WARNINGS and Adverse Events
- Grade 3/4 neutropenia occurred in 21% of REVLIMID®(lenalidomide) + dex patients vs 3% of placebo + dex patients; 2% of REVLIMID® + dex patients had febrile neutropenia vs 0% of placebo + dex patients.
- Grade 3/4 thrombocytopenia occurred in 10% of REVLIMID® + dex patients vs 6% of placebo + dex patients.
- Grade 3/4 anemia occurred in 8% of REVLIMID® + dex patients vs 4% of placebo + dex patients.
The overall incidence of thrombotic events-including DVT, pulmonary embolism (PE), thrombosis, and thromboembolism-was higher among patients taking REVLIMID® + dex (12%; 43/346) vs placebo + dex (4%; 14/345).
- Grade 3/4 DVT was significantly more frequent with REVLIMID® + dex (7%) vs placebo + dex (3%).
- Grade 3/4 PE was not significantly different with REVLIMID® + dex (3%) vs placebo + dex (1%).
- Prophylactic anticoagulation was not used in these 2 studies.
- There was no significant difference between treatment arms in neuropathy (REVLIMID® + dex, 2%; placebo + dex, 0.6%, P=NS).
| |
REVLIMID® + dex
(n=346) |
Placebo + dex
(n=345) |
| Hematologic |
All grades |
Grade 3/4 |
All grades |
Grade 3/4 |
| Neutropenia |
28%* |
21%* |
5% |
3% |
| Anemia NOS |
24%* |
8%* |
17% |
4% |
| Thrombocytopenia |
17%* |
10%* |
10% |
6% |
| Leukopenia NOS |
__† |
4%* |
__† |
<1% |
| Lymphopenia |
__† |
2% |
__† |
1% |
| Nonhematologic |
All grades |
Grade 3/4 |
All grades |
Grade 3/4 |
| Constipation |
39%* |
2% |
19% |
<1% |
| Fatigue |
38% |
6% |
37% |
4% |
| Insomnia |
32% |
__‡ |
37% |
__‡ |
| Muscle cramp |
30% |
__‡ |
21% |
__‡ |
| Diarrhea NOS |
29% |
2% |
25% |
1% |
| Asthenia |
23% |
4% |
25% |
5% |
| Pyrexia |
23% |
1% |
19% |
2% |
| Nausea |
22% |
__‡ |
19% |
__‡ |
| Headache |
21% |
__‡ |
21% |
__‡ |
| Edema peripheral |
21% |
__‡ |
19% |
__‡ |
| Dizziness |
21% |
__‡ |
15% |
__‡ |
| Dyspnea |
20% |
3% |
15% |
2% |
| Tremor |
20%* |
__‡ |
7% |
__‡ |
| Weight decreased |
18% |
__‡ |
14% |
__‡ |
| Rash NOS |
16%* |
__‡ |
8% |
__‡ |
| Back pain |
15% |
__‡ |
14% |
__‡ |
| Hyperglycemia NOS |
15% |
8% |
14% |
8% |
| Muscle weakness NOS |
15% |
5% |
15% |
3% |
Vision blurred |
15% |
__‡ |
10% |
__‡ |
| Cough |
15% |
__‡ |
21% |
__‡ |
| Dyspepsia |
14% |
__‡ |
13% |
__‡ |
| Upper respiratory tract infections NOS |
14% |
__‡ |
13% |
__‡ |
| Anorexia |
14% |
__‡ |
9% |
__‡ |
| Dysgeusia |
13% |
__‡ |
9% |
__‡ |
| Parasthesia |
12% |
__‡ |
13% |
__‡ |
| Pneumonia NOS |
11% |
6% |
8% |
5% |
| Hypokalemia |
11% |
3% |
5% |
1% |
| Vomiting NOS |
10% |
__‡ |
8% |
__‡ |
| Arthralgia |
10% |
__‡ |
15% |
__‡ |
Pooled analysis from Studies 1 and 2.
NOS=not otherwise specified.
*More frequent with REVLIMID® + dex than with placebo + dex.
†Occurred in <10% of patients.
‡Occurred in <2% of patients.
