Refixia

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ANNEX I 
 

SUMMARY OF PRODUCT CHARACTERISTICS 



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This medicinal product is subject to additional monitoring. This will allow quick identification of 
new safety information. Healthcare professionals are asked to report any suspected adverse reactions. 
See section 4.8 for how to report adverse reactions. 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Refixia 500 IU powder and solvent for solution for injection 
Refixia 1000 IU powder and solvent for solution for injection 
Refixia 2000 IU powder and solvent for solution for injection 
 
 
2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 
Refixia 500 IU powder and solvent for solution for injection 
Each vial contains nominally 500 IU nonacog beta pegol*. 
After reconstitution, 1 ml of Refixia contains approximately 125 IU nonacog beta pegol. 
 
Refixia 1000 IU powder and solvent for solution for injection 
Each vial contains nominally 1000 IU nonacog beta pegol*. 
After reconstitution, 1 ml of Refixia contains approximately 250 IU nonacog beta pegol. 
 
Refixia 2000 IU powder and solvent for solution for injection 
Each vial contains nominally 2000 IU nonacog beta pegol*. 
After reconstitution, 1 ml of Refixia contains approximately 500 IU nonacog beta pegol. 
 
*recombinant human factor IX, produced in Chinese Hamster Ovary (CHO) cells by recombinant 
DNA technology, covalently conjugated to a 40 kDa polyethylene-glycol (PEG). 
 
The potency (International Units) is determined using the European Pharmacopeia one-stage clotting 
test. The specific activity of Refixia is approximately 152 IU/mg protein. 
 
Refixia is a purified recombinant human factor IX (rFIX) with a 40 kDa polyethylene-glycol (PEG) 
selectively attached to specific N-linked glycans in the rFIX activation peptide. Upon activation of 
Refixia, the activation peptide including the 40 kDa polyethylene-glycol moiety is cleaved off, leaving 
the native activated factor IX molecule. The primary amino acid sequence of the rFIX in Refixia is 
identical to the Ala148 allelic form of human plasma-derived factor IX. No additives of human or 
animal origin are used in the cell culture, purification, conjugation, or formulation of Refixia. 
 
Excipient with known effect 
Less than 1 mmol sodium (23 mg) per vial. 
 
For the full list of excipients, see section 6.1. 
 
 
3. PHARMACEUTICAL FORM 
 
Powder and solvent for solution for injection. 
 
The powder is white to off-white. 
 
The solvent is clear and colourless. 
 
pH: 6.4. 
 
Osmolality: 272 mOsmol/kg. 
 



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4. CLINICAL PARTICULARS 
 
4.1 Therapeutic indications 
 
Treatment and prophylaxis of bleeding in patients 12 years and above with haemophilia B (congenital 
factor IX deficiency). 
 
4.2 Posology and method of administration 
 
Treatment should be under the supervision of a physician experienced in the treatment of haemophilia. 
 
Previously untreated patients 
The safety and efficacy of Refixia in previously untreated patients have not yet been established. 
 
Treatment monitoring 
Routine monitoring of factor IX activity levels for the purpose of dose adjustment is not necessary. In 
the clinical trial programme, dose adjustment was not performed. Mean steady state factor IX trough 
levels above 15% were observed for all age groups, see section 5.2 for details. 
 
Due to the interference of polyethylene glycol (PEG) in the one-stage clotting assay with various aPTT 
reagents, it is recommended to use a chromogenic assay (e.g. Rox Factor IX or Biophen) when 
monitoring is needed. If a chromogenic assay is not available, it is recommended to use a one-stage 
clotting assay with an aPTT reagent (e.g. Cephascreen) qualified for use with Refixia. For modified 
long-acting factor products it is known that the one-stage clotting assay results are highly dependent 
on the aPTT reagent and reference standard used. For Refixia some reagents will cause 
underestimation (30–50%), while most silica containing reagents will cause severe overestimation of 
the factor IX activity (more than 400%). Therefore, silica based reagents should be avoided. Use of a 
reference laboratory is recommended when a chromogenic assay or a qualified one-stage clotting 
assay is not available locally. 
 
Posology 
The number of units of factor IX administered is expressed in International Units (IU), which are 
related to the current WHO standard for factor IX products. Factor IX activity in plasma is expressed 
either as a percentage (relative to normal human plasma) or in International Units (relative to an 
International Standard for factor IX in plasma). 
 
Prophylaxis 
40 IU/kg body weight once weekly. 
Adjustments of doses and administration intervals may be considered based on achieved FIX levels 
and individual bleeding tendency. The trough levels achieved with the weekly 40 IU/kg dosing 
regimen are summarised in section 5.2. 
 
Patients on prophylaxis who forget a dose are advised to take their dose upon discovery and thereafter 
continue with the usual once weekly dosing schedule. A double dose should be avoided. 
 
On-demand treatment 
Dose and duration of the substitution therapy depend on the location and severity of the bleeding, see 
Table 1 for dosing guidance in bleeding episodes. 
 
Table 1 Treatment of bleeding episodes with Refixia 

Degree of 
haemorrhage 

Recommended 
dose IU/kg of 
Refixia 

Dosing recommendations 



4 

Early 
haemarthrosis, 
muscle bleeding or 
oral bleeding. 
 
More extensive 
haemarthrosis, 
muscle bleeding or 
haematoma. 

40 A single dose is recommended. 

Severe or life 
threatening 
haemorrhages. 

80 Additional doses of 40 IU/kg can be 
given. 

 
Surgery 
The dose level and dosing intervals for surgery depend on the procedure and local practice. General 
recommendations are provided in Table 2. 
 
Table 2 Treatment in surgery with Refixia 

Type of surgical 
procedure 

Recommended 
dose IU/kg body 
weight 

Dosing recommendations 

Minor surgery 
including tooth 
extraction. 

40 Additional doses can be given if needed.  

Major surgery. 80 Pre-operative dose. 

40 Consider two repeated doses of 40 IU/kg 
(in 1–3 day intervals) within the first 
week after surgery. 
 
Due to the long half-life of Refixia, the 
frequency of dosing in the post-surgical 
period may be extended to once weekly 
after the first week until bleeding stops 
and healing is achieved. 

 
Paediatric population 
The dose recommendations in adolescents (12–18 years) are the same as for adults: 40 IU/kg body 
weight. The long-term safety of Refixia in children below 12 years has not yet been established. 
 
Method of administration 
Intravenous use. 
 
Refixia is administered by intravenous bolus injection over several minutes after reconstitution of the 
powder for injection with the histidine solvent. The rate of administration should be determined by the 
patient’s comfort level up to a maximum injection rate of 4 ml/min. 
 
For instructions on reconstitution of the medicinal product before administration, see section 6.6. 
 
In case of self-administration or administration by caregiver appropriate training is needed. 
 
4.3 Contraindications 



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Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. 
 
Known allergic reaction to hamster protein. 
 
4.4 Special warnings and precautions for use 
 
Hypersensitivity 
Allergic type hypersensitivity reactions are possible with Refixia. The product contains traces of 
hamster proteins. If symptoms of hypersensitivity occur, patients should be advised to discontinue use 
of the medicinal product immediately and contact their physician. Patients should be informed of the 
early signs of hypersensitivity reactions including hives, generalised urticaria, tightness of the chest, 
wheezing, hypotension, and anaphylaxis. 
 
In case of shock, standard medical treatment for shock should be implemented. 
 
