For US healthcare professionals only

Important Safety Information | Prescribing Information | Patient Support | Celltrion USA | Patient Site

For US healthcare professionals only

Prescribing Information

Resources for you and your patients

You play a critical role in guiding your patients through their treatment journey. To help support your practice and your patients, we’ve designed a comprehensive Patient Starter Kit to help empower patients as they begin using ZYMFENTRA™.

Zymfentra Patient Starter Kit

ZYMFENTRA Patient Starter Kit

  • A large cooler
  • A small cooler
  • Mobile ice pack
  • Patient education brochure
  • How to Use ZYMFENTRA brochure
  • Dosing diary
Request Kit

Frequently asked questions

What is ZYMFENTRA?

ZYMFENTRA is a tumor necrosis factor (TNF) blocker indicated in adults for maintenance treatment of1:

  • moderately to severely active ulcerative colitis following treatment with an infliximab product administered intravenously 
  • moderately to severely active Crohn’s disease following treatment with an infliximab product administered intravenously

What warnings and precautions are associated with ZYMFENTRA?1

  • Increased risk of serious infections leading to hospitalization or death, including tuberculosis (TB), bacterial sepsis, invasive fungal infections (such as histoplasmosis) and infections due to other opportunistic pathogens
  • Discontinue ZYMFENTRA if a patient develops a serious infection or sepsis
  • Perform test for latent TB; if positive, start treatment for TB prior to starting ZYMFENTRA. Monitor all patients for active TB during treatment, even if initial latent TB test is negative
  • Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with tumor necrosis factor (TNF) blockers, including infliximab products
  • Postmarketing cases of fatal hepatosplenic T-cell lymphoma (HSTCL) have been reported in patients treated with TNF blockers including infliximab products. Almost all had received azathioprine or 6-mercaptopurine concomitantly with a TNF blocker at or prior to diagnosis. The majority of cases were reported in patients with Crohn’s disease or ulcerative
    colitis, most of whom were adolescent or young adult males

What are the contraindications for ZYMFENTRA?

ZYMFENTRA is contraindicated in patients with a history of a severe hypersensitivity reaction to other infliximab products, any of its ingredients, or any murine proteins. Reactions have included anaphylaxis.1

What is the recommended dosing for ZYMFENTRA?

ZYMFENTRA is indicated as maintenance treatment only, starting at Week 10 and thereafter: 120 mg subcutaneously once every 2 weeks. To shift patients who are responding to maintenance therapy with an infliximab product administered intravenously, administer the first subcutaneous dose of ZYMFENTRA in place of the next scheduled intravenous infusion and every 2 weeks thereafter.1 ZYMFENTRA is intended for use under the guidance and supervision of a healthcare professional. If a healthcare professional determines that it is appropriate, patients may self-inject ZYMFENTRA.

All patients must complete an intravenous induction regimen with an infliximab product before starting ZYMFENTRA.

What’s important to know about the pharmacokinetic profile of ZYMFENTRA?

ZYMFENTRA, the only FDA-approved subcutaneous (SC) formulation of infliximab, offers consistent steady and stable infliximab trough levels in patients with UC and CD.1-3

What clinical studies support the efficacy and safety of ZYMFENTRA?

The safety and efficacy of ZYMFENTRA were assessed in two 54-week randomized, double-blind, placebo-controlled clinical trials1:

  • UC Trial I: adult subjects with moderately to severely active UC (defined as a modified Mayo score between 5 to 9 with an endoscopic subscore of 2 or 3)
  • CD Trial I: adult subjects with moderately to severely active CD, defined as Crohn’s Disease Activity Index score of 220 to 450 points, and a centrally reviewed Simplified Endoscopic Activity Score for Crohn’s Disease of ≥6 points for ileal-colonic CD (or ≥4 points for isolated ileal disease).

What is the mechanism of action for ZYMFENTRA?

Infliximab-dyyb neutralizes the biological activity of TNFα by binding with high affinity to the soluble and transmembrane forms of TNFα and inhibit binding of TNFα with its receptors. Infliximab-dyyb has shown biological activities, such as TNFα neutralization activity and TNFα binding affinities, complement component 1q (C1q) binding affinity and crystallizable fragment (Fc) receptor binding affinities in a wide variety of in vitro bioassays. The relationship of these biological response markers to the mechanism(s) by which infliximab-dyyb exerts its clinical effects is unknown.1

What were the most common adverse reactions reported with ZYMFENTRA?

