Nonacog beta pegol

Identification

Summary

Nonacog beta pegol is a recombinant coagulation Factor IX derivative used to treat hemophilia B.

Generic Name
Nonacog beta pegol
DrugBank Accession Number
DB13933
Background

Nonacog beta pegol is a recombinant coagulation factor IX derivative. It is produced without animal-derived materials and with an attached 40kDa polyethylene glycol (PEG) molecule for peptide activation by a site-directed glycoPEGylation. Once activated, the activation molecule with PEG are cleaved to leave the activated factor IX (Factor IXa).1 Nonacog beta pegol was developed by Novo Nordisk, obtained EMA marketing authorisation in June 6, 2017.9

Type
Biotech
Groups
Approved, Investigational
Synonyms
  • Coagulation Factor IX (Recombinant), GlycoPEGylated
  • Nonacog beta pegol

Pharmacology

Indication

Nonacog beta pegol is indicated for the use in adults and children with hemophilia B for control and prevention of bleeding episodes, routine prophylaxis and perioperative management.10 In the EMA approval, it is also indicated for on-demand treatment of bleeding episodes.9 Hemophilia B is characterized by a deficiency in the coagulation factor IX which results in prolonged oozing after injuries and delayed or recurring bleeding prior wound healing. Hemophilia B patients present more frequent bleeding episodes during childhood and adolescence than in adulthood.7

Pharmacology
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Associated Conditions
Contraindications & Blackbox Warnings
Contraindications
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Pharmacodynamics

After nonacog beta pegol is activated by the coagulation factor IXa and tissue-coagulation factor VIIa, the peptide is cleaved off.10 In preclinical studies, once the peptide is free, there was a restoration of whole blood clotting time activity and the activated-partial thromboplastin time was returned to normal limits. In clinical trials, the administration of nonacog beta pegol significantly increased the levels of factor IX in plasma and temporarily correct the level of activated partial thromboplastin time.11 The effect of nonacog beta pegol translated into good hemostasis when used to treat bleeds on-demand and in a reduction of annualized bleeding rates when used as prophylaxis without formation of factor IX inhibitors, allergic reactions or thromboembolic complications.2 The reports in clinical trials have also shown a significant prolongation in the duration of the hemostatic effect.12

Mechanism of action

Nonacog beta pegol is activated by the factor IXa and the tissue complex factor VII. When activated, the peptide including the 40kDa PEG moiety is cleaved off leaving an activated recombinant factor IX ready to be part of the coagulation cascade replacing the missing clotting factor IX.9 Thus, after activation, nonacog beta pegol will present the same mechanism of action than the endogenous coagulation factor IXa.10 The activated coagulation factor IX function is, in combination with the factor VIIIa, to activate the coagulation factor X to trigger the coagulation cascade that finalizes in the conversion of prothrombin into thrombin and the thrombin-driven conversion of fibrinogen into fibrin for the formation of a clot.3

TargetActionsOrganism
ACoagulation factor VII
cofactor
Humans
ACoagulation factor VIII
cofactor
Humans
ACoagulation factor X
agonist
Humans
Absorption

In preclinical overdose studies, there was reported an AUC of 1200 IU/kg in rats and 3750 IU/kg in monkeys.11 In clinical studies, the absorption properties of nonacog beta pegol were AUC of 92 IU h/ml at steady state.9 In precliniacl studies, there was a reduced accumulation of systemic drug after multiple dosing.12

Volume of distribution

The reported volume of distribution for nonacog beta pegol is variable depending on the patient's age. After single administration, the volume of distribution goes from 72 ml/kg when the patient is less than 6 years old, 68 ml/kg between 7-12 years old, 59 ml/kg between 13-17 years old and 47 ml/kg when the patient is over 18 years old.9 At steady state, the volume of distribution of nonacog beta pegol is 64 ml/kg.9

Protein binding

Nonavog brta pegol is not expected to bind to plasma proteins.12

Metabolism

Nonacog beta pegol is rapidly distributed with the highest distribution in the well-perfused tissues. The proteinic part of nonacog beta pegol is degraded over time leaving just the 40 kDa PEG in circulation for 7.5-9 times longer than the original compound.10 As previously reported, the nonacog beta pegol will undergo uptake into cells and the protein part will be degraded in the lysosomes/endosomes leaving the PEG part to return to the plasma.5

Route of elimination

Nonacog beta pegol is eliminated from all tissues indicating that it will reach steady state in plasma and tissue but it will not accumulate. The 40 kDa PEG is eliminated by urine and feces taking approximately 49 and 40% of the administered dose respectively.6 The PEG part of the drug seems to be eliminated with a bi-phasic profile that was registered at 2-3 days and at 15-18 days.12

Half-life

The terminal half life of nonacog beta pegol is in the range of 96-110 hours which is 5 times longer than an unmodified coagulation factor IX.4

Clearance

The registered clearance rate of nonacog beta pegol at steady state is of 0.4 ml h/kg.9

Adverse Effects
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Toxicity

There are reports indicating that long-term administration of nonacog beta pegol results in the development of cross-reacting neutralizing antibodies.11 Studies regarding carcinogenicity, genotoxicity and reproductive toxicity have not been made.9

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 therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Abciximab.
AcenocoumarolThe therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Acenocoumarol.
Alpha-1-proteinase inhibitorAlpha-1-proteinase inhibitor may increase the thrombogenic activities of Nonacog beta pegol.
AlteplaseThe therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Alteplase.
Aminocaproic acidThe risk or severity of adverse effects can be increased when Aminocaproic acid is combined with Nonacog beta pegol.
AncrodThe therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Ancrod.
AnistreplaseThe therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Anistreplase.
Antihemophilic factor (recombinant), PEGylatedThe therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Antihemophilic factor (recombinant), PEGylated.
Antithrombin AlfaThe therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Antithrombin Alfa.
Antithrombin III humanThe therapeutic efficacy of Nonacog beta pegol can be decreased when used in combination with Antithrombin III human.
Interactions
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Food Interactions
No interactions found.

