• About Amgen
  • Science
  • Corporate Giving
  • Site Map
  • Search
  • Privacy & Terms
  • Contact Us
Amgen
  • Patients
  • Medical Professionals
  • Partners
  • Investors
  • Careers
  • Media
  • print
  • mail
  • Home
  • Reimbursement Connection®
  • Kepivance®
    (palifermin)
  • Coding and Claims - Forms and Documents

  • Overview
  • Amgen™ Oncology Assistance
  • Aranesp®
    (darbepoetin alfa)
  • Neulasta®
    (pegfilgrastim)
  • NEUPOGEN®
    (Filgrastim)
  • Nplate™
    (romiplostim)
  • EPOGEN®
    (Epoetin alfa)
  • Sensipar®
    (cinacalcet)
  • Enbrel®
    (etanercept)
  • Kepivance®
    (palifermin)
  • Kineret®
    (anakinra)
  • Vectibix®
    (panitumumab)
Forms and Documents
The information below includes the FDA Approval Letter and an Authorization to Disclose Health Information. The FDA Approval Letter may be helpful if a payer is unfamiliar with Kepivance™. If your are unsure of a patient's coverage for Kepivance™, the Reimbursement Connection® is available to research patient benefits. Before performing such research, however, the Reimbursement Connection® must receive an Authorization to Disclose Health Information form signed by the patient.
 
 
Kepivance J Code Announcement
FDA Approval Letter
Insurance Verification Request
Authorization to Disclose Health Information




Kepivance J Code Announcement
 
FDA Approval Letter  Kepivance J Code Announcement

Back to Top


Kepivance Example FDA Approval Letter
 
Example FDA Approval Letter
FDA Approval Letter  FDA Approval Letter


Back to Top


Kepivance Insurance Verification Request
 
FDA Approval Letter  Kepivance Insurance Verification Request

Back to Top



Authorization to Disclose Health Information
 

Authorization to Disclose Health Information
Authorization to Disclose Health Information  Authorization to Disclose Health Information

Back to Top


You need to have Adobe® Acrobat® installed to view PDF files. If you do not have Acrobat® Reader®, you can download it for free from Adobe® website.   Get Adobe Acobat Reader
 
Adobe® Reader® is a registered trademark of Adobe Systems, Inc.
 

Kepivance® is indicated to decrease the incidence and duration of severe oral mucositis in patients with hematologic malignancies receiving myelotoxic therapy requiring hematopoietic stem cell support. The safety and efficacy of Kepivance® have not been established in patients with non-hematologic malignancies.

Important Safety Information

In patients with hematologic malignancies, the most common serious adverse reaction in clinical trials attributed to Kepivance® was skin rash reported in less than 1% of patients. Other serious adverse reactions occurred at a similar rate in patients who received Kepivance® or placebo with the most frequent being fever, gastrointestinal events, and respiratory events. The most commonly reported adverse reactions attributed to Kepivance® were rash, erythema, edema, pruritus, dysesthesia, mouth/tongue thickness/discoloration, and taste alteration.

* Results from a randomized, double-blind, placebo-controlled, phase 3 study (N = 212) in which patients with hematologic malignancies who were undergoing hematopoietic stem cell transplantation (HSCT) after myelotoxic therapy received either Kepivance® or placebo.1,2
† Analyses were performed in the overall patient population (patients who did not experience the event were assigned a duration of 0 days), and in a subset of patients who developed Grade 3/4 oral mucositis. Oral assessments were based on the World Health Organization (WHO) oral toxicity scale.2
‡ Mouth and throat soreness (MTS) and functional activity scores were collected with the use of a daily questionnaire and measured using a 5-point scale. MTS was a prespecified endpoint. Other functional activities were planned analyses.2

References

  1. Kepivance® (palifermin) prescribing information, Amgen.
  2. Spielberger R, Stiff P, Bensinger W, et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med.2004;351:2590-2598.
  3. Rubenstein EB, Peterson DE, Schubert M, et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer. 2004;100(suppl 9):2026-2046.
  4. Spielberger R, Emmanouilides C, Stiff P, et al. Use of recombinant human keratinocyte growth factor (palifermin) can reduce severe oral mucositis in patients with hematologic malignancies undergoing autologous peripheral blood progenitor cell transplantation after radiationbased conditioning. J Support Oncol.2004;2(suppl 2):73-74.

© 2006 Amgen All Rights Reserved. Prescribing Information for Kepivance®

  • Related Links
  • Amgen Medical Information Connection™
  • Amgen Oncology Institute
  • AmgenOncology.com
footer