Inhibitors 
After repeated treatment with human coagulation factor IX (rDNA) products, patients should be 
monitored for the development of neutralising antibodies (inhibitors) that should be quantified in 
Bethesda Units (BU) using appropriate biological testing. 
 
There have been reports in the literature showing a correlation between the occurrence of a factor IX 
inhibitor and allergic reactions. Therefore, patients experiencing allergic reactions should be evaluated 
for the presence of an inhibitor. It should be noted that patients with factor IX inhibitors may be at an 
increased risk of anaphylaxis with subsequent challenge with factor IX. 
 
Because of the risk of allergic reactions with factor IX products, the initial administrations of factor IX 
should, according to the treating physician’s judgement, be performed under medical observation 
where proper medical care for allergic reactions could be provided. 
 
In case of residual FIX activity levels, there is a risk of interference when performing the Nijmegen 
modified Bethesda assay for inhibitor testing. Therefore a pre-heating step or a wash-out is 
recommended in order to ensure detection of low-titre inhibitors. 
 
Thromboembolism 
Because of the potential risk of thrombotic complications, clinical surveillance for early signs of 
thrombotic and consumptive coagulopathy should be initiated with appropriate biological testing when 
administering this product to patients with liver disease, to patients post-operatively, to new-born 
infants, or to patients at risk of thrombotic phenomena or DIC. In each of these situations, the benefit 
of treatment with Refixia should be weighed against the risk of these complications. 
 
Cardiovascular event 
In patients with existing cardiovascular risk factors, substitution therapy with FIX may increase the 
cardiovascular risk. 
 
Catheter-related complications 
If a central venous access device (CVAD) is required, risk of CVAD-related complications including 
local infections, bacteraemia and catheter site thrombosis should be considered. 
 
Paediatric population 
Refixia is not indicated for use in children (below 12 years). The listed warnings and precautions apply 
both to adults and adolescents (12–18 years). 
 
Sodium content 
This medicinal product contains less than 1 mmol sodium (23 mg) per vial, i.e. it is essentially 
“sodium-free”. 
 



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Record of use 
It is strongly recommended that every time that Refixia is administered to a patient, the name and 
batch number of the product are recorded in order to maintain a link between the patient and the batch 
of the medicinal product. 
 
4.5 Interaction with other medicinal products and other forms of interaction 
 
No interactions of human coagulation factor IX (rDNA) products with other medicinal products have 
been reported. 
 
4.6 Fertility, pregnancy and lactation 
 
Animal reproduction studies have not been conducted with factor IX. Based on the rare occurrence of 
haemophilia B in women, experience regarding the use of factor IX during pregnancy and 
breastfeeding is not available. Therefore, factor IX should be used during pregnancy and lactation only 
if clearly indicated. 
 
4.7 Effects on ability to drive and use machines 
 
Refixia has no influence on the ability to drive and use machines. 
 
4.8 Undesirable effects 
 
Summary of the safety profile 
Hypersensitivity or allergic reactions (which may include angioedema, burning and stinging at the 
infusion site, chills, flushing, generalised urticaria, headache, hives, hypotension, lethargy, nausea, 
restlessness, tachycardia, tightness of the chest, tingling, vomiting, wheezing) have been observed 
rarely with recombinant factor IX products and may in some cases progress to severe anaphylaxis 
(including shock). In some cases, these reactions have progressed to severe anaphylaxis, and they have 
occurred in close temporal association with development of factor IX inhibitors (see also section 4.4). 
Nephrotic syndrome has been reported following attempted immune tolerance induction in 
haemophilia B patients with factor IX inhibitors and a history of allergic reaction. 
 
Very rarely development of antibodies to hamster protein with related hypersensitivity reactions has 
been observed. 
 
Patients with haemophilia B may develop neutralising antibodies (inhibitors) to factor IX. If such 
inhibitors occur, the condition will manifest itself as an insufficient clinical response. In such cases, it 
is recommended that a specialised haemophilia centre is contacted. 
 
There is a potential risk of thromboembolic episodes following the administration of factor IX 
products, with a higher risk for low purity preparations. The use of low purity factor IX products has 
been associated with instances of myocardial infarction, disseminated intravascular coagulation, 
venous thrombosis and pulmonary embolism. The use of high purity factor IX products like Refixia is 
rarely associated with such adverse reactions. 
 
Tabulated list of adverse reactions 
The table presented below is according to the MedDRA system organ classification (SOC and 
Preferred Term Level). 
 
Frequencies have been evaluated according to the following convention: very common (≥ 1/10); 
common (≥ 1/100 to < 1/10); uncommon (≥ 1/1,000 to < 1/100); rare (≥ 1/10,000 to < 1/1,000); very 
rare (< 1/10,000), not known (cannot be estimated from the available data). 
Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness. 
 
A total of 115 previously treated male patients with moderate or severe haemophilia B have been 
exposed to Refixia for a total of 170 patient years in the completed clinical trials. 



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Table 3 Frequency of adverse reactions in clinical trials 

System Organ Class Adverse reaction Frequency 

Immune system disorders Hypersensitivity 
Anaphylaxis 
Inhibitors 

Uncommon 
Unknown 
Unknown 

Cardiac disorders Palpitations Uncommon 

Gastrointestinal disorders Nausea Common 

Skin and subcutaneous tissue 
disorders 

Pruritus* Common 

General disorders and 
administration site conditions 

Fatigue 
Hot flush 
Injection site reactions** 

Common 
Uncommon 
Common 

*Pruritus includes the terms pruritus and ear pruritus 
**Injection site reactions include injection site pain, infusion site pain, injection site swelling, injection site erythema and 
injection site rash. 
 
Description of selected adverse reactions 
In an ongoing trial in previously untreated patients, anaphylaxis has occurred in close temporal 
association with development of factor IX inhibitors following treatment with Refixia. There are 
insufficient data to provide information on inhibitor incidence in previously untreated patients. 
 
Paediatric population 
Refixia is indicated for patients 12 years and above. No difference in the safety profile of Refixia was 
observed between previously treated adolescent (12–18 years) and adult patients. 
 
Reporting of suspected adverse reactions 
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V. 
 
4.9 Overdose 
 
Overdoses up to 169 IU/kg have been reported in clinical trials. No symptoms associated with 
overdoses have been reported. 
 
 
5. PHARMACOLOGICAL PROPERTIES 
 
5.1 Pharmacodynamic properties 
 
Pharmacotherapeutic group: antihaemorrhagics, blood coagulation factor IX, ATC code: B02BD04. 
 
Mechanism of action 
Refixia is a purified recombinant human factor IX (rFIX) with a 40 kDa polyethylene-glycol (PEG) 
conjugated to the protein. The average molecular weight of Refixia is approximately 98 kDa and the 
molecular weight of the protein moiety alone is 56 kDa. Upon activation of Refixia, the activation 
peptide including the 40 kDa polyethylene-glycol moiety is cleaved off, leaving the native activated 
factor IX molecule. 
 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


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Factor IX is a single chain glycoprotein. It is a vitamin-K dependent coagulation factor and it is 
synthesised in the liver. Factor IX is activated by factor XIa and by factor VII/tissue factor complex. 
Activated factor IX, in combination with activated factor VIII, activates factor X. Activated factor X 
converts prothrombin into thrombin. Thrombin then converts fibrinogen into fibrin and a clot is 
formed. Haemophilia B is a sex-linked hereditary disorder of blood coagulation due to decreased 
levels of factor IX and results in profuse bleeding into joints, muscles, or internal organs, either 
spontaneously or as a result of accidental or surgical trauma. By replacement therapy the plasma levels 
of factor IX are increased, thereby enabling a temporary correction of the factor deficiency and 
correction of the bleeding tendencies. 
 
