Adult Kidney Transplant Recipients

NULOJIX®(belatacept) is indicated for prophylaxis of organ rejection in adult patients receiving a kidney transplant. NULOJIX is to be used in combination with basiliximab induction, mycophenolate mofetil, and corticosteroids.

Limitations of Use

Use NULOJIX only in patients who are EBV seropositive [see CONTRAINDICATIONS and WARNINGS AND PRECAUTIONS].

Use of NULOJIX for the prophylaxis of organ rejection in transplanted organs other than kidney has not been established [see WARNINGS AND PRECAUTIONS].

Dosage in Adult Kidney Transplant Recipients

NULOJIX should be administered in combination with basiliximab induction, mycophenolate mofetil (MMF), and corticosteroids. In clinical trials the median (25^th 75^th percentile) corticosteroid doses were tapered to approximately 15 mg (10-20 mg) per day by the first 6 weeks and remained at approximately 10 mg (5-10 mg) per day for the first 6 months post-transplant. Corticosteroid utilization should be consistent with the NULOJIX clinical trial experience [see WARNINGS AND PRECAUTIONS and Clinical Studies].

Due to an increased risk of post-transplant lymphoproliferative disorder (PTLD) predominantly involving the central nervous system (CNS), progressive multifocal leukoencephalopathy (PML), and serious CNS infections, administration of higher than the recommended doses or more frequent dosing of NULOJIX is not recommended [see WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS].

NULOJIX is for intravenous infusion only. Patients do not require premedication prior to administration of NULOJIX.

Dosing instructions are provided in Table 1.

• The total infusion dose of NULOJIX should be based on the actual body weight of the patient  at the time of transplantation, and should not be modified during the course of therapy, unless  there is a change in body weight of greater than 10%.
• The prescribed dose of NULOJIX must be evenly divisible by 12.5 mg in order for the dose  to be prepared accurately using the reconstituted solution and the silicone-free disposable  syringe provided. Evenly divisible increments are 0, 12.5, 25, 37.5, 50, 62.5, 75, 87.5, and  100. For example:
  • A patient weighs 64 kg. The dose is 10 mg per kg.
  • Calculated Dose: 64 kg x10 mg per kg = 640 mg
  • The closest doses evenly divisible by 12.5 mg below and above 640 mg are 637.5 mg and 650 mg.
  • The nearest dose to 640 mg is 637.5 mg.
  • Therefore, the actual prescribed dose for the patient should be 637.5 mg.

Table 1: Dosing*,† of NULOJIX for Kidney Transplant Recipients

Preparation and Administration Instructions

NULOJIX is for intravenous infusion only.

Caution: NULOJIX must be reconstituted/prepared using only the silicone-free disposable syringe provided with each vial.

If the silicone-free disposable syringe is dropped or becomes contaminated, use a new silicone-free disposable syringe from inventory. For information on obtaining additional silicone-free disposable syringes, contact Bristol-Myers Squibb at 1-888-NULOJIX.

Preparation for Administration

1. Calculate the number of NULOJIX vials required to provide the total infusion dose. Each vial contains 250 mg of belatacept lyophilized powder.
2. Reconstitute the contents of each vial of NULOJIX with 10.5 mL of a suitable diluent using the silicone-free disposable syringe provided with each vial and an 18- to 21-gauge needle.
   Suitable diluents include: sterile water for injection (SWFI), 0.9% sodium chloride (NS), or 5% dextrose in water (D5W).
   Note: If the NULOJIX powder is accidentally reconstituted using a different syringe than the one provided, the solution may develop a few translucent particles. Discard any solutions prepared using siliconized syringes.
3. To reconstitute the NULOJIX powder, remove the flip-top from the vial and wipe the top with an alcohol swab. Insert the syringe needle into the vial through the center of the rubber stopper and direct the stream of diluent (10.5 mL of SWFI, NS, or D5W) to the glass wall of the vial.
4. To minimize foam formation, rotate the vial and invert with gentle swirling until the contents are completely dissolved. Avoid prolonged or vigorous agitation. Do not shake.
5. The reconstituted solution contains a belatacept concentration of 25 mg/mL and should be clear to slightly opalescent and colorless to pale yellow. Do not use if opaque particles, discoloration, or other foreign particles are present.
6. Calculate the total volume of the reconstituted 25 mg/mL NULOJIX solution required to provide the total infusion dose.
   Volume of 25 mg/mL NULOJIX solution (in mL) = Prescribed Dose (in mg) ÷ 25 mg/mL
7. Prior to intravenous infusion, the required volume of the reconstituted NULOJIX solution must be further diluted with a suitable infusion fluid (NS or D5W). NULOJIX should be reconstituted with:
   • SWFI should be further diluted with either NS or D5W
   • NS should be further diluted with NS
   • D5W should be further diluted with D5W
8. From the appropriate size infusion container, withdraw a volume of infusion fluid that is equal to the volume of the reconstituted NULOJIX solution required to provide the prescribed dose. With the same silicone-free disposable syringe used for reconstitution, withdraw the required amount of belatacept solution from the vial, inject it into the infusion container, and gently rotate the infusion container to ensure mixing.
   The final belatacept concentration in the infusion container should range from 2 mg/mL to 10 mg/mL. Typically, an infusion volume of 100 mL will be appropriate for most patients and doses, but total infusion volumes ranging from 50 mL to 250 mL may be used. Any unused solution remaining in the vials must be discarded.
9. Prior to administration, the NULOJIX infusion should be inspected visually for particulate matter and discoloration. Discard the infusion if any particulate matter or discoloration is observed.
10. The entire NULOJIX infusion should be administered over a period of 30 minutes and must be administered with an infusion set and a sterile, non-pyrogenic, low-protein-binding filter (with a pore size of 0.2-1.2 μm).
    • The reconstituted solution should be transferred from the vial to the infusion bag or bottle immediately. The NULOJIX infusion must be completed within 24 hours of reconstitution of the NULOJIX lyophilized powder. If not used immediately, the infusion solution may be stored under refrigeration conditions: 2°-8°C (36°-46°F) and protected from light for up to 24 hours (a maximum of 4 hours of the total 24 hours can be at room temperature: 20°-25°C [68°-77°F] and room light).
    • Infuse NULOJIX in a separate line from other concomitantly infused agents. NULOJIX should not be infused concomitantly in the same intravenous line with other agents. No physical or biochemical compatibility studies have been conducted to evaluate the coadministration of NULOJIX with other agents.

Dosage Forms And Strengths

Lyophilized powder for injection: 250 mg per vial.

Storage And Handling

NULOJIX®(belatacept) lyophilized powder for intravenous infusion is supplied as a single-use vial with a silicone-free disposable syringe in the following packaging configuration:

Storage

NULOJIX lyophilized powder is stored refrigerated at 2°-8°C (36°-46°F). Protect NULOJIX from light by storing in the original package until time of use.

The reconstituted solution should be transferred from the vial to the infusion bag or bottle immediately. The NULOJIX infusion must be completed within 24 hours of constitution of the NULOJIX lyophilized powder. If not used immediately, the infusion solution may be stored under refrigeration conditions: 2°-8°C (36°-46°F) for up to 24 hours (a maximum of 4 hours of the total 24 hours can be at room temperature: 20°-25°C [68°-77°F] and room light) [see DOSAGE AND ADMINISTRATION].

Bristol-Myers Squibb Company Princeton, New Jersey 08543. Revised: 04/2013

Last reviewed on RxList: 4/22/2013
This monograph has been modified to include the generic and brand name in many instances.