The most common adverse reactions reported in ≥3% of subjects and at a higher rate than placebo in UC Trial I were: COVID-19, anemia, arthralgia, injection-site reaction, increased alanine aminotransferase, and abdominal pain.1

The most common adverse reactions reported in ≥3% of subjects and at a higher rate than placebo in CD Trial I were: COVID-19, headache, upper respiratory tract infection, injection-site reaction, diarrhea, increased blood creatinine phosphokinase, arthralgia, increased alanine aminotransferase, hypertension, urinary tract infection, neutropenia, dizziness, and leukopenia.1

What type of patient support is available for my patients prescribed ZYMFENTRA?

The Celltrion CONNECT® Patient Support Program provides ongoing support to patients prescribed ZYMFENTRA. For details on program benefits, click here.

How should ZYMFENTRA be stored?

Store ZYMFENTRA refrigerated at 2°C to 8°C (36°F to 46°F). If needed, ZYMFENTRA may be stored at room temperature at 20°C to 25°C (68°F to 77°F) for up to 14 days. Once ZYMFENTRA has been stored at room temperature, it should not be placed back into the refrigerator. Discard ZYMFENTRA if not used within the 14 days. DO NOT FREEZE. Keep the product in its outer carton until time of administration in order to protect from light.1

Enrolling patients in the Celltrion CONNECT® Patient Support Program

The Celltrion CONNECT® Patient Support Program can help you understand health insurance coverage requirements, answer billing and coding questions, and enroll eligible patients in all program services. These include financial assistance programs, helping to secure appropriate access to ZYMFENTRA for eligible patients.

To enroll your patients in Celltrion CONNECT®:

Celltrion Connect Logo

Visit Celltrion CONNECT® Website

For more information, call 1-877-812-6662 (1-877-81CONNC) Monday – Friday, 8 AM – 8 PM EST.

Visit Celltrion CONNECT
Celltrion Cares Logo

Celltrion CARES™ Co-Pay Assistance Program*

Learn more about our co-pay assistance program for eligible patients.

Visit Celltrion CARES
Celltrion Nurse Connector Logo

Dedicated Nursing Support

We offer patients individualized support from RNsthroughout their treatment journey.

Learn More

*Other terms and conditions apply. Visit www.CelltrionConnect.com for full eligibility criteria.
Nurse Connectors are not affiliated with any healthcare provider or office, and do not provide medical advice.

References: 1. ZYMFENTRA™ Prescribing Information, Celltrion, Inc., 2024. 2. Little RD, Ward MG, Wright E, et al. Therapeutic drug monitoring of subcutaneous infliximab in inflammatory bowel disease—understanding pharmacokinetics and exposure response relationships in a new era of subcutaneous biologics. J Clin Med. 2022;11(20):6173. Published 2022 Oct 19. doi:10.3390/jcm11206173 3. Data on file. Celltrion, Inc.

IMPORTANT SAFETY INFORMATION

WARNING: SERIOUS INFECTIONS and MALIGNANCY

SERIOUS INFECTIONS
Patients treated with TNF blockers, including ZYMFENTRA, are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.

Discontinue ZYMFENTRA if a patient develops a serious infection or sepsis.

Reported infections include: 

  • Active tuberculosis, including reactivation of latent tuberculosis. Patients with tuberculosis have frequently presented with disseminated or extrapulmonary disease. Test patients for latent tuberculosis before ZYMFENTRA use and during therapy. Initiate treatment for latent infection prior to ZYMFENTRA use.
  • Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may present with disseminated, rather than localized, disease. Antigen and antibody testing for histoplasmosis may be negative in some patients with active infection. Consider empiric anti-fungal therapy in patients at risk for invasive fungal infections who develop severe systemic illness. 
  • Bacterial, viral and other infections due to opportunistic pathogens, including Legionella and Listeria. 

Carefully consider the risks and benefits of treatment with ZYMFENTRA prior to initiating therapy in patients with chronic or recurrent infection.

Closely monitor patients for the development of signs and symptoms of infection during and after treatment with ZYMFENTRA, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.

MALIGNANCY
Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, including infliximab products.

Postmarketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in patients treated with TNF blockers, including infliximab products. These cases have had a very aggressive disease course and have been fatal. Almost all patients had received treatment with azathioprine or 6-mercaptopurine concomitantly with a TNF blocker at or prior to diagnosis. The majority of reported cases have occurred in patients with Crohn’s disease or ulcerative colitis and most were in young adult males.

Contraindications

  • ZYMFENTRA is contraindicated in patients with a history of a severe hypersensitivity reaction to infliximab-dyyb, other infliximab products, any of the inactive ingredients in ZYMFENTRA, or any murine proteins. Reactions have included anaphylaxis.

Warnings and Precautions

  • Serious infections: Avoid in patients with active infection. If infection develops, conduct a prompt/complete diagnostic workup appropriate for immunocompromised patients and initiate antimicrobials. If systemic illness develops in patients who reside or travel to regions where mycoses are endemic, consider empiric antifungals.
  • Malignancies: Malignancies, including lymphoma, were greater in TNF-blocker-treated patients. Consider the higher risk of hepatosplenic T-cell lymphoma (HSTCL) with combination therapy versus increased risk of immunogenicity and hypersensitivity reactions with monotherapy.
  • Hepatitis B virus (HBV) reactivation: Test for HBV infection before starting treatment. Monitor HBV carriers during and several months after therapy for active HBV infection. If reactivation occurs, stop ZYMFENTRA and begin anti-viral therapy.
  • Hepatotoxicity: Severe hepatic reactions, some fatal or necessitating liver transplantation have occurred in patients receiving infliximab products. Monitor hepatic enzymes and liver function tests every 3-4 months during treatment; investigate liver enzyme elevations and interrupt treatment if drug-induced liver injury is suspected. Instruct patients to seek immediate medical attention if symptoms develop.
  • Congestive heart failure (CHF): New onset or worsening symptoms may occur. Avoid in patients with CHF. Monitor for new/worsening symptoms when administering ZYMFENTRA.
  • Hematologic reactions: Advise patients to seek immediate medical attention if signs and symptoms of cytopenia develop; consider stopping if significant hematologic abnormalities develop. 
  • Hypersensitivity and other administration reactions: Serious hypersensitivity reactions, including anaphylaxis have occurred with intravenous formulations of infliximab; discontinue ZYMFENTRA and start appropriate therapy.
  • Neurologic reactions: Exacerbation or new onset CNS demyelinating disorders may occur; consider discontinuation of ZYMFENTRA.
  • Risk of infection with concurrent administration of other biological products: Concurrent use with other immunosuppressive biologics may increase risk of infection.
  • Risk of additive immunosuppressive effects from prior biological products: Consider the half-life and mode of action of prior biologics.
  • Autoimmunity: Formation of autoantibodies and development of lupus-like syndrome may occur; discontinue ZYMFENTRA if symptoms develop.
  • Vaccinations and use of live vaccines/therapeutic infectious agents: Prior to initiating ZYMFENTRA bring patients up to date with vaccinations. Live vaccines or therapeutic infectious agents should not be given with ZYMFENTRA. A 6-month waiting period following birth is recommended before the administration of live vaccines to infants exposed in utero to infliximab.

Common Adverse Reactions (≥3%)

  • Ulcerative Colitis: COVID-19, anemia, arthralgia, injection site reaction, increased alanine aminotransferase, and abdominal pain.
  • Crohn’s Disease: COVID-19, headache, upper respiratory tract infection, injection site reaction, diarrhea, increased blood creatine phosphokinase, arthralgia, increased alanine aminotransferase, hypertension, urinary tract infection, neutropenia, dizziness, and leukopenia.

Drug Interactions

  • Concurrent use with immunosuppressive biologics used to treat UC and CD is not recommended due to risk of infection.
  • Formation of CYP450 enzymes may be suppressed by increased levels of cytokines during chronic inflammation. ZYMFENTRA could normalize the formation of CYP450 enzymes potentially resulting in decreased exposure of CYP450 substrates and requiring dose adjustments.

Please see full Prescribing Information, including BOXED WARNING.

INDICATIONS

Crohn’s Disease 

  • ZYMFENTRA is indicated in adults for maintenance treatment of moderately to severely active Crohn’s disease following treatment with an infliximab product administered intravenously.

Ulcerative Colitis

  • ZYMFENTRA is indicated in adults for maintenance treatment of moderately to severely active ulcerative colitis following treatment with an infliximab product administered intravenously.