Clinical efficacy 
The completed clinical trial programme included one phase 1 trial and four phase 3 multicentre, non-
controlled trials. 
 
Prophylaxis 
Fifty-four of the patients across all age-groups were treated with a weekly prophylactic dose of 
40 IU/kg where 23 (43%) of these patients had no bleeding episodes. 
 
Pivotal trial 
The pivotal trial included 74 adolescent (13–17 years) and adult (18–65 years) previously treated 
patients. The trial included one open-label on-demand arm with treatment for approximately 28 weeks 
and two prophylaxis treatment arms with single-blind randomisation to either 10 IU/kg or 40 IU/kg 
once-weekly for approximately 52 weeks. When comparing the 10 IU/kg and 40 IU/kg treatments, the 
annualised bleeding rate for patients in the 40 IU/kg arm was found to be 49% lower than the bleeding 
rate (95% CI: 5%;73%) for patients in the 10 IU/kg arm (p<0.05). 
 
The median (IQR) overall annual bleeding rate (ABR) in patients (13–65 years) treated with a 
prophylactic dose of 40 IU/kg once weekly was 1.04 (0.00; 4.01) whereas the traumatic ABR was 0.00 
(0.00; 2.05), joint ABR was 0.97 (0.00; 2.07) and spontaneous ABR was 0.00 (0.00; 0.99). 
Of note, ABR is not comparable between different factor concentrates and between different clinical 
studies. 
 
In this pivotal trial in adolescent and adult patients, there were 70 breakthrough bleeding episodes for 
16 out of 29 patients in the 40 IU/kg prophylaxis arm. The overall success rate for treatment of 
breakthrough bleeds was 97.1% (67 out of 69 evaluated bleeds). A total of 69 (98.6%) of the 70 
bleeding episodes were treated with one injection. Bleeding episodes were treated with Refixia at 
40 IU/kg for mild or moderate bleeds. 
 
In 29 adult and adolescent patients treated, 13 patients with 20 target joints were treated for one year 
with a weekly prophylactic dose of 40 IU/kg. Eighteen out of these 20 joints (90%) were no longer 
considered target joints at the end of the trial. 
 
On-demand treatment 
In the pivotal trial there was a non-randomised arm where 15 patients were treated in an on-demand 
regimen with 40 IU/kg for mild or moderate bleeds and 80 IU/kg for severe bleeds. The overall 
success rate (defined as excellent or good) for treatment of bleeds was 95% with 98% of the bleeds 
treated with one or two injections. 
 
Paediatric population 
The use of Refixia in children below 12 years is not indicated (see section 4.2 for information on 
paediatric use). 
 
A trial including 25 paediatric previously treated patients (ages 0–12 years) who received a 
prophylactic dose 40 IU/kg once weekly was performed. 
In children aged 0–12 years, the median (IQR) annualised bleeding rate was 1.0 (0.00; 2.06) and the 
spontaneous bleeding rate was 0.00 (0.00; 0.00). 
 



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For treatment of bleeds in paediatrics, the overall success rate (defined as excellent or good) was 93% 
(39 out of 42 bleeds), where 36 (86 %) of the bleeds were resolved with 1 injection, and 5 (12%) of the 
bleeds were resolved with 2 injections of Refixia. 
 
The European Medicines Agency has deferred the completion of the study with Refixia in previously 
untreated patients (see section 4.2 for information on paediatric use). 
 
Overall haemostatic efficacy 
Bleeding episodes were treated with Refixia at 40 IU/kg for mild or moderate bleeds or 80 IU/kg for 
severe bleeds, where one bleed was evaluated as severe. An overall assessment of haemostatic efficacy 
was performed by the patient or caretaker (for home treatment) or study site investigator (for treatment 
under health care professional supervision) using a 4-point scale of excellent, good, moderate, or poor. 
The overall success rate (defined as excellent or good) for treatment of bleeds was 93% (551 out of 
591). Of the 597 treated bleeds observed in 79 (75%) of the 105 patients, 521 (87%) of the bleeds were 
resolved with 1 injection and 60 (10%) of the bleeds were resolved with 2 injections of Refixia. 
 
The success rate and dose needed for treatment of the bleeding episodes were independent of the 
localisation of the bleed. The success rate for treatment of bleeding episodes was also independent of 
whether the bleed was traumatic or spontaneous of nature. 
 
Surgery 
Three trials of which one trial was a dedicated surgery trial included in total 15 major and 26 minor 
surgery procedures (patients aged 13 to 56 years). Haemostatic effect of Refixia during surgery was 
confirmed with a success rate of 100% in the 15 major surgeries in the trials. All evaluated minor 
surgeries were performed successfully. 
 
In a dedicated surgery trial, the efficacy analysis included 13 major surgical procedures performed in 
13 previously treated adult and adolescent patients. The procedures included 9 orthopaedic, 1 
gastrointestinal, and 3 surgeries in the oral cavity. The patients received 1 pre-operative injection of 
80 IU/kg on the day of surgery, and post-operatively, injections of 40 IU/kg. A pre-operative dose of 
80 IU/kg Refixia was effective and no patients required additional doses on the day of surgery. In the 
post-surgery period Day 1 to 6 and Day 7 to 13, the median number of additional 40 IU/kg doses 
administered was 2.0 and 1.5, respectively. The mean total consumption of Refixia during and after 
surgery was 241 IU/kg (range: 81–460 IU/kg). 
 
5.2 Pharmacokinetic properties 
 
Refixia has a prolonged half-life compared to unmodified factor IX. All pharmacokinetic studies with 
Refixia were conducted in previously treated patients with haemophilia B (factor IX ≤2%). The 
analysis of plasma samples was conducted using the one-stage clotting assay. 
 
Steady state pharmacokinetic parameters for adolescents and adults are shown in Table 4 
 
Table 4 Steady state pharmacokinetic parameters of Refixia (40 IU/kg) in adolescents and 

adults (geometric mean (CV%)) 
PK Parameter 13–17 years  

N=3 
≥18 years  
N=6 

Half-life (t1/2) (hours) 103 (14) 115 (10) 

Incremental Recovery (IR) (IU/ml per 
IU/kg) 

0.018 (28) 0.019 (20) 

Area under the curve (AUC)0-168h 
(IU*hours/ml) 

91 (22) 93 (15) 

Clearance (CL) (ml/hour/kg) 0.4 (17) 0.4 (11) 

Mean residence time (MRT) (hours) 144 (15) 158 (10) 



10 

Volume of distribution (Vss) (ml/kg) 61 (31) 66 (12) 

Factor IX activity 168 h post dosing 
(IU/ml) 

0.29 (19) 0.32 (17) 

Clearance = body weight adjusted clearance; Incremental recovery = incremental recovery 30 min post dosing, Volume of 
distribution = body weight adjusted volume of distribution at steady state. CV = coefficient of variation. 
 
All patients assessed in the steady state pharmacokinetic session had factor IX activity levels above 
0.24 IU/ml at 168 hours post dosing with a weekly dose of 40 IU/kg. 
 
Single-dose pharmacokinetic parameters of Refixia are listed by age in Table 5. The use of Refixia in 
children below 12 years is not indicated. 
 
