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Folic Acid, Pyridoxine, and Cyanocobalamin Combination
ORIGINAL INVESTIGATION Folic Acid, Pyridoxine, and Cyanocobalamin Combination Treatment and Age-Related Macular Degeneration in Women The Women’s Antioxidant and Folic Acid Cardiovascular Study William G. Christen, ScD; Robert J. Glynn, ScD; Emily Y. Chew, MD; Christine M. Albert, MD; JoAnn E. Manson, MD Background: Observational epidemiologic studies indi- and visually significant AMD, defined as confirmed in- cate a direct association between homocysteine concentra- cident AMD with visual acuity of 20/30 or worse attrib- tion in the blood and the risk of age-related macular degen- utable to this condition. eration (AMD), but randomized trial data to examine the effect of therapy to lower homocysteine levels in AMD are Results:Afteranaverageof7.3yearsoftreatmentandfollow- lacking. Our objective was to examine the incidence of AMD up, there were 55 cases of AMD in the combination treat- in a trial of combined folic acid, pyridoxine hydrochloride ment group and 82 in the placebo group (relative risk, 0.66; (vitamin B6), and cyanocobalamin (vitamin B12) therapy. 95% confidence interval, 0.47-0.93 [P=.02]). For visually significant AMD, there were 26 cases in the combination Methods: We conducted a randomized, double-blind, treatment group and 44 in the placebo group (relative risk, placebo-controlled trial including 5442 female health care 0.59; 95% confidence interval, 0.36-0.95 [P=.03]). professionals 40 years or older with preexisting cardio- vascular disease or 3 or more cardiovascular disease risk Conclusions: These randomized trial data from a large factors. A total of 5205 of these women did not have a cohort of women at high risk of cardiovascular disease diagnosis of AMD at baseline and were included in this indicate that daily supplementation with folic acid, pyri- analysis. -
Management of Chronic Myelogenous Leukemia in Pregnancy
ANTICANCER RESEARCH 35: 1-12 (2015) Review Management of Chronic Myelogenous Leukemia in Pregnancy AMIT BHANDARI, KATRINA ROLEN and BINAY KUMAR SHAH Cancer Center and Blood Institute, St. Joseph Regional Medical Center, Lewiston, ID, U.S.A. Abstract. Discovery of tyrosine kinase inhibitors has led to Leukemia in pregnancy is a rare condition, with an annual improvement in survival of chronic myelogenous leukemia incidence of 1-2/100,000 pregnancies (8). Since the first (CML) patients. Many young CML patients encounter administration of imatinib (the first of the TKIs) to patients pregnancy during their lifetime. Tyrosine kinase inhibitors with CML in June 1998, it is estimated that there have now inhibit several proteins that are known to have important been 250,000 patient years of exposure to the drug (mostly functions in gonadal development, implantation and fetal in patients with CML) (9). TKIs not only target BCR-ABL development, thus increasing the risk of embryo toxicities. tyrosine kinase but also c-kit, platelet derived growth factors Studies have shown imatinib to be embryotoxic in animals with receptors α and β (PDGFR-α/β), ARG and c-FMS (10). varying effects in fertility. Since pregnancy is rare in CML, Several of these proteins are known to have functions that there are no randomized controlled trials to address the may be important in gonadal development, implantation and optimal management of this condition. However, there are fetal development (11-15). Despite this fact, there is still only several case reports and case series on CML in pregnancy. At limited information on the effects of imatinib on fertility the present time, there is no consensus on how to manage and/or pregnancy. -
R Graphics Output
