300 mcg
LiquidIntramuscular; Intravenous1500 [iU]/1mL
LiquidIntramuscular; Intravenous15000 [iU]/1mL
LiquidIntramuscular; Intravenous2500 [iU]/1mL
LiquidIntramuscular; Intravenous5000 [iU]/1mL
KitIntramuscular; Intravenous
InjectionIntramuscular; Intravenous1500 [iU]/1
InjectionIntramuscular; Intravenous15000 [iU]/1
InjectionIntramuscular; Intravenous2500 [iU]/1
InjectionIntramuscular; Intravenous5000 [iU]/1
KitIntramuscular; Intravenous1500 unit / kit
KitIntramuscular; Intravenous5000 unit / kit
KitIntramuscular; Intravenous600 unit / kit
SolutionIntramuscular; Intravenous1500 unit / vial
SolutionIntramuscular; Intravenous15000 unit / vial
SolutionIntramuscular; Intravenous2500 unit / vial
SolutionIntramuscular; Intravenous5000 unit / vial
SolutionIntramuscular; Intravenous600 unit / vial
Prices
Not Available
Patents
Not Available

Properties

State
Liquid
Experimental Properties
Not Available

Targets

Drugtargets2
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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Antibody
General Function
Ammonium transmembrane transporter activity
Specific Function
Not Available
Gene Name
RHD
Uniprot ID
A6PZ59
Uniprot Name
Rhesus blood group D antigen
Molecular Weight
45275.06 Da

Drug created at May 20, 2016 19:42 / Updated at December 01, 2021 01:05