THERE IS NO PARTIAL PROTECTION FROM HEPATITIS B...• Store in a refrigerator at 2 C to 8 C (35 F to...
Transcript of THERE IS NO PARTIAL PROTECTION FROM HEPATITIS B...• Store in a refrigerator at 2 C to 8 C (35 F to...
INDICATIONHEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults 18 years of age and older. IMPORTANT SAFETY INFORMATION Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (eg, anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.Please see additional Important Safety Information throughout this brochure and accompanying full Prescribing Information.
THERE IS NO PARTIAL PROTECTION FROM HEPATITIS B
THERE IS NO PARTIAL PROTECTION FROM HEPATITIS B
PROTECTED UNPROTECTED
TRADITIONAL 3-DOSE HEPATITIS B VACCINES MAY CREATE A FALSE SENSE OF SECURITY THAT PUTS PATIENTS, HEALTHCARE PROVIDERS (HCPs), AND INSTITUTIONS AT RISK2,3
10mIU/mL
Anti-HBs 10 mIU/mL is considered a correlate
of vaccine-inducedclinical protection1
You can only be confident of PROTECTIVE IMMUNITY if your anti-HBs threshold is 10 mIU/mL1
The majority of people who do not receive all 3 doses of traditional
hepatitis B vaccines fail to achieve protective immunity2
Abbreviation: Anti-HBs, antibody against hepatitis B surface antigen.
~20%
TO 30%
IN CLINICAL STUDIES, MANY FAILED TO ACHIEVE PROTECTIVE IMMUNITY EVEN AFTER COMPLETING ALL 3 DOSES OF A TRADITIONAL HEPATITIS B VACCINE
~20% to 30% ofpeople failed toachieve protective immunity and remain unprotected6
~35% of people with diabetes failed to achieve protective immunity and remain unprotected6,7
96%FAILED TO ACHIEVE
PROTECTIVE IMMUNITY
FAILED TO ACHIEVE
PROTECTIVE IMMUNITY
FAILED TO ACHIEVE
PROTECTIVE IMMUNITY
73% 18.7%
ENGERIX-B6,8
RISK OF HBV INFECTION REMAINS
Month
Dose
10 2 3 4 5 6 7
1 2 3
~35%
IT TAKES 6 MONTHS TO COMPLETE A TRADITIONAL 3-DOSE HEPATITIS B VACCINE SERIES2
FOR MOST PEOPLE, THE RISK OF INFECTION REMAINS UNTIL AFTER THE THIRD DOSE IS COMPLETED2
TRADITIONAL 3-DOSE HEPATITIS B VACCINES HAVE BEEN PROVEN DIFFICULT TO COMPLETE
of HCPs did not receive all 3 doses4
of adults aged 19+ did not receiveall 3 doses5~40% ~75%
Abbreviation: HBV, hepatitis B virus.
HEPATITIS B INFECTION IS DANGEROUS
~5,500 HBV-RELATED DEATHS OCCUR EACH YEAR IN THE US11
HBV can remain infectious outside the body for at least 7 days9,10
HEPATITIS B CAN HAVE SERIOUS CONSEQUENCES
of hepatocellular carcinomas are caused by HBV11
upto
of cirrhosis diagnoses are
caused by HBV12
50% 15%
HBV 100XHIV9
more infectious than
is
7DAYS
Hepatitis B does not discriminate. It can have a lasting impact on everyone in the healthcare continuum, and it puts patients, HCPs, and institutions at risk.9,10,13,14
EFFECTIVE VACCINATION IS CRITICAL TO REDUCING THE SPREAD OF THE DISEASE2
THERE IS NO CURE FOR HEPATITIS B
HEPATITIS B INFECTION CAN PUT EVERYONE AT RISK
HEPATITIS B VACCINES HAVE BEEN AVAILABLE FOR NEARLY 40 YEARS, YET HBV INFECTIONS ARE ON THE RISE15,16
THE RISK OF POTENTIAL EXPOSURE TO HBV FOR HCPs REMAINS HIGH
MOST INFECTED HCPs COULD NOT RECALL ANY EXPOSURE15
DESPITE THE HIGH RISK FOR HCPs, EXPOSURES OFTEN GO UNREPORTED
HCPs experience 600,000 to 800,000potential exposures each year through needlesticks and contact with bodily fluids13,14
46% of percutaneous exposures among interns, fellows, and residents are not reported to occupational health15
As many as 2.2 million peoplein the US areinfected with hepatitis B17
Estimated new cases of HBV in the US have risen ~11% over a 5-year period16
PROTECT WITH THE ONLY 2-DOSE, 1-MONTH HEPATITIS B VACCINE FOR ADULTS6,18
UNANIMOUSLY RECOMMENDED BY THE ACIP14
FASTER PROTECTION WITH HEPLISAV-B
THERE IS NO PARTIAL PROTECTION FROM HBV
95% of Those Who Received HEPLISAV-B Were Protected After Just 2 Doses in 1 Month6,8*
Percentage of People Aged 18 to 55 Achieving Protective Immunity†TRIAL 1
IMPORTANT SAFETY INFORMATIONAppropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of HEPLISAV-B.Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response to HEPLISAV-B.Please see additional Important Safety Information throughout this brochure and accompanying full Prescribing Information.