Table 5 Single-dose pharmacokinetic parameters of Refixia (40 IU/kg) by age (geometric 

mean (CV%)) 

PK Parameter 0–6 years 
N=12 

7–12 years 
N=13 

13–17 years 
N=3 

≥18 years 
N=6 

Half-life (t1/2) 
(hours) 

70 (16) 76 (26) 89 (24) 83 (23) 

Incremental 
Recovery (IR) 
(IU/ml per IU/kg) 

0.015 (7) 0.016 (16) 0.020 (15) 0.023 (11) 

Area under the 
curve (AUC)inf 
(IU*hours/ml) 

46 (14) 56 (19) 80 (35) 91 (16) 

Clearance CL 
(ml/hour/kg) 

0.8 (13) 0.6 (22) 0.5 (30) 0.4 (15) 

Mean residence 
time (MRT) 
(hours) 

95 (15) 105 (24) 124 (24) 116 (22) 

Volume of 
distribution (Vss) 
(ml/kg) 

72 (15) 68 (22) 59 (8) 47 (16) 

Factor IX activity 
168 h post dosing 
(IU/ml) 

0.08 (16) 0.11 (19) 0.15 (60) 0.17 (31) 

Clearance = body weight adjusted clearance; Incremental recovery = incremental recovery 30 min post dosing, Volume of 
distribution = body weight adjusted volume of distribution at steady state. CV = coefficient of variation. 
 
As expected, body weight adjusted clearance in paediatric and adolescent patients was higher 
compared to adults. No dose adjustment was required for paediatric or adolescent patients in clinical 
trials. 
 
The mean trough levels at steady state are presented in Table 6; based on all pre-dose measurements 
taken every 8 weeks at steady state for all patients on once weekly dosing of 40 IU/kg. The use of 
Refixia in children below 12 years is not indicated. 
 
Table 6 Mean of trough levels* of Refixia (40 IU/kg) at steady state 

 0–6 years 7–12 years 13–17 years 18–65 years 



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N=12 N=13 N=9 N=20 

Estimated mean 
factor IX trough 
levels IU/ml  
(95% CI) 

0.15 
(0.13;0.18) 

0.19 
(0.16;0.22) 

0.24 
(0.20;0.28) 

0.29 
(0.26;0.33) 

* Factor IX trough levels = factor IX activity measured prior to next weekly dose (5 to 10 days post dosing) at steady state. 
 
Pharmacokinetics were investigated in 16 adult and adolescent patients of which 6 were normal weight 
(BMI 18.5–24.9 kg/m2) and 10 were overweight (BMI 25–29.9 kg/m2). There were no apparent 
differences in the pharmacokinetic profiles between normal weight and overweight patients.  
 
5.3 Preclinical safety data 
 
In a repeat dose toxicity study in monkeys, mild and transient body tremors were seen 3 hours post 
dosing and abated within 1 hour. These body tremors were seen at doses of Refixia (3,750 IU/kg), 
which were more than 90 times higher than the recommended dose for humans (40 IU/kg). No 
mechanism behind the tremors was identified. Tremors have not been reported in the clinical trials. 
 
Non-clinical data reveal no concern for humans based on conventional safety pharmacology and 
repeated dose toxicity studies in rats and monkeys. 
 
In repeat dose toxicity studies in rats and monkeys, 40 kDa polyethylene-glycol (PEG) was detected 
by immunohistochemical staining in epithelial cells of choroid plexus in the brain. This finding was 
not associated with tissue damage or abnormal clinical signs. 
 
In distribution and excretion studies in mice and rats, the 40 kDa polyethylene-glycol (PEG) moiety of 
Refixia was shown to be widely distributed to and eliminated from organs, and excreted via plasma in 
urine (44–56%) and faeces (28–50%). Based on modelled data using observed terminal half-lives (15–
49 days) in rat tissue distribution studies, the 40 kDa polyethylene-glycol (PEG) moiety will reach 
steady state levels in all human tissues within 1–2 years of treatment. 
 
Long-term studies in animals to evaluate the carcinogenic potential of Refixia, or studies to determine 
the effects of Refixia on genotoxicity, fertility, development, or reproduction have not been performed. 
 
 
6. PHARMACEUTICAL PARTICULARS 
 
6.1 List of excipients 
 
Powder 
Sodium chloride 
Histidine 
Sucrose 
Polysorbate 80 
Mannitol 
Sodium hydroxide (for pH adjustment) 
Hydrochloric acid (for pH adjustment) 
 
Solvent 
Histidine 
Water for injections 
Sodium hydroxide (for pH adjustment) 
Hydrochloric acid (for pH adjustment) 
 
6.2 Incompatibilities 



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In the absence of compatibility studies, this medicine must not be mixed with other medicinal products 
or reconstituted with infusion solutions other than the provided histidine solvent. 
 
6.3 Shelf life 
 
Unopened 
2 years. During the shelf life Refixia may be stored up to 30°C for a single period not exceeding 
6 months. Once the product has been taken out of the refrigerator the product must not be returned to 
the refrigerator. Please record the beginning of storage at room temperature on the product carton. 
 
After reconstitution 
 
Chemical and physical in-use stability have been demonstrated for 24 hours stored in a refrigerator 
(2°C – 8°C) and 4 hours stored at room temperature (≤ 30°C). 
 
From a microbiological point of view, the reconstituted product should be used immediately. If not 
used immediately, in-use storage times and conditions prior to use are the responsibility of the users 
and would normally not be recommended for longer than 4 hours stored at room temperature (≤ 30°C) 
or 24 hours in a refrigerator (2°C – 8°C), unless reconstitution has taken place under controlled and 
validated aseptic conditions. 
 
6.4 Special precautions for storage 
 
Store in a refrigerator (2°C – 8°C). Do not freeze. 
Store in the original package in order to protect from light. 
For storage at room temperature and storage conditions after reconstitution of the medicinal product, 
see section 6.3. 
 
6.5 Nature and contents of container 
 
Each pack contains: 
– 1 glass vial (type I) with powder and chlorobutyl rubber stopper 
– 1 sterile vial adapter for reconstitution 
– 1 pre-filled syringe of 4 ml histidine solvent with backstop (polypropylene), a rubber plunger 

(bromobutyl) and a tip cap with a stopper (bromobutyl) 
– 1 plunger rod (polypropylene). 
 
Pack size of 1. 
 
6.6 Special precautions for disposal and other handling 
 
Refixia is to be administered intravenously after reconstitution of the powder with the solvent supplied 
in the syringe. After reconstitution the solution appears as a clear and colourless liquid free of visible 
particles. Reconstituted medicinal product should be inspected visually for particulate matter and 
discoloration prior to administration. Do not use solutions that are cloudy or have deposits. 
 
For instructions on reconstitution of the medicinal product before administration, see the package 
leaflet. 
 
The rate of administration should be determined by the patient’s comfort level up to a maximum 
injection rate of 4 ml/min. 
 
An infusion set (tubing and butterfly needle), sterile alcohol swabs, gauze pads and plasters will also 
be needed. These devices are not included in the Refixia package. 
 
Always use an aseptic technique. 



13 

 
Disposal 
After injection, safely dispose of the syringe with the infusion set and the vial with the vial adapter. 
Any unused medicinal product or waste material should be disposed of in accordance with local 
requirements. 
 