Dexamethasone sodium phosphate ( 0.339 ) Melengestrol acetate ( 0.282 ) 17beta−Trenbolone ( 0.252 ) 17alpha−Estradiol ( 0.24 ) 17alpha−Hydroxyprogesterone ( 0.238 ) Triamcinolone ( 0.233 ) Zearalenone ( 0.216 ) CP−634384 ( 0.21 ) 17alpha−Ethinylestradiol ( 0.203 ) Raloxifene hydrochloride ( 0.203 ) Volinanserin ( 0.2 ) Tiratricol ( 0.197 ) trans−Retinoic acid ( 0.192 ) Chlorpromazine hydrochloride ( 0.191 ) PharmaGSID_47315 ( 0.185 ) Apigenin ( 0.183 ) Diethylstilbestrol ( 0.178 ) 4−Dodecylphenol ( 0.161 ) 2,2',6,6'−Tetrachlorobisphenol A ( 0.156 ) o,p'−DDD ( 0.155 ) Progesterone ( 0.152 ) 4−Hydroxytamoxifen ( 0.151 ) SSR150106 ( 0.149 ) Equilin ( 0.3 ) 3,5,3'−Triiodothyronine ( 0.256 ) 17−Methyltestosterone ( 0.242 ) 17beta−Estradiol ( 0.24 ) 5alpha−Dihydrotestosterone ( 0.235 ) Mifepristone ( 0.218 ) Norethindrone ( 0.214 ) Spironolactone ( 0.204 ) Farglitazar ( 0.203 ) Testosterone propionate ( 0.202 ) meso−Hexestrol ( 0.199 ) Mestranol ( 0.196 ) Estriol ( 0.191 ) 2,2',4,4'−Tetrahydroxybenzophenone ( 0.185 ) 3,3,5,5−Tetraiodothyroacetic acid ( 0.183 ) Norgestrel ( 0.181 ) Cyproterone acetate ( 0.164 ) GSK232420A ( 0.161 ) N−Dodecanoyl−N−methylglycine ( 0.155 ) Pentachloroanisole ( 0.154 ) HPTE ( 0.151 ) Biochanin A ( 0.15 ) Dehydroepiandrosterone ( 0.149 ) PharmaCode_333941 ( 0.148 ) Prednisone ( 0.146 ) Nordihydroguaiaretic acid ( 0.145 ) p,p'−DDD ( 0.144 ) Diphenhydramine hydrochloride ( 0.142 ) Forskolin ( 0.141 ) Perfluorooctanoic acid ( 0.14 ) Oleyl sarcosine ( 0.139 ) Cyclohexylphenylketone ( 0.138 ) Pirinixic acid ( 0.137 ) -
Nilotinib (Tasigna®) EOCCO POLICY
nilotinib (Tasigna®) EOCCO POLICY Policy Type: PA/SP Pharmacy Coverage Policy: EOCCO136 Description Nilotinib (Tasigna) is a Bcr-Abl kinase inhibitor that binds to, and stabilizes, the inactive conformation of the kinase domain of the Abl protein. Length of Authorization Initial: Three months Renewal: 12 months Quantity Limits Product Name Dosage Form Indication Quantity Limit Newly diagnosed OR resistant/ intolerant 50 mg capsules 112 capsules/28 days Ph+ CML in chronic phase nilotinib 150 mg capsules Newly diagnosed Ph+ CML in chronic phase 112 capsules/28 days (Tasigna) Resistant or intolerant Ph + CML 200 mg capsules 112 capsules/28 days Gastrointestinal Stromal Tumors (GIST) Initial Evaluation I. Nilotinib (Tasigna) may be considered medically necessary when the following criteria are met: A. Medication is prescribed by, or in consultation with, an oncologist; AND B. Medication will not be used in combination with other oncologic medications (i.e., will be used as monotherapy); AND C. A diagnosis of one of the following: 1. Chronic myelogenous leukemia (CML) ; AND i. Member is newly diagnosed with Philadelphia chromosome-positive (Ph+) or BCR-ABL1 mutation positive CML in chronic phase; OR ii. Member is diagnosed with chronic OR accelerated phase Ph+ or BCR-ABL1 mutation positive CML; AND a. Member is 18 years of age or older; AND b. Treatment with a tyrosine kinase inhibitor [e.g. imatinib (Gleevec)] has been ineffective, contraindicated, or not tolerated; OR iii. Member is diagnosed with chronic phase Ph+ or BCR-ABL1 mutation positive CML; AND a. Member is one year of age or older; AND 1 nilotinib (Tasigna®) EOCCO POLICY b. -
Cancer Drug Pharmacology Table
CANCER DRUG PHARMACOLOGY TABLE Cytotoxic Chemotherapy Drugs are classified according to the BC Cancer Drug Manual Monographs, unless otherwise specified (see asterisks). Subclassifications are in brackets where applicable. Alkylating Agents have reactive groups (usually alkyl) that attach to Antimetabolites are structural analogues of naturally occurring molecules DNA or RNA, leading to interruption in synthesis of DNA, RNA, or required for DNA and RNA synthesis. When substituted for the natural body proteins. substances, they disrupt DNA and RNA synthesis. bendamustine (nitrogen mustard) azacitidine (pyrimidine analogue) busulfan (alkyl sulfonate) capecitabine (pyrimidine analogue) carboplatin (platinum) cladribine (adenosine analogue) carmustine (nitrosurea) cytarabine (pyrimidine analogue) chlorambucil (nitrogen mustard) fludarabine (purine analogue) cisplatin (platinum) fluorouracil (pyrimidine analogue) cyclophosphamide (nitrogen mustard) gemcitabine (pyrimidine analogue) dacarbazine (triazine) mercaptopurine (purine analogue) estramustine (nitrogen mustard with 17-beta-estradiol) methotrexate (folate analogue) hydroxyurea pralatrexate (folate analogue) ifosfamide (nitrogen mustard) pemetrexed (folate analogue) lomustine (nitrosurea) pentostatin (purine analogue) mechlorethamine (nitrogen mustard) raltitrexed (folate analogue) melphalan (nitrogen mustard) thioguanine (purine analogue) oxaliplatin (platinum) trifluridine-tipiracil (pyrimidine analogue/thymidine phosphorylase procarbazine (triazine) inhibitor) -