• 13.7% difference (95% CI, 10.4 to 17.5) in protective immunity between patient groups at primary endpoint6
• The primary analysis compared the rate of protective immunity at week 12 for HEPLISAV-B with that at week 28 for Engerix-B6
• Statistical significance was met; however, statistical significance was not prespecified in trial 18
• Noninferiority was met because the lower bound of the 95% confidence interval of the difference in SPRs was greater than -10%6
†Protective immunity defined as antibody concentration ≥10 mIU/mL.11*Compared to 81.3% who received 3 doses of Engerix-B.6
2 Months 3 Months 4 Months 5 Months 6 Months 7 Months
TRAIL 1
100
80
60
40
20
0
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1 Month
95.0% 98.2%
81.3%
Primary endpoint
HEPLISAV-Bmeasured timepoint
Engerix-Bmeasured timepoint
HEPLISAV-B2-dose series (N=1511)
Engerix-B3-dose series (N=521)
32.7%
FASTER AND HIGHER RATES OF PROTECTION WITH HEPLISAV-BHEPLISAV-B Provided Statistically Significantly Higher Rates ofProtection Than Engerix-B at Every Timepoint in Adults Aged 40 to 70 Years6,8
Percentage of People Aged 40 to 70 Achieving Protective Immunity*TRIAL 2
• 19.6% (95% CI, 14.7 to 24.8) difference in protective immunity between patient groups at primary endpoint6,8
• The primary analysis compared the rate of protective immunity at week 12 for HEPLISAV-B with that at week 32 for Engerix-B6
*Protective immunity defined as antibody concentration ≥10 mIU/mL.11
Percentage of People Aged 18 to 70 Achieving Protective Immunity*
HIGHER RATES OF PROTECTION IN HYPORESPONSIVE POPULATIONSHEPLISAV-B Even Provided Statistically Significantly Higher Rates of Protection in Diabetics and Other Known Hyporesponsive Populations6,7
TRIAL 3
IMPORTANT SAFETY INFORMATIONHepatitis B has a long incubation period. HEPLISAV-B may not prevent hepatitis B infection in individuals who have an unrecognized hepatitis B infection at the time of vaccine administration.The most common patient-reported adverse reactions reported within 7 days of vaccination were injection site pain (23%-39%), fatigue (11%-17%), and headache (8%-17%).Please see additional Important Safety Information throughout this brochure and accompanying full Prescribing Information.
Trial 3 study design: A clinical trial in adults aged 18 to 70 years who received HEPLISAV-B (N=4537) or Engerix-B (N=2289). The primary analysis evaluated the noninferiority of the rate of protective immunity at week 28 induced by HEPLISAV-B (n=640) to Engerix-B (n=321) in patients with type 2 diabetes mellitus. A secondary immunogenicity objective was to demonstrate the noninferiority of the rate of protective immunity with HEPLISAV-B at week 24 compared with Engerix-B at week 28 in all subjects and in subgroups defined by age, sex, body mass index (BMI), and smoking status among adults aged 18 to 70 years.7
N=961
N=3353N=6665 N=5434 N=3241 N=2082
HEPLISAV-B
HEPLISAV-B
Engerix-B
Engerix-B
TOTAL TRIAL POPULATION MALE
95.4% 81.3%
94.5% 78.8%
VS VS
PATIENTS WITH DIABETES
OBESITY
65.1%90.0%
94.7% 75.4%
VS
VS
AGED 40 TO 70 SMOKERS
94.6% 78.7%
95.9% 78.6%
VS VS
*Protective immunity defined as antibody concentration ≥10 mIU/mL.11
THERE IS NO PARTIAL PROTECTION FROM HBV
2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10 Months 11 Months 12 Months1 Month
TRAIL 2
100
80
60
40
20
0
90.1% 95.1%
21.5%
72.9% 70.5%
HEPLISAV-B2-dose series (N=1121)
Engerix-B3-dose series (N=353)
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Primary endpoint
HEPLISAV-Bmeasured timepoint
Engerix-Bmeasured timepoint
RATES OF PROTECTION >90% ACROSS 3 STUDY POPULATIONS
TRIAL SUMMARY
Regardless of Patient Type, 2 Doses of HEPLISAV-B in 1 Month Protected >90% of Adults Across 3 Pivotal Trials vs 3 Doses of Engerix-B6
†Subgroups defined by age, sex, body mass index (BMI),and smoking status among adults aged 18 to 70 years.7
Error bars represent 95% confidence intervals
Percentage of People Achieving Protective Immunity*
*Protective immunity defined as antibody concentration ≥10 mIU/mL.11
THERE IS NO PARTIAL PROTECTION FROM HBV
The Advisory Committee on Immunization Practices (ACIP) Recommends the Use of HEPLISAV-B for Protecting Adults at Risk of Hepatitis B Infection18
IMPORTANT SAFETY INFORMATIONDo not administer HEPLISAV-B to individuals with a history of severe allergic reaction (eg, anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of HEPLISAV-B.Please see additional Important Safety Information throughout this brochure and accompanying full Prescribing Information.