Products

Products
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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
RebinynPowder, for solution2000 unit / vialIntravenousNovo Nordisk2018-03-23Not applicableCanada flag
RebinynPowder, for solution500 unit / vialIntravenousNovo Nordisk2018-03-23Not applicableCanada flag
RebinynPowder, for solution1000 unit / vialIntravenousNovo Nordisk2018-03-23Not applicableCanada flag
RefixiaInjection, powder, for solution1000 IUIntravenousNovo Nordisk2020-12-22Not applicableEU flag
RefixiaInjection, powder, for solution500 IUIntravenousNovo Nordisk2020-12-22Not applicableEU flag
RefixiaInjection, powder, for solution2000 IUIntravenousNovo Nordisk2020-12-22Not applicableEU flag

Categories

Drug Categories
Classification
Not classified
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
27Y83O992Q
CAS number
1175512-71-6

References

General References
  1. Collins PW, Moss J, Knobe K, Groth A, Colberg T, Watson E: Population pharmacokinetic modeling for dose setting of nonacog beta pegol (N9-GP), a glycoPEGylated recombinant factor IX. J Thromb Haemost. 2012 Nov;10(11):2305-12. doi: 10.1111/jth.12000. [Article]
  2. Syed YY: Nonacog Beta Pegol: A Review in Haemophilia B. Drugs. 2017 Dec;77(18):2003-2012. doi: 10.1007/s40265-017-0836-8. [Article]
  3. Palta S, Saroa R, Palta A: Overview of the coagulation system. Indian J Anaesth. 2014 Sep;58(5):515-23. doi: 10.4103/0019-5049.144643. [Article]
  4. Mancuso ME: GlycoPEGylated factor IX: a new step forward. Blood. 2014 Dec 18;124(26):3836-7. doi: 10.1182/blood-2014-10-604983. [Article]
  5. Baumann A, Tuerck D, Prabhu S, Dickmann L, Sims J: Pharmacokinetics, metabolism and distribution of PEGs and PEGylated proteins: quo vadis? Drug Discov Today. 2014 Oct;19(10):1623-31. doi: 10.1016/j.drudis.2014.06.002. Epub 2014 Jun 11. [Article]
  6. Sternebring O, Christensen JK, Bjornsdottir I: Pharmacokinetics, tissue distribution, excretion, and metabolite profiling of PEGylated rFIX (nonacog beta pegol, N9-GP) in rats. Eur J Pharm Sci. 2016 Sep 20;92:163-72. doi: 10.1016/j.ejps.2016.06.025. Epub 2016 Jul 1. [Article]
  7. Konkle B., Huston H. and Fletcher S. (2017). Gene Reviews. University of Washington..
  8. Globe Newswire [Link]
  9. Novo Nordisk News [Link]
  10. FDA Advisory committees [Link]
  11. FDA Advisory committees [Link]
  12. EMA Reports [Link]
RxNav
1990855
Wikipedia
Factor_IX

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
3Active Not RecruitingTreatmentCongenital Hematological Disorder / Hemophilia B1
3CompletedTreatmentCongenital Hematological Disorder / Hemophilia B3
3RecruitingTreatmentCongenital Hematological Disorder / Hemophilia B1
1CompletedTreatmentCongenital Hematological Disorder / Hemophilia B1
Not AvailableCompletedNot AvailableHemophilia1
Not AvailableEnrolling by InvitationNot AvailableHemophilia B2

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Powder, for solutionIntravenous1000 unit / vial
Powder, for solutionIntravenous2000 unit / vial
Powder, for solutionIntravenous500 unit / vial
Injection, powder, for solutionIntravenous1000 IU
Injection, powder, for solutionIntravenous2000 IU
Injection, powder, for solutionIntravenous500 IU
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
PropertyValueSource
water solubilitySolubleBolourchian N., et al. 12(Suppl): 11-20. (2013)

Targets

Drugtargets
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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Cofactor
General Function
Serine-type peptidase activity
Specific Function
Initiates the extrinsic pathway of blood coagulation. Serine protease that circulates in the blood in a zymogen form. Factor VII is converted to factor VIIa by factor Xa, factor XIIa, factor IXa, o...
Gene Name
F7
Uniprot ID
P08709
Uniprot Name
Coagulation factor VII
Molecular Weight
51593.465 Da
References
  1. Novo Nordisk News [Link]
  2. FDA Advisory committees [Link]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Cofactor
General Function
Oxidoreductase activity
Specific Function
Factor VIII, along with calcium and phospholipid, acts as a cofactor for factor IXa when it converts factor X to the activated form, factor Xa.
Gene Name
F8
Uniprot ID
P00451
Uniprot Name
Coagulation factor VIII
Molecular Weight
267007.42 Da
References
  1. Novo Nordisk News [Link]
  2. FDA Advisory committees [Link]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Agonist
General Function
Serine-type endopeptidase activity
Specific Function
Factor Xa is a vitamin K-dependent glycoprotein that converts prothrombin to thrombin in the presence of factor Va, calcium and phospholipid during blood clotting.
Gene Name
F10
Uniprot ID
P00742
Uniprot Name
Coagulation factor X
Molecular Weight
54731.255 Da
References
  1. Novo Nordisk News [Link]
  2. FDA Advisory committees [Link]

Drug created on December 22, 2017 14:27 / Updated on August 04, 2021 18:23