In the pooled multiple myeloma studies Grade 3 and 4 hematologic toxicities were more frequent in patients treated with the combination of REVLIMID® and dexamethasone than in patients treated with dexamethasone alone. See ADVERSE REACTIONS Table 7 in the Prescribing Information. Patients on therapy should have their complete blood counts monitored every 2 weeks for the first 12 weeks and then monthly thereafter. Patients may require dose interruption and/or dose reduction.
REVLIMID® (lenalidomide) in combination with dexamethasone is indicated for the treatment of multiple myeloma patients who have received at least one prior therapy.
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REVLIMID® (lenalidomide) is indicated for the treatment of patients with transfusion-dependent anemia due to Low- or Intermediate-1–risk myelodysplastic syndromes associated with a deletion 5q cytogenetic abnormality with or without additional cytogenetic abnormalities.
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WARNINGS:
1. POTENTIAL FOR HUMAN BIRTH DEFECTS.
LENALIDOMIDE IS AN ANALOGUE OF THALIDOMIDE. THALIDOMIDE IS A KNOWN HUMAN TERATOGEN THAT CAUSES SEVERE LIFE-THREATENING HUMAN BIRTH DEFECTS.
IF LENALIDOMIDE IS TAKEN DURING PREGNANCY, IT MAY CAUSE BIRTH DEFECTS OR DEATH TO AN UNBORN BABY. FEMALES SHOULD BE ADVISED TO AVOID PREGNANCY WHILE TAKING REVLIMID® (lenalidomide).
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Special Prescribing Requirements
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BECAUSE OF THIS POTENTIAL TOXICITY AND TO AVOID FETAL EXPOSURE TO REVLIMID® (lenalidomide), REVLIMID® (lenalidomide) IS ONLY AVAILABLE UNDER A SPECIAL RESTRICTED DISTRIBUTION PROGRAM. THIS PROGRAM IS CALLED "RevAssist®".
UNDER THIS PROGRAM, ONLY PRESCRIBERS AND PHARMACISTS REGISTERED WITH THE PROGRAM CAN PRESCRIBE AND DISPENSE THE PRODUCT.
IN ADDITION, REVLIMID® (lenalidomide) MUST ONLY BE DISPENSED TO PATIENTS WHO ARE REGISTERED AND MEET ALL THE CONDITIONS OF THE RevAssist® PROGRAM.
2. HEMATOLOGIC TOXICITY (NEUTROPENIA AND THROMBOCYTOPENIA).
THIS DRUG IS ASSOCIATED WITH SIGNIFICANT NEUTROPENIA AND THROMBOCYTOPENIA. EIGHTY PERCENT OF PATIENTS WITH DEL 5q MYELODYSPLASTIC SYNDROMES HAD TO HAVE A DOSE DELAY/REDUCTION DURING THE MAJOR STUDY.
THIRTY-FOUR PERCENT OF PATIENTS HAD TO HAVE A SECOND DOSE DELAY/REDUCTION. GRADE 3 OR 4 HEMATOLOGIC TOXICITY WAS SEEN IN 80% OF PATIENTS ENROLLED IN THE STUDY.
PATIENTS ON THERAPY FOR DEL 5q MYELODYSPLASTIC SYNDROMES SHOULD HAVE THEIR COMPLETE BLOOD COUNTS MONITORED WEEKLY FOR THE FIRST 8 WEEKS OF THERAPY AND AT LEAST MONTHLY THEREAFTER.
PATIENTS MAY REQUIRE DOSE INTERRUPTION AND/OR REDUCTION. PATIENTS MAY REQUIRE USE OF BLOOD PRODUCT SUPPORT AND/OR GROWTH FACTORS. (SEE DOSAGE AND ADMINISTRATION)
3. DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM.
THIS DRUG HAS DEMONSTRATED A SIGNIFICANTLY INCREASED RISK OF DEEP VENOUS THROMBOSIS (DVT) AND PULMONARY EMBOLISM (PE) IN PATIENTS WITH MULTIPLE MYELOMA WHO WERE TREATED WITH REVLIMID® (lenalidomide) COMBINATION THERAPY.
PATIENTS AND PHYSICIANS ARE ADVISED TO BE OBSERVANT FOR THE SIGNS AND SYMPTOMS OF THROMBOEMBOLISM. PATIENTS SHOULD BE INSTRUCTED TO SEEK MEDICAL CARE IF THEY DEVELOP SYMPTOMS SUCH AS SHORTNESS OF BREATH, CHEST PAIN, OR ARM OR LEG SWELLING.