PROTECT WITH THE ONLY 2-DOSE HEPATITIS B VACCINE AVAILABLE FOR ADULT PATIENTS6,18
3 DOSES IN 6 MONTHS
VS
Engerix-B19
1
4
2
5
3
6
HEPLISAV-B6
2 DOSES 1 MONTH APART
(0.5 mL each)
1
ADMINISTRATION AND STORAGE6
• Administer HEPLISAV-B by intramuscular injectionin the deltoid region
• Store in a refrigerator at 2°C to 8°C (35°F to 46°F)
• Do not freeze• Prefilled syringes are latex-free
% o
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100
90
80
70
60
50
40
30
20
10
0N=1511
HEPLISAV-B2 doses in 1 month
N=521 N=1121 N=353 N=4376 N=2289
Trial 1:Adults Aged 18 to 55
Trial 2:Adults Aged 40 to 70
Trial 3:Diabetics and Others†
Engerix-B3 doses in 6 months
95.0%
81.3%90.1%
70.5%
95.4%
81.3%
*Redness and swelling ≥2.5 cm. †Oral temperature ≥100.4°F (38.0°C).
Percentage With Local or Systemic Reactions Within 7 Days of Vaccination: Trial 16
Percentage With Local or Systemic Reactions Within 7 Days of Vaccination: Trial 26
HEPLISAV-B Engerix-BPost-Dose: Post-Dose:
REACTION 1 2 1 2 3Local N=1810 N=1798 N=605 N=603 N=598
Injection-Site Pain 38.5% 34.8% 33.6% 24.7% 20.2%
Injection-Site Redness* 4.1% 2.9% 0.5% 1.0% 0.7%
Injection-Site Swelling* 2.3% 1.5% 0.7% 0.5% 0.5%Systemic
Fatigue 17.4% 13.8% 16.7% 11.9% 10.0%
Headache 16.9% 12.8% 19.2% 12.3% 9.5%
Malaise 9.2% 7.6% 8.9% 6.5% 6.4%
N=1784 N=1764 N=596 N=590 N=561
Fever† 1.1% 1.5% 1.8% 1.7% 1.8%
HEPLISAV-B Engerix-BPost-Dose: Post-Dose:
REACTION 1 2 1 2 3Local N=1952 N=1905 N=477 N=464 N=448
Injection-Site Pain 23.7% 22.8% 18.4% 15.9% 13.8%
Injection-Site Redness* 0.9% 0.7% 0.6% 0.2% 0.2%
Injection-Site Swelling* 0.9% 0.6% 0.6% 0.6% 0.2%Systemic
Fatigue 12.6% 10.8% 12.8% 12.1% 9.4%
Headache 11.8% 8.1% 11.9% 9.5% 8.5%
Malaise 7.7% 7.0% 8.6% 7.1% 5.1%
Myalgia 8.5% 6.4% 9.6% 8.0% 4.5%
N=1923 N=1887 N=472 N=459 N=438
Fever† 0.6% 0.6% 0.6% 0.9% 0.7%
Data Derived From the Largest Clinical Trial Safety Database (n=14,238) for a Hepatitis B Vaccine8
SAFETY PROFILE DEMONSTRATED ACROSS TRIALS IN MORE THAN10,000 PATIENTS8
Unsolicited Adverse Events Reported in 3 Pivotal Clinical Trials6
SAFETY PROFILE DEMONSTRATED ACROSS 3 TRIALS WITH 12 MONTHSOF FOLLOW-UP8
*For trial 3, only unsolicited medically attended adverse events, those for which a subject sought medical care, were captured.†For trials 2 and 3, new-onset autoimmune adverse events are listed.
