Ceprotin

Ceprotin is a powder and solvent, which are mixed together to form a solution for injection. It contains the active substance human protein C.

Protein C is a natural substance in the blood that controls clotting. Ceprotin is used in patients with severe congenital (hereditary) protein C deficiency to treat purpura fulminans (extensive clotting of blood within the blood vessels, which causes the death of the tissues just beneath the skin, often leading to organ failure and amputations) and coumarin-induced skin necrosis (a complication of anticoagulant treatment with medicines such as warfarin, causing skin death). Ceprotin is also used for the short-term prevention of clotting in patients with severe congenital protein C deficiency in certain situations when there is an increased risk of clotting, such as surgery or when treatment with a coumarin is not sufficient or possible.

The medicine can only be obtained with a prescription.

Ceprotin treatment should only be started by a doctor who has experience in this type of therapy and where it is possible to measure protein C activity. Ceprotin is given by intravenous injection (injection into a vein) at a maximum injection rate of 2 ml per minute except for children with a body weight of less than 10 kg, where the injection rate should not exceed 0.2 ml per kilogram body weight per minute.

Ceprotin contains human protein C, extracted and purified from human plasma (the liquid part of the blood). In the body, protein C controls the generation of thrombin, one of the substances (factors) involved in blood clotting. Protein C slows down the production of thrombin, and therefore slows down further clotting. An injection of Ceprotin gives an immediate but temporary increase in levels of protein C. Replacement of protein C in protein C deficient patients should control or prevent thrombotic (clotting) problems in these patients.

Ceprotin has been studied in a total of 79 patients, 22 of whom had a diagnosis of the more severe forms of congenital protein C deficiency. The main measures of the study were normalisation of protein C levels and other indicators of coagulation (clotting) activation. Additionally, any improvement in skin lesions was monitored.

In patients with severe congenital protein C deficiency, Ceprotin improved all 16 cases of purpura fulminans and all six episodes of coumarin-induced skin necrosis. The results in the treatment of other types of clotting disorders, and of patients with other protein C deficiencies, were not sufficient to assess completely the use of Ceprotin in these groups.

Hypersensitivity (allergic reactions) has sometimes been seen. If Ceprotin is used in patients with severe congenital protein C deficiency, antibodies inhibiting protein C may develop. For the full list of all side effects reported with Ceprotin, see the Package Leaflet.

Ceprotin should not be used in people who may be hypersensitive (allergic) to human protein C, mouse protein or to heparin, except in life-threatening complications.

When patients start receiving other anticoagulant medicines, such as warfarin, special care is needed and Ceprotin treatment must be continued until the warfarin treatment is adjusted.

The Committee for Medicinal products for Human Use (CHMP) decided that Ceprotin’s benefits are greater than its risks for patients with severe congenital protein C deficiency. The Committee recommended that Ceprotin be given marketing authorisation.

Ceprotin was originally authorised under ’Exceptional Circumstances‘, because it was not possible at the time to obtain complete information on the medicine due to the low number of patients diagnosed with this disease. As the company had supplied the additional information requested, the ’Exceptional Circumstances’ ended on 28 July 2006.

The European Commission granted a marketing authorisation valid throughout the European Union for Ceprotin to Baxter AG on 16 July 2001. The marketing authorisation was renewed on 16 July 2006.