 
7. MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
8. MARKETING AUTHORISATION NUMBERS 
 
EU/1/17/1193/001 
EU/1/17/1193/002 
EU/1/17/1193/003 
 
 
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 
 
10. DATE OF REVISION OF THE TEXT 
 
Detailed information on this medicinal product is available on the website of the European Medicines 
Agency http://www.ema.europa.eu. 
 

http://www.ema.europa.eu/


14 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX II 
 

A. MANUFACTURERS OF THE BIOLOGICAL ACTIVE SUBSTANCE AND 
MANUFACTURER RESPONSIBLE FOR BATCH RELEASE 

 
B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE 

 
C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 

AUTHORISATION 
 

D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND 
EFFECTIVE USE OF THE MEDICINAL PRODUCT 

 



15 

A. MANUFACTURERS OF THE BIOLOGICAL ACTIVE SUBSTANCE AND 
MANUFACTURER RESPONSIBLE FOR BATCH RELEASE 

 
Name and address of the manufacturers of the biological active substance 
 
Novo Nordisk A/S 
Brennum Park 25K 
DK-3400 Hillerød 
Denmark 
 
Novo Nordisk A/S 
Hagedornsvej 1 
DK-2820 Gentofte 
Denmark 
 
Name and address of the manufacturer responsible for batch release 
 
Novo Nordisk A/S 
Novo Alle 
DK-2880 Bagsværd 
Denmark 
 
 
B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE 
 
Medicinal product subject to restricted medical prescription (see Annex I: Summary of Product 
Characteristics, section 4.2). 
 
 
C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 

AUTHORISATION  
 
• Periodic safety update reports  
 
The requirements for submission of periodic safety update reports for this medicinal product are set 
out in the list of Union reference dates (EURD list) provided for under Article 107c(7) of Directive 
2001/83/EC and any subsequent updates published on the European medicines web-portal. 
The marketing authorisation holder shall submit the first periodic safety update report for this 
product within 6 months following authorisation.  
 
 
D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND 

EFFECTIVE USE OF THE MEDICINAL PRODUCT 
 
• Risk Management Plan (RMP) 
 
The MAH shall perform the required pharmacovigilance activities and interventions detailed in the 
agreed RMP presented in Module 1.8.2 of the marketing authorisation and any agreed subsequent 
updates of the RMP. 
An updated RMP should be submitted: 

• At the request of the European Medicines Agency; 
• Whenever the risk management system is modified, especially as the result of new 

information being received that may lead to a significant change to the benefit/risk profile 
or as the result of an important (pharmacovigilance or risk minimisation) milestone being 
reached.  

 
• Obligation to conduct post-authorisation measures  



16 

 
The MAH shall complete, within the stated timeframe, the below measures: 
 
Description Due date 
Non-interventional post-authorisation safety study (PASS): In order to investigate 
the potential effects of PEG accumulation in the choroid plexus of the brain and 
other tissues/organs, the MAH should conduct and submit the results of a non-
interventional post-authorisation safety study deriving from a registry of 
Haemophilia patients according to an agreed protocol. 

Submission of 
study results: 
Q2-2028 

 



17 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX III 
 

LABELLING AND PACKAGE LEAFLET 



18 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

A. LABELLING 



19 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 
 
Carton 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Refixia 500 IU powder and solvent for solution for injection 
 
nonacog beta pegol 
(recombinant coagulation factor IX) 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE 
 
Powder: 500 IU nonacog beta pegol (approx. 125 IU/ml after reconstitution), 
 
 
3. LIST OF EXCIPIENTS 
 
Powder: 
sodium chloride, histidine, sucrose, polysorbate 80, mannitol, sodium hydroxide, hydrochloric acid 
 
Solvent: Histidine, water for injections, sodium hydroxide, hydrochloric acid 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
Powder and solvent for solution for injection 
 
Pack contains: 1 powder vial, 4 ml solvent in a pre-filled syringe, 1 plunger rod and 1 vial adapter 
 
 
5. METHOD AND ROUTE OF ADMINISTRATION 
 
Read the package leaflet before use 
 
Intravenous use, after reconstitution 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children 
 
 
7. OTHER SPECIAL WARNINGS, IF NECESSARY 
 
 
8. EXPIRY DATE 
 
EXP 
 
 
9. SPECIAL STORAGE CONDITIONS 



20 

 
Store in a refrigerator. Do not freeze 
Can be stored at room temperature (up to 30°C) for a single period up to 6 months. Must not be 
returned to refrigerator after storage at room temperature 
 
Date removed from refrigerator: ____________ 
 
Store in the original package to protect from light 
 
 
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
12. MARKETING AUTHORISATION NUMBER 
 
EU/1/17/1193/001 
 
 
13. BATCH NUMBER 
 
Lot 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
Refixia 500 IU 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER – HUMAN READABLE DATA 
 
PC: 
SN:  
NN:  



21 

MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS 
 
Vial 
 
 
1. NAME OF THE MEDICINAL PRODUCT AND ROUTE OF ADMINISTRATION 
 
Refixia 500 IU powder for solution for injection 
 
nonacog beta pegol 
 
IV 
 
 
2. METHOD OF ADMINISTRATION 
 
 
3. EXPIRY DATE 
 
EXP 
 
 
4. BATCH NUMBER 
 
Lot 
 
 
5. CONTENTS BY WEIGHT, BY VOLUME OR BY UNIT 
 
500 IU 
 
 
6. OTHER 
 
Novo Nordisk A/S



22 

 
PARTICULARS TO APPEAR ON THE OUTER PACKAGING 
 
Carton 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Refixia 1000 IU powder and solvent for solution for injection 
 
nonacog beta pegol 
(recombinant coagulation factor IX) 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE 
 
Powder: 1000 IU nonacog beta pegol (approx. 250 IU/ml after reconstitution), 
 
 
3. LIST OF EXCIPIENTS 
 
Powder: 
sodium chloride, histidine, sucrose, polysorbate 80, mannitol, sodium hydroxide, hydrochloric acid 
 
Solvent: Histidine, water for injections, sodium hydroxide, hydrochloric acid 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
Powder and solvent for solution for injection 
 
Pack contains: 1 powder vial, 4 ml solvent in a pre-filled syringe, 1 plunger rod and 1 vial adapter 
 
 
5. METHOD AND ROUTE OF ADMINISTRATION 
 
Read the package leaflet before use 
 
Intravenous use, after reconstitution 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children 
 
 
7. OTHER SPECIAL WARNINGS, IF NECESSARY 
 
 
8. EXPIRY DATE 
 
EXP 
 
 



23 

9. SPECIAL STORAGE CONDITIONS 
 
Store in a refrigerator. Do not freeze 
Can be stored at room temperature (up to 30°C) for a single period up to 6 months. Must not be 
returned to refrigerator after storage at room temperature 
 
Date removed from refrigerator: ____________ 
 
Store in the original package to protect from light 
 
 
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
12. MARKETING AUTHORISATION NUMBER 
 
EU/1/17/1193/002 
 
 
13. BATCH NUMBER 
 
Lot 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
Refixia 1000 IU 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER – HUMAN READABLE DATA 
 
PC: 
SN: 
NN: 



24 

MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS 
 
Vial 
 
 
1. NAME OF THE MEDICINAL PRODUCT AND ROUTE OF ADMINISTRATION 
 
Refixia 1000 IU powder for solution for injection 
 
nonacog beta pegol 
 
IV 
 
 
2. METHOD OF ADMINISTRATION 
 
 
3. EXPIRY DATE 
 
EXP 
 
 
4. BATCH NUMBER 
 
Lot 
 
 
5. CONTENTS BY WEIGHT, BY VOLUME OR BY UNIT 
 
1000 IU 
 
 
6. OTHER 
 
Novo Nordisk A/S 



25 

PARTICULARS TO APPEAR ON THE OUTER PACKAGING 
 
Carton 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Refixia 2000 IU powder and solvent for solution for injection 
 
nonacog beta pegol 
(recombinant coagulation factor IX) 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE 
 