• Herpes zoster was reported in 0.7% of HEPLISAV-B patients and 0.3% of patients receiving Engerix-B
Unsolicited Adverse Events*
Serious Adverse Events
Immune-Mediated Adverse Events
Trial 1 HEPLISAV-B N=1810Within 28 days of any injection
42.0% Within 7 months of the first
vaccine dose
1.5% 0.2%
Engerix-B N=605 41.3% 2.1% 0.7%
Trial 2HEPLISAV-B N=1968 Within 28 days
of any injection
35.4% Within 12 months of the first
vaccine dose
3.9% 0.2%
Engerix-B N=481 36.2% 4.8% 0.0%
Trial 3HEPLISAV-B N=5587
Within 28 days of any injection
20.1% Within 13 months of the first
vaccine dose
6.2% 0.1%
Engerix-B N=2781 20.1% 5.3% 0.0%
Percentage Who Experienced Adverse Events After Vaccination
REFERENCES1. Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67(1):1-31. 2. Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006;55(RR-16):1-33. 3. Louther J, Feldman J, Rivera P, Villa N, DeHovitz J, Sepkowitz KA. Hepatitis B vaccination program at a New York City hospital: seroprevalence, seroconversion, and declination. Am J Infect Control. 1998;26(4):423-427. 4. Immunization and Infectious Diseases. Office of Disease Prevention and Health Promotion website. https://www.healthypeople.gov/2020/data-search/Search-the-Data#objid=4677. Accessed January 7, 2019. 5. Williams WW, Lu PJ, O’Halloran A, et al. Surveillance of vaccination coverage among adult populations - United States, 2015. MMWR Surveill Summ. 2017;66(11):1-28. 6. HEPLISAV-B [package insert]. Berkeley, CA: Dynavax Technologies Corporation; 2017. 7. Jackson S, Lentino J, Kopp J, et al. Immunogenicity of a two-dose investigational hepatitis B vaccine, HBsAg-1018, using a toll-like receptor 9 agonist adjuvant compared with a licensed hepatitis B vaccine in adults. Vaccine. 2018;36(5):668-674. 8. Dynavax Technologies Corporation. FDA Advisory Committee Briefing Document: HEPLISAV-B™ (Hepatitis B Vaccine [Recombinant], Adjuvanted). Presented at: Meeting of the Vaccines and Related Biological Products Advisory Committee; July 28, 2017; Silver Spring, MD. 9. Walayat S, Ahmed Z, Martin D, Puli S, Cashman M, Dhillon S. Recent advances in vaccination of non-responders to standard dose hepatitis B virus vaccine. World J Hepatol. 2015;7(24):2503-2509. 10. Than TT, Jo E, Todt D, et al. High environmental stability of hepatitis B virus and inactivation requirements for chemical biocides. J Infect Dis. 2018 Oct 24. doi: 10.1093/infdis/jiy620. [Epub ahead of print]. 11. Centers for Disease Control and Prevention. Hepatitis B. In: Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Washington, DC: Public Health Foundation; 2015:149-174. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hepb.pdf. Accessed October 16, 2017. 12. Starr SP, Raines D. Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 2011;84(12):1353-1359. 13. American Nurses Association’s Needle Stick Prevention Guide. World Health Organization website. http://www.who.int/occupational_health/activities/2need guide.pdf. Accessed July 18, 2018. 14. Schillie S, Harris A, Link-Gelles R, Romero J, Ward J, Nelson N. Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant. MMWR Morb Mortal Wkly Rep. 2018;67(15):455-458. 15. Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep. 2013;62(RR-10):1-19. 16. Viral hepatitis statistics and surveillance. Centers for Disease Control and Prevention website. https://www.cdc.gov/hepatitis/statistics. Accessed September 28, 2018. 17. Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012;56(2):422-433. 18. Kim DK, Hunter P; for the Advisory Committee on Immunization Practices. Recommended adult immunization schedule, United States, 2019. Ann Intern Med. 2019;170(3):182-192. 19. Engerix-B [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2015.
THERE IS NO PARTIAL PROTECTION FROM HBV
Please see additional Important Safety Information throughout this brochure and accompanying full Prescribing Information.
Traditional 3-dose hepatitis B vaccines leave many adults
unprotected6,8
HEPLISAV-B protectedmore people quickly with
2 doses in 1 month6,8
HEPLISAV-B protected >90% of adults in head-to-head trials,
regardless of patient type6
FASTER AND HIGHER RATES OF PROTECTION FROM HEPATITIS B6
HeplisavB.com
© 2019 Dynavax Technologies Corporation. All rights reserved. March 2019 US-19-00-00034
IMPORTANT SAFETY INFORMATION Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (eg, anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.
ADVOCATE FOR BETTER PROTECTION—FOR YOU, YOUR COLLEAGUES, YOUR PATIENTS, AND YOUR INSTITUTION
INDICATIONHEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults 18 years of age and older.
Please see additional Important Safety Information throughout this brochure and accompanying full Prescribing Information.Engerix-B is a registered trademark of the GSK group of companies.