Prescription Drugs Requiring Prior Authorization
PRESCRIPTION DRUGS REQUIRING PRIOR AUTHORIZATION Revised 10/16 As part of our drug utilization management program, members must request and receive prior authorization for certain prescription drugs in order to use their prescription drug benefits. Below is a list of drugs that currently require prior authorization. This list will be updated periodically as new drugs that require prior authorization are introduced. As benefits may vary by group and individual plans, the inclusion of a medication on this list does not imply prescription drug coverage. The Schedule of Benefits contains a list of drug categories that require prior authorization. Prior authorization requests are processed by our pharmacy benefit manager, Express Scripts, Inc. (ESI). Physicians must call ESI to obtain an authorization. (1-800-842-2015). Drug Name Generic Name Drug Classification Abstral fentanyl citrate oral tablet Controlled Dangerous Substance Accu-Chek Test Strips blood glucose test strips Blood Glucose Test Strips Actemra tocilizumab Monoclonal Antibody Acthar corticotropin Hormone Actimmune interferon gamma 1b Interferon Actiq fentanyl citrate OTFC Controlled Dangerous Substance Adcirca tadalafil Pulmonary Vasodilator Adempas riociguat Pulmonary Vasodilator Adlyxin lixisenatide Type 2 Diabetes Advocate Test Strips blood glucose test strips Blood Glucose Test Strips Aerospan** flunisolide Corticosteroids (Inhaled) Afrezza insulin Insulin (inhaled) Ampyra dalfampridine Multiple Sclerosis Agent Altoprev** lovastatin Cholesterol Alvesco** ciclesonide Corticosteroids -
Multi-Discipline Review
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 761139Orig1s000 MULTI-DISCIPLINE REVIEW Summary Review Office Director Cross Discipline Team Leader Review Clinical Review Non-Clinical Review Statistical Review Clinical Pharmacology Review NDA/BLA Multi-disciplinary Review and Evaluation {BLA 761139} ENHERTU (fam-trastuzumab deruxtecan-nxki) NDA/BLA Multi-disciplinary Review and Evaluation Disclaimer: In this document, the sections labeled as “The Applicant’s Position” are completed by the Applicant, which do not necessarily reflect the positions of the FDA. Application Type Biologics License Application (BLA) 351(a) Application Number BLA 761139 Priority or Standard Priority Submit Date(s) August 29, 2019 Received Date(s) August 29, 2019 PDUFA Goal Date April 29, 2020 Division/Office DO1/OOD/OND/CDER Review Completion Date Electronic Stamp Date Established Name fam-trastuzumab deruxtecan-nxki (Proposed) Trade Name ENHERTU Pharmacologic Class HER2-directed antibody and topoisomerase inhibitor conjugate Code name Applicant Daiichi Sankyo, Inc Formulation(s) 100 mg lyophilized powder Dosing Regimen 5.4 mg IV every 3 weeks (b) (4) Applicant Proposed Indication(s)/Population(s) Recommendation on Accelerated Approval Regulatory Action Recommended Treatment of adult patients with unresectable or metastatic Indication(s)/Population(s) HER2-positive breast cancer who have received two or more (if applicable) prior anti-HER2-based regimens in the metastatic setting. 1 Version date: June 11, 2019 (ALL NDA/BLA reviews) Disclaimer: In this document, the sections labeled as “The Applicant’s Position” are completed by the Applicant and do not necessarily reflect the positions of the FDA. Reference ID: 4537638 NDA/BLA Multi-disciplinary Review and Evaluation {BLA 761139} ENHERTU (fam-trastuzumab deruxtecan-nxki) Table of Contents Reviewers of Multi-Disciplinary Review and Evaluation ............................................................. -
Guidelines on Food Fortification with Micronutrients