Powder: 2000 IU nonacog beta pegol (approx. 500 IU/ml after reconstitution), 
 
 
3. LIST OF EXCIPIENTS 
 
Powder: 
sodium chloride, histidine, sucrose, polysorbate 80, mannitol, sodium hydroxide, hydrochloric acid 
 
Solvent: Histidine, water for injections, sodium hydroxide, hydrochloric acid 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
Powder and solvent for solution for injection 
 
Pack contains: 1 powder vial, 4 ml solvent in a pre-filled syringe, 1 plunger rod and 1 vial adapter 
 
 
5. METHOD AND ROUTE OF ADMINISTRATION 
 
Read the package leaflet before use 
 
Intravenous use, after reconstitution 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children 
 
 
7. OTHER SPECIAL WARNINGS, IF NECESSARY 
 
 
8. EXPIRY DATE 
 
EXP 
 
 
9. SPECIAL STORAGE CONDITIONS 



26 

 
Store in a refrigerator. Do not freeze 
Can be stored at room temperature (up to 30°C) for a single period up to 6 months. Must not be 
returned to refrigerator after storage at room temperature 
 
Date removed from refrigerator: ____________ 
 
Store in the original package to protect from light 
 
 
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd 
Denmark 
 
 
12. MARKETING AUTHORISATION NUMBER 
 
EU/1/17/1193/003 
 
 
13. BATCH NUMBER 
 
Lot 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
Refixia 2000 IU 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER – HUMAN READABLE DATA 
 
PC: 
SN: 
NN: 
 



27 

MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS 
 
Vial 
 
 
1. NAME OF THE MEDICINAL PRODUCT AND ROUTE OF ADMINISTRATION 
 
Refixia 2000 IU powder for solution for injection 
 
nonacog beta pegol 
 
IV 
 
 
2. METHOD OF ADMINISTRATION 
 
 
3. EXPIRY DATE 
 
EXP 
 
 
4. BATCH NUMBER 
 
Lot 
 
 
5. CONTENTS BY WEIGHT, BY VOLUME OR BY UNIT 
 
2000 IU 
 
 
6. OTHER 
 
Novo Nordisk A/S 



28 

MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS 
 
Pre-filled syringe 
 
 
1. NAME OF THE MEDICINAL PRODUCT AND ROUTE OF ADMINISTRATION 
 
Solvent for Refixia 
 
Histidine solution 
 
 
2. METHOD OF ADMINISTRATION 
 
 
3. EXPIRY DATE 
 
EXP 
 
 
4. BATCH NUMBER 
 
Lot 
 
 
5. CONTENTS BY WEIGHT, BY VOLUME OR BY UNIT 
 
4 ml 
 
 
6. OTHER 
 
Novo Nordisk A/S 



29 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

B. PACKAGE LEAFLET 



30 

Package leaflet: Information for the user 
 

Refixia 500 IU powder and solvent for solution for injection 
Refixia 1000 IU powder and solvent for solution for injection 
Refixia 2000 IU powder and solvent for solution for injection 

nonacog beta pegol 
 

This medicine is subject to additional monitoring. This will allow quick identification of new 
safety information. You can help by reporting any side effects you may get. See the end of section 4 
for how to report side effects. 
 
Read all of this leaflet carefully before you start using this medicine because it contains 
important information for you. 
• Keep this leaflet. You may need to read it again. 
• If you have any further questions, ask your doctor. 
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, 

even if their signs of illness are the same as yours.  
• If you get any side effects, talk to your doctor. This includes any possible side effects not listed 

in this leaflet. See section 4. 
 
What is in this leaflet 
 
1. What Refixia is and what it is used for 
2. What you need to know before you use Refixia 
3. How to use Refixia 
4. Possible side effects 
5. How to store Refixia 
6. Contents of the pack and other information 
 
 
1. What Refixia is and what it is used for 
 
What Refixia is 
Refixia contains the active substance nonacog beta pegol and is a long-acting recombinant coagulation 
factor IX product. Factor IX is a protein naturally found in the blood that helps to stop bleeding. 
 
What Refixia is used for 
Refixia is used to treat and prevent bleeding in patients 12 years and above with haemophilia B 
(inborn factor IX deficiency). 
 
In patients with haemophilia B, factor IX is missing or does not work properly. Refixia replaces this 
faulty or missing factor IX and helps blood to form clots at the site of bleeding. When you bleed, 
Refixia is activated in the blood to form factor IX. 
 
 
2. What you need to know before you use Refixia 
 
Do not use Refixia: 
• if you are allergic to the active substance or any of the other ingredients of this medicine (listed 

in section 6). 
• if you are allergic to hamster proteins. 
 
If you are not sure if either of the above applies to you, talk to your doctor before using this medicine. 
 
Warnings and precautions 
 
 



31 

Allergic reactions and development of inhibitors 
There is a rare risk that you may experience a sudden and severe allergic reaction (e.g. anaphylactic 
reaction) to Refixia. Stop the injection and contact your doctor or an emergency unit immediately if 
you have signs of an allergic reaction such as rash, hives, weals, itching on large areas of skin, redness 
and/or swelling of lips, tongue, face or hands, difficulty in swallowing or breathing, shortness of 
breath, wheezing, tightness of the chest, pale and cold skin, fast heartbeat, and/or dizziness. 
 
Your doctor may need to treat you promptly for these reactions. Your doctor may also do a blood test 
to check if you have developed factor IX inhibitors (neutralising antibodies) against your medicine, as 
inhibitors may develop together with allergic reactions. If you have such antibodies, you may be at an 
increased risk of sudden and severe allergic reactions (e.g. anaphylactic reaction) during future 
treatment with factor IX. 
 
Because of the risk of allergic reactions with factor IX, your initial treatment with Refixia should be 
given in a medical clinic or in the presence of health care professionals where proper medical care for 
allergic reactions can be provided if needed. 
 
Talk to your doctor immediately if your bleeding does not stop as expected or if you have to 
significantly increase your usage of Refixia in order to stop a bleed. Your doctor will do a blood test to 
check if you have developed inhibitors (neutralising antibodies) against Refixia. The risk for 
developing inhibitors is highest if you have not been treated with factor IX medicines before i.e. for 
small children. 
 
Blood clots 
Tell your doctor, if any of the following apply to you as there is an increased risk of blood clots during 
treatment with Refixia: 
• you have recently had surgery 
• you suffer from other serious illness e.g. liver disease, heart disease, or cancer 
• you have risk factors for heart disease e.g high blood pressure, obesity, or smoking. 
 
Kidney disorder (nephrotic syndrome) 
There is a rare risk of developing a specific kidney disorder called “nephrotic syndrome” following 
high doses of factor IX in haemophilia B patients with factor IX inhibitors and a history of allergic 
reactions. 
 
Catheter-related problems 
If you have a central venous access device (CVAD), you may develop infections or blood clots at the 
site of the catheter. 
 
Other medicines and Refixia 
Tell your doctor if you are taking, have recently taken or might take any other medicines. 
 
Pregnancy and breast-feeding 
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask 
your doctor for advice before using Refixia. 
 
