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Marstacimab

Class
Antihemophilic agents
Subclass
Anti-tissue factor pathway inhibitor monoclonal antibodies
Substance name
Marstacimab, marstacimab-hncq
Brand names
Hympavzi®
Common formulations
Solution for injection
Dosage and administration
Adults patients
Bleeding episodes in patients with hemophilia A • Without factor VIII inhibitors
•
Loading: 300 mg SC once
•
Maintenance: 150 mg SC weekly, 1 week after the loading dose
Administered subcutaneously in the abdomen or thigh on the same day each week, at any time of day. Consider increasing the dose to 300 mg once weekly in patients weighing ≥ 50 kg if the control of bleeding episodes is deemed inadequate. Temporarily discontinue marstacimab before major surgery.
Bleeding episodes in patients with hemophilia B • Without factor IX inhibitors
•
Loading: 300 mg SC once
•
Maintenance: 150 mg SC weekly, 1 week after the loading dose
Administered subcutaneously in the abdomen or thigh on the same day each week, at any time of day. Consider increasing the dose to 300 mg once weekly in patients weighing ≥ 50 kg if the control of bleeding episodes is deemed inadequate. Temporarily discontinue marstacimab before major surgery.
Indications for use
Labeled indications
Adults
•
Prevention of bleeding episodes in patients with hemophilia A (without factor VIII inhibitors)
•
Prevention of bleeding episodes in patients with hemophilia B (without factor IX inhibitors)
Safety risks
Warnings and precautions
Hypersensitivity reactions
•
Maintain a high level of suspicion, as marstacimab is associated with an increased risk of hypersensitivity reactions, including urticaria and pruritus.
Thromboembolism
•
Maintain a high level of suspicion, as marstacimab may increase the risk of thromboembolic complications. Interrupt marstacimab if thromboembolism occurs and manage as clinically indicated. Administer factor VIII and IX products for the treatment of breakthrough bleeding. Use the minimum effective dose of factor VIII or IX in patients on marstacimab prophylaxis when necessary.
Specific populations
Renal impairment
eGFR ≥ 60 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR < 60 mL/min/1.73 m²
•
No guidance available.
Renal replacement therapy
Any modality
•
No guidance available.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
No guidance available.
Child-Pugh C (severe)
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Insufficient evidence. May cause fetal harm based on mechanism of action.
•
Monoclonal antibodies cross the placenta, with transport increasing as pregnancy progresses and peaks during the third trimester. Advise pregnant patients regarding the potential risk to the ferus.
•
Verify pregnancy status in females of reproductive potential before initiating treatment. Advise using effective contraception during treatment and for at least 2 months after the last dose.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Headache, injection site reactions, itching
Unknown frequency
•
Thromboembolism
Interactions
Drug(s)
Check Interactions
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