IT IS NOT KNOWN WHETHER PROPHYLACTIC ANTICOAGULATION OR ANTIPLATELET THERAPY PRESCRIBED IN CONJUNCTION WITH REVLIMID® (lenalidomide) MAY LESSEN THE POTENTIAL FOR VENOUS THROMBOEMBOLIC EVENTS.
THE DECISION TO TAKE PROPHYLACTIC MEASURES SHOULD BE DONE CAREFULLY AFTER AN ASSESSMENT OF AN INDIVIDUAL PATIENT’S UNDERLYING RISK FACTORS.
You can get the information about REVLIMID® (lenalidomide) and the RevAssist® program on the Internet at www.REVLIMID.com or by calling the manufacturer's toll-free number at 1-888-423-5436.
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ADDITIONAL WARNINGS: HEMATOLOGIC TOXICITY
Multiple Myeloma
In the pooled multiple myeloma studies, Grade 3 and 4 hematologic toxicities were more frequent in patients treated with the combination of REVLIMID® (lenalidomide) and dexamethasone than in patients treated with dexamethasone alone. Patients on therapy should have their complete blood counts monitored every 2 weeks for the first 12 weeks and then monthly thereafter. Patients may require dose interruption and/or dose reduction.
CONTRAINDICATIONS:
Hypersensitivity: REVLIMID® (lenalidomide) is contraindicated in any patients who have demonstrated hypersensitivity to the drug or its components.
PRECAUTIONS:
Renal impairment: REVLIMID® (lenalidomide) is substantially excreted by the kidney, so the risk of toxic reactions may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it would be prudent to monitor renal function.
Nursing mothers: It is not known whether REVLIMID® (lenalidomide) is excreted in human milk. Because of the potential for adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother.
ADVERSE REACTIONS:
Multiple Myeloma
In the REVLIMID® (lenalidomide)/dexamethasone treatment group, 151 patients (45%) underwent at least one dose interruption with or without a dose reduction of REVLIMID® (lenalidomide) compared to 21% in the placebo/dexamethasone treatment group. Of these patients who had one dose interruption with or without a dose reduction, 50% in the REVLIMID® (lenalidomide)/dexamethasone treatment group underwent at least one additional dose interruption with or without a dose reduction compared to 21% in the placebo/dexamethasone treatment group.
Other adverse events reported in multiple myeloma patients (REVLIMID® (lenalidomide)/dexamethasone vs dexamethasone/placebo): constipation (39% vs 19%), fatigue (38% vs 37%), insomnia (32% vs 37%), muscle cramp (30% vs 21%), diarrhea (29% vs 25%), neutropenia (28% vs 5%), anemia (24% vs 17%), asthenia (23% vs 25%), pyrexia (23% vs 19%), nausea (22% vs 19%), headache (21% vs 21%), peripheral edema (21% vs 19%), dizziness (21% vs 15%), dyspnea (20% vs 15%), tremor (20% vs 7%), decreased weight (18% vs 14%), thrombocytopenia (17% vs 10%), rash (16% vs 8%), back pain (15% vs 14%), hyperglycemia (15% vs 14%), and muscle weakness (15% vs 15%).
Myelodysplastic Syndromes
Other adverse reactions reported in del 5q MDS patients (REVLIMID® (lenalidomide)): diarrhea (49%), pruritus (42%), rash (36%), fatigue (31%), constipation (24%), nausea (24%), nasopharyngitis (23%), arthralgia (22%), pyrexia (21%), back pain (21%), peripheral edema (20%), cough (20%), dizziness (20%), headache (20%), muscle cramp (18%), dyspnea (17%), and pharyngitis (16%).
DOSAGE AND ADMINISTRATION:
Dosing is continued or modified based upon clinical and laboratory findings. Dosing modifications are recommended to manage Grade 3 or 4 neutropenia or thrombocytopenia or other Grade 3 or 4 toxicity judged to be related to lenalidomide. For other Grade 3 or 4 toxicities judged to be related to lenalidomide, hold treatment and restart at next lower dose level when toxicity has resolved to less than or equal to Grade 2.
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| Please see full Prescribing Information, including Boxed WARNINGS, CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS and the FDA-approved MEDICATION GUIDE. |
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