Driving and using machines 
Refixia has no influence on the ability to drive and use machines. 
 
Refixia contains sodium 
This medicine contains less than 1 mmol sodium (23 mg) per vial, i.e. it is essentially “sodium-free”. 
 
 
3. How to use Refixia 
 



32 

Treatment with Refixia will be started by a doctor who is experienced in the care of patients with 
haemophilia B. Always use this medicine exactly as your doctor has told you. Check with your doctor 
if you are not sure about how to use Refixia. 
 
Your doctor will calculate your dose for you. The dose will depend on your weight and what the 
medicine is being used for. 
 
Prevention of bleeding 
The dose of Refixia is 40 international units (IU) per kg of body weight. This is given as one injection 
every week. Your doctor may choose another dose or how often the injections should be given, based 
on your need. 
 
Treatment of bleeding 
The dose of Refixia is 40 international units (IU) per kg of body weight. Depending on the location 
and the severity of bleeding you may need a higher dose (80 IU per kg) or extra injections. Discuss 
with your doctor the dose and number of injections you need. 
 
Use in children and adolescents 
Refixia can be used only in adolescents (12 years and above). The dose in adolescents is also 
calculated according to body weight and is the same dose as for adults. 
 
How Refixia is given 
Refixia is given as an injection into a vein. See “Instructions on how to use Refixia” for more 
information. 
 
If you use more Refixia than you should 
If you use more Refixia than you should, contact your doctor. 
 
If you have to significantly increase your usage of Refixia to stop a bleed, talk to your doctor 
immediately. For further information, see section 2 “Allergic reactions and development of inhibitors”. 
 
If you forget to use Refixia 
If you forget a dose, inject the missed dose as soon as you remember. Do not inject a double dose to 
make up for a forgotten dose. If you are in doubt contact your doctor. 
 
If you stop using Refixia 
If you stop using Refixia you may no longer be protected against bleeding or a current bleed may not 
stop. Do not stop using Refixia without talking to your doctor. 
 
If you have any further questions on the use of this medicine, ask your doctor. 
 
 
4. Possible side effects 
 
Like all medicines, this medicine can cause side effects, although not everybody gets them. 
 
Allergic reactions are possible with this medicine. 
If sudden and severe allergic reactions (e.g. anaphylactic reactions) occur, the injection must be 
stopped immediately. You must contact your doctor or an emergency unit immediately if you have 
early signs of an allergic reaction such as: 
• difficulty in swallowing or breathing 
• shortness of breath or wheezing 
• chest tightness 
• redness and/or swelling of the lips, tongue, face or hands 
• rash, hives, weals or itching 
• pale and cold skin, fast heartbeat, and/or dizziness (low blood pressure). 
 



33 

The following side effects have been observed with Refixia: 
 
Common side effects (may affect up to 1 in 10 people) 
• itching (pruritus) 
• skin reactions at the site of injection 
• feeling sick (nausea) 
• feeling very tired. 
 
Uncommon side effects (may affect up to 1 in 100 people) 
• allergic reactions (hypersensitivity). This may become severe and could be life-threatening 

(anaphylactic reactions) 
• heart palpitations 
• hot flush. 
 
Side effects with unknown frequency (frequency cannot be estimated from the available data) 
• neutralising antibodies (inhibitors). 
 
Reporting of side effects 
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side 
effects not listed in this leaflet. You can also report side effects directly via the national reporting 
system listed in Appendix V. By reporting side effects you can help provide more information on the 
safety of this medicine. 
 
 
5. How to store Refixia 
 
Keep this medicine out of the sight and reach of children. 
 
Do not use Refixia after the expiry date which is stated after “EXP” on the carton and on the vial and 
the pre-filled syringe labels. The expiry date refers to the last day of that month. 
 
Store in a refrigerator (2°C – 8°C). Do not freeze. Store in the original package in order to protect 
from light. 
 
Refixia may be taken out of the refrigerator for a maximum period of 6 months and stored at room 
temperature (up to 30°C). Please record on the carton the date Refixia is removed from the refrigerator 
and placed at room temperature. This new expiry date should never exceed the one initially mentioned 
on the outer carton. If the medicine has not been used before the new expiry date, it should be disposed 
of. After storage at room temperature the medicine must not be put back in the refrigerator. 
 
Use the injection immediately after reconstitution. If it cannot be used immediately, use within 
24 hours if stored in a refrigerator at 2°C – 8°C or within 4 hours if stored out of the refrigerator at a 
maximum temperature of 30°C. 
 
The powder in the vial appears as a white to off-white powder. Do not use the powder if the colour has 
changed. 
 
The reconstituted solution will be clear and colourless. Do not use the reconstituted solution if you 
notice any particles or discolouration. 
 
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to 
throw away medicines you no longer use. These measures will help protect the environment. 
 
 
6. Contents of the pack and other information 
 
What Refixia contains 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


34 

• The active substance is nonacog beta pegol (pegylated human coagulation factor IX (rDNA)). 
Each vial of Refixia contains nominally 500 IU, 1000 IU or 2000 IU nonacog beta pegol 
corresponding to approximately 125 IU/ml, 250 IU/ml or 500 IU/ml respectively after 
reconstitution with histidine solvent. 

• The other ingredients in the powder are sodium chloride, histidine, sucrose, polysorbate 80, 
mannitol, sodium hydroxide and hydrochloric acid. 

• The ingredients in the sterilised solvent are histidine, water for injections, sodium hydroxide and 
hydrochloric acid. 

 
What Refixia looks like and contents of the pack 
• Refixia is provided as a powder and solvent for solution for injection (500 IU, 1000 IU or 

2000 IU powder in a vial and 4 ml solvent in a pre-filled syringe, a plunger rod with a vial 
adapter – pack size of 1). 

• The powder is white to off-white and the solvent is clear and colourless. 
 
Marketing Authorisation Holder and Manufacturer 
 
Novo Nordisk A/S 
Novo Allé 
DK-2880 Bagsværd, Denmark 
 
 
This leaflet was last revised in 
 
 
Other sources of information 
 
Detailed information on this medicine is available on the European Medicines Agency web site: 
http://www.ema.europa.eu. 

http://www.ema.europa.eu/


35 

 

Instructions on how to use Refixia 
 
Read these instructions carefully before using Refixia. 
 
Refixia is supplied as a powder. Before injection it must be reconstituted with the solvent supplied in 
the syringe. The solvent is a histidine solution. The reconstituted product must be injected into your 
vein (intravenous (IV) injection). The equipment in this package is designed to reconstitute and inject 
Refixia. 
 
You will also need an infusion set (tubing and butterfly needle), sterile alcohol swabs, gauze pads and 
plasters. These items are not included in the Refixia package. 
 
Do not use the equipment without proper training from your doctor or nurse. 
 
Always wash your hands and ensure that the area around you is clean. 
 
When you prepare and inject medicine directly into the veins, it is important to use a clean and germ 
free (aseptic) technique. Incorrect technique can introduce germs that can infect the blood. 
 
Do not open the equipment until you are ready to use it. 
 
Do not use the equipment if it has been dropped, or if it is damaged. Use a new package instead. 
 
Do not use the equipment if it has expired. Use a new package instead. The expiry date is printed on 
the outer carton, on the vial, on the vial adapter, and on the pre-filled syringe. 
 
Do not use the equipment if you suspect it is contaminated. Use a new package instead. 
 