GUIDELINES ON FOOD FORTIFICATION FORTIFICATION FOOD ON GUIDELINES Interest in micronutrient malnutrition has increased greatly over the last few MICRONUTRIENTS WITH years. One of the main reasons is the realization that micronutrient malnutrition contributes substantially to the global burden of disease. Furthermore, although micronutrient malnutrition is more frequent and severe in the developing world and among disadvantaged populations, it also represents a public health problem in some industrialized countries. Measures to correct micronutrient deficiencies aim at ensuring consumption of a balanced diet that is adequate in every nutrient. Unfortunately, this is far from being achieved everywhere since it requires universal access to adequate food and appropriate dietary habits. Food fortification has the dual advantage of being able to deliver nutrients to large segments of the population without requiring radical changes in food consumption patterns. Drawing on several recent high quality publications and programme experience on the subject, information on food fortification has been critically analysed and then translated into scientifically sound guidelines for application in the field. The main purpose of these guidelines is to assist countries in the design and implementation of appropriate food fortification programmes. They are intended to be a resource for governments and agencies that are currently implementing or considering food fortification, and a source of information for scientists, technologists and the food industry. The guidelines are written from a nutrition and public health perspective, to provide practical guidance on how food fortification should be implemented, monitored and evaluated. They are primarily intended for nutrition-related public health programme managers, but should also be useful to all those working to control micronutrient malnutrition, including the food industry. -
Lenvatinib in Advanced, Radioactive Iodine– Refractory, Differentiated Thyroid Carcinoma Kay T
Published OnlineFirst October 20, 2015; DOI: 10.1158/1078-0432.CCR-15-0923 CCR Drug Updates Clinical Cancer Research Lenvatinib in Advanced, Radioactive Iodine– Refractory, Differentiated Thyroid Carcinoma Kay T. Yeung1 and Ezra E.W. Cohen2 Abstract Management options are limited for patients with radioactive therapy for these patients. Median PFS of 18.3 months in the iodine refractory, locally advanced, or metastatic differentiated lenvatinib group was significantly improved from 3.6 months in thyroid carcinoma. Prior to 2015, sorafenib, a multitargeted the placebo group, with an HR of 0.21 (95% confidence interval, tyrosine kinase inhibitor, was the only approved treatment and 0.4–0.31; P < 0.0001). ORR was also significantly increased in the was associated with a median progression-free survival (PFS) of lenvatinib arm (64.7%) compared with placebo (1.5%). In this 11 months and overall response rate (ORR) of 12% in a phase III article, we will review the molecular mechanisms of lenvatinib, trial. Lenvatinib, a multikinase inhibitor with high potency the data from preclinical studies to the recent phase III clinical against VEGFR and FGFR demonstrated encouraging results in trial, and the biomarkers being studied to further guide patient phase II trials. Recently, the pivotal SELECT trial provided the selection and predict treatment response. Clin Cancer Res; 21(24); basis for the FDA approval of lenvatinib as a second targeted 5420–6. Ó2015 AACR. Introduction PI3K–mTOR pathways (reviewed in ref. 3). The signals ultimately converge in the nucleus, influencing transcription of oncogenic Thyroid carcinoma is the most common endocrine malignan- proteins including, but not limited to, NF-kB), hypoxia-induced cy, with an estimated incidence rate of 13.5 per 100,000 people factor 1 alpha unit (HIF1a), TGFb, VEGF, and FGF. -
Tasigna, INN-Nilotinib
ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Tasigna 50 mg hard capsules Tasigna 200 mg hard capsules 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Tasigna 50 mg hard capsules One hard capsule contains 50 mg nilotinib (as hydrochloride monohydrate). Excipient with known effect One hard capsule contains 39.03 mg lactose monohydrate. Tasigna 200 mg hard capsules One hard capsule contains 200 mg nilotinib (as hydrochloride monohydrate). Excipient with known effect One hard capsule contains 156.11 mg lactose monohydrate. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Hard capsule. Tasigna 50 mg hard capsules White to yellowish powder in hard gelatin capsule with red opaque cap and light yellow opaque body, size 4 with black radial imprint “NVR/ABL” on cap. Tasigna 200 mg hard capsules White to yellowish powder in light yellow opaque hard gelatin capsules, size 0 with red axial imprint “NVR/TKI”. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Tasigna is indicated for the treatment of: - adult and paediatric patients with newly diagnosed Philadelphia chromosome positive chronic myelogenous leukaemia (CML) in the chronic phase, - adult patients with chronic phase and accelerated phase Philadelphia chromosome positive CML with resistance or intolerance to prior therapy including imatinib. Efficacy data in patients with CML in blast crisis are not available, - paediatric patients with chronic phase Philadelphia chromosome positive CML with resistance or intolerance to prior therapy including imatinib. 2 4.2 Posology and method of administration Therapy should be initiated by a physician experienced in the diagnosis and the treatment of patients with CML. -
Primary and Acquired Resistance to Immunotherapy in Lung Cancer: Unveiling the Mechanisms Underlying of Immune Checkpoint Blockade Therapy
cancers Review Primary and Acquired Resistance to Immunotherapy in Lung Cancer: Unveiling the Mechanisms Underlying of Immune Checkpoint Blockade Therapy Laura Boyero 1 , Amparo Sánchez-Gastaldo 2, Miriam Alonso 2, 1 1,2,3, , 1,2, , José Francisco Noguera-Uclés , Sonia Molina-Pinelo * y and Reyes Bernabé-Caro * y 1 Institute of Biomedicine of Seville (IBiS) (HUVR, CSIC, Universidad de Sevilla), 41013 Seville, Spain; [email protected] (L.B.); [email protected] (J.F.N.-U.) 2 Medical Oncology Department, Hospital Universitario Virgen del Rocio, 41013 Seville, Spain; [email protected] (A.S.-G.); [email protected] (M.A.) 3 Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain * Correspondence: [email protected] (S.M.-P.); [email protected] (R.B.-C.) These authors contributed equally to this work. y Received: 16 November 2020; Accepted: 9 December 2020; Published: 11 December 2020 Simple Summary: Immuno-oncology has redefined the treatment of lung cancer, with the ultimate goal being the reactivation of the anti-tumor immune response. This has led to the development of several therapeutic strategies focused in this direction. However, a high percentage of lung cancer patients do not respond to these therapies or their responses are transient. Here, we summarized the impact of immunotherapy on lung cancer patients in the latest clinical trials conducted on this disease. As well as the mechanisms of primary and acquired resistance to immunotherapy in this disease. Abstract: After several decades without maintained responses or long-term survival of patients with lung cancer, novel therapies have emerged as a hopeful milestone in this research field. -
Sedative Hypnotics
Louisiana Medicaid Sedative Hypnotics The Louisiana Uniform Prescription Drug Prior Authorization Form should be utilized to request: • Prior authorization for non-preferred sedative hypnotics; OR • Clinical authorization for tasimelteon (Hetlioz®, Hetlioz LQ™). Additional Point-of-Sale edits may apply. Some of tThese agents may have Black Box Warnings and/or may be subject to Risk Evaluation and Mitigation Strategy (REMS) under FDA safety regulations. Please refer to individual prescribing information for details. ___________________________________________________________________________________ Non-Preferred Agents Approval Criteria for Initial and Reauthorization Requests • There is no preferred alternative that is the exact same chemical entity, formulation, strength, etc.; AND • The requested medication has been prescribed for an approved diagnosis (if applicable); AND • Previous use of a preferred product - ONE of the following is required: o The recipient has had a treatment failure with at least one preferred product; OR o The recipient has had an intolerable side effect to at least one preferred product; OR o The recipient has documented contraindication(s) to all of the preferred products that are appropriate to use for the condition being treated; OR o There is no preferred product that is appropriate to use for the condition being treated; AND • By submitting the authorization request, the prescriber attests to the following: o The prescribing information for the requested medication has been thoroughly reviewed, including