Do not dispose of any of the items until after you have injected the reconstituted solution. 
 
The equipment is for single use only. 

Contents 
The package contains: 
• 1 vial with Refixia powder 
• 1 vial adapter 
• 1 pre-filled syringe with solvent 
• 1 plunger rod (placed under the syringe) 
 
 



36 

 

Vial with Refixia powder 

Plastic cap 
Rubber stopper 

(under plastic cap) 

Overview 

  
 

Vial adapter 

Protective cap 

Spike 
(under protective paper) 

Protective 
paper 

 
 

Pre-filled syringe with solvent 

Syringe tip 
(under syringe cap) Scale 

Plunger 

Syringe cap 

 
 



37 

 

Plunger rod 

Thread Wide top 
end 

 

1. Prepare the vial and the syringe 
 
• Take out the number of Refixia packages 

you need. 
 

• Check the expiry date. 
 

• Check the name, strength and colour of 
the package, to make sure it contains the 
correct product. 

 
• Wash your hands and dry them properly 

using a clean towel or air dry. 
 

• Take the vial, the vial adapter and the pre-
filled syringe out of the carton. Leave the 
plunger rod untouched in the carton. 

 
• Bring the vial and the pre-filled syringe 

to room temperature. You can do this by 
holding them in your hands until they feel 
as warm as your hands. 

 
• Do not use any other way to warm the 

vial and pre-filled syringe. 

 A 

 

• Remove the plastic cap from the vial. If 
the plastic cap is loose or missing, do not 
use the vial. 

 
• Wipe the rubber stopper with a sterile 

alcohol swab and allow it to air dry for a 
few seconds before use to ensure that it is 
as germ free as possible. 

 
• Do not touch the rubber stopper with 

your fingers as this can transfer germs. 

 B 

 
 



38 

2. Attach the vial adapter 
 
• Remove the protective paper from the 

vial adapter. 
 

If the protective paper is not fully sealed 
or if it is broken, do not use the vial 
adapter. 
 
Do not take the vial adapter out of the 
protective cap with your fingers. 
If you touch the spike on the vial adapter, 
germs from your fingers can be transferred. 

 C 

 

• Place the vial on a flat and solid surface. 
 
• Turn over the protective cap, and snap 

the vial adapter onto the vial. 
 

Once attached, do not remove the vial 
adapter from the vial. 

 D 

 
 

• Lightly squeeze the protective cap with 
your thumb and index finger as shown. 

 
Remove the protective cap from the vial 
adapter. 
 
Do not lift the vial adapter from the vial 
when removing the protective cap. 

 E 

 

3. Attach the plunger rod and the syringe 
 
• Grasp the plunger rod by the wide top end 

and take it out of the carton. Do not touch 
the sides or the thread of the plunger 
rod. If you touch the sides or the thread, 
germs from your fingers can be transferred. 

 
• Immediately connect the plunger rod to 

the syringe by turning it clockwise into the 
plunger inside the pre-filled syringe until 
resistance is felt. 

 

 F 

 

• Remove the syringe cap from the 
pre-filled syringe by bending it down until 
the perforation breaks. 

 
• Do not touch the syringe tip under the 

syringe cap. If you touch the syringe tip, 
germs from your fingers can be transferred. 

 
If the syringe cap is loose or missing, do 

 G 

 



39 

not use the pre-filled syringe. 

• Screw the pre-filled syringe securely onto 
the vial adapter until resistance is felt. 

 H 

 

4. Reconstitute the powder with the solvent 
 
• Hold the pre-filled syringe slightly tilted 

with the vial pointing downwards. 
 
• Push the plunger rod to inject all the 

solvent into the vial. 

 I 

 

• Keep the plunger rod pressed down and 
swirl the vial gently until all the powder is 
dissolved. 

 
Do not shake the vial as this will cause 
foaming. 

 
• Check the reconstituted solution. It must 

be clear and colourless and no particles 
should be visible. If you notice particles 
or discolouration, do not use it. Use a 
new package instead. 

 J 

 

Refixia is recommended to be used immediately after it has been reconstituted. This is because if 
left, the medicine may no longer be sterile and could cause infections. 
 
If you cannot use the reconstituted Refixia solution immediately, it should be used within 4 hours 
when stored at room temperature (up to 30°C) and within 24 hours when stored in a refrigerator 
(2°C – 8°C). Store the reconstituted product in the vial. 
 
Do not freeze reconstituted Refixia solution or store it in syringes. 
 
Keep reconstituted Refixia solution out of direct light. 
 

 
If your dose requires more than one vial, repeat steps A to J with additional vials, vial adapters and 
pre-filled syringes until you have reached your required dose. 



40 

• Keep the plunger rod pushed completely 
in. 

 
• Turn the syringe with the vial upside 

down. 
 

• Stop pushing the plunger rod and let it 
move back on its own while the 
reconstituted solution fills the syringe. 

 
• Pull the plunger rod slightly downwards 

to draw the reconstituted solution into the 
syringe. 

 
• In case you only need part of the entire 

vial, use the scale on the syringe to see 
how much reconstituted solution you 
withdraw, as instructed by your doctor 
or nurse. 

 
If, at any point, there is air in the syringe, 
inject the air back into the vial. 

 
• While holding the vial upside down, tap 

the syringe gently to let any air bubbles 
rise to the top. 

 
• Push the plunger rod slowly until all air 

bubbles are gone. 

 K 

 

• Unscrew the vial adapter with the vial. 
 
• Do not touch the syringe tip. If you touch 

the syringe tip, germs from your fingers 
can be transferred. 

 L 

 

5. Inject the reconstituted solution 
 
Refixia is now ready to inject into your vein. 
• Inject the reconstituted solution as instructed by your doctor or nurse. 
• Inject slowly over 1 to 3 minutes. 
• Do not mix Refixia with any other intravenous infusions or medications. 
 
Injecting Refixia via needleless connectors for intravenous (IV) catheters 
 
Caution: The pre-filled syringe is made of glass and is designed to be compatible with standard luer-
lock connections. Some needleless connectors with an internal spike are incompatible with the 
pre-filled syringe. This incompatibility may prevent administration of the drug and/or result in damage 
to the needleless connector. 
 
Injecting the solution via a central venous access device (CVAD) such as a central venous catheter or 
a subcutaneous port: 
• Use a clean and germ free (aseptic) technique. Follow the instructions for proper use for your 

connector and CVAD in consultation with your doctor or nurse. 



41 

• Injecting into a CVAD may require using a sterile 10 ml plastic syringe for withdrawal of the 
reconstituted solution. This should be done right after step J. 

• If the CVAD line needs to be flushed before or after Refixia injection, use sodium chloride 
9 mg/ml solution for injection. 

Disposal 
 
• After injection, safely dispose of all 

unused Refixia solution, the syringe with 
the infusion set, the vial with the vial 
adapter and other waste materials as 
instructed by your pharmacist. 

 
Do not throw it out with the ordinary 
household waste.  

 M 

 

Do not disassemble the equipment before disposal. 
 
Do not reuse the equipment. 

 


	SUMMARY OF PRODUCT CHARACTERISTICS
	A. MANUFACTURERS OF THE BIOLOGICAL ACTIVE SUBSTANCE AND MANUFACTURER RESPONSIBLE FOR BATCH RELEASE
	B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE
	C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING AUTHORISATION 
	D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND EFFECTIVE USE OF THE MEDICINAL PRODUCT
	A. LABELLING
	B. PACKAGE LEAFLET