Decitabine/cedazuridine

Decitabine/cedazuridine
Combination of
DecitabineNucleoside metabolic inhibitor
CedazuridineCytidine deaminase inhibitor
Names
Trade namesInqovi
Other namesASTX727, C-DEC
Clinical data
Main usesMyelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML)[1]
Side effectsTiredness, constipation, bleeding, muscle pain, mouth sores, nausea, shortness of breath, rash, swelling, pneumonia, liver problems[1]
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Pregnancy
category
  • AU: X (High risk)[2]
  • Not recommended
Routes of
use		By mouth
External links
AHFS/Drugs.comMonograph
Legal
License data
Legal status

Decitabine/cedazuridine, sold under the brand name Inqovi, is a combination medication used to treat myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML).[1] It is taken by mouth.[1]

Common side effects include tiredness, constipation, bleeding, muscle pain, mouth sores, nausea, shortness of breath, rash, swelling, pneumonia, and liver problems.[1] Other side effects may include bone marrow suppression and infertility.[1] Use in pregnancy may harm the baby.[1] Decitabine is a nucleoside metabolic inhibitor and cedazuridine is a cytidine deaminase inhibitor.[1]

The combination was approved for medical use in the United States and in Canada in 2020.[6][7] In the United States the cost every four weeks is about 7,800 USD as of 2021.[8]

Medical uses

Decitabine/cedazuridine is indicated for treatment of adults with myelodysplastic syndromes (MDS), including previously treated and untreated, de novo and secondary MDS with the following French American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, and chronic myelomonocytic leukemia [CMML]) and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System groups.[9][10][5]

MDS is a type of blood cancer in which blood cells in the bone marrow are defective leading to a low number of one or more types of blood cells.[11]

Dosage

The typical dose is one pill of 35 mg decitabine and 100 mg cedazuridine for the first five days of every 28 days.[1]

History

Decitabine/cedazuridine was approved for medical use in the United States and in Canada in July 2020.[9][10][12][11]

The U.S. Food and Drug Administration (FDA) granted the application of decitabine combined with cedazuridine priority review and orphan drug designation.[9][13] The orphan drug designation was granted in August 2019 for the treatment of myelodysplastic syndromes (including chronic myelomonocytic leukemia).[13][14]

Decitabine combined with cedazuridine was investigated in two open-label, randomized, crossover trials.[10] Trial ASTX727-01-B (NCT02103478) included 80 adult participants with MDS (International Prognostic Scoring System [IPSS] Intermediate-1, Intermediate-2, or high-risk) or CMML and trial ASTX727-02 (NCT03306264) included 133 adult participants with MDS or CMML, including all French-American-British classification criteria and IPSS Intermediate-1, Intermediate-2, or high-risk prognostic scores.[10] The trials were conducted at 51 sites in the United States and Canada.[11]

In both trials, participants were randomized 1:1 to receive decitabine combined with cedazuridine (35 mg decitabine and 100 mg cedazuridine) orally in cycle 1 and decitabine 20 mg/m2 intravenously in cycle 2 or the reverse sequence.[10] Both decitabine combined with cedazuridine and intravenous decitabine were administered once daily on days 1 through 5 of a 28-day cycle.[10] Starting with cycle 3, all participants received decitabine combined with cedazuridine orally once daily on days 1 through 5 of each 28-day cycle until disease progression or unacceptable toxicity.[10] Both trials provided comparison of exposure and safety in the first two cycles between oral decitabine combined with cedazuridine and intravenous decitabine and description of disease response with decitabine combined with cedazuridine.[10] Comparison of disease response between the decitabine combined with cedazuridine and intravenous decitabine was not possible because all participants received decitabine combined with cedazuridine starting from Cycle 3.[10]

The FDA approval of decitabine combined with cedazuridine was based on clinical trial results which showed similar drug concentrations between intravenous decitabine and decitabine combined with cedazuridine.[9][10] Additionally, about half of the participants who were formerly dependent on transfusions were able to no longer require transfusions during an 8-week period.[9] The safety profile of decitabine combined with cedazuridine was also similar to intravenous decitabine.[9] The FDA granted the approval of Inqovi to Astex Pharmaceuticals, Inc., a subsidiary of Otsuka Pharmaceutical Co. Ltd.[9]

References

  1. 1 2 3 4 5 6 7 8 9 "DailyMed - INQOVI- cedazuridine and decitabine tablet, film coated". dailymed.nlm.nih.gov. Archived from the original on 3 December 2021. Retrieved 21 December 2021.
  2. ↑ "Archive copy" (PDF). Archived (PDF) from the original on 13 June 2021. Retrieved 13 June 2021.{{cite web}}: CS1 maint: archived copy as title (link)
  3. ↑ "Archive copy" (PDF). Archived (PDF) from the original on 13 June 2021. Retrieved 13 June 2021.{{cite web}}: CS1 maint: archived copy as title (link)
  4. ↑ "Archive copy". Archived from the original on 28 August 2021. Retrieved 15 March 2022.{{cite web}}: CS1 maint: archived copy as title (link)
  5. 1 2 "Inqovi (decitabine and cedazuridine) tablets, for oral use" (PDF). U.S. Food and Drug Administration (FDA). Otsuka Pharmaceutical Co. Archived (PDF) from the original on 8 July 2020. Retrieved 7 July 2020.
  6. ↑ "Decitabine and Cedazuridine Monograph for Professionals". Drugs.com. Retrieved 21 December 2021.
  7. ↑ Canada, Health (26 July 2021). "Approved in 2020: Drugs for human use". www.canada.ca. Archived from the original on 22 October 2021. Retrieved 21 December 2021.
  8. ↑ "Inqovi Prices, Coupons & Patient Assistance Programs". Drugs.com. Retrieved 21 December 2021.
  9. 1 2 3 4 5 6 7 "FDA Approves New Therapy for Myelodysplastic Syndromes (MDS) That Can Be Taken at Home". U.S. Food and Drug Administration (FDA) (Press release). 7 July 2020. Archived from the original on 7 July 2020. Retrieved 7 July 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  10. 1 2 3 4 5 6 7 8 9 10 "FDA approves oral combination of decitabine and cedazuridine for myelodysplastic syndromes". U.S. Food and Drug Administration (FDA). 7 July 2020. Archived from the original on 3 August 2020. Retrieved 7 July 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  11. 1 2 3 "Drug Trials Snapshots: Inqovi". U.S. Food and Drug Administration (FDA). 7 July 2020. Archived from the original on 26 July 2020. Retrieved 25 July 2020.
  12. ↑ "Astex Pharmaceuticals, Taiho Oncology, and Otsuka Pharmaceutical announce FDA and Health Canada approval of Inqovi (decitabine and cedazuridine) tablets, oral hypomethylating agent (HMA) therapy for intermediate and high-risk MDS and CMML". Taiho Pharmaceutical Group (Press release). 7 July 2020. Archived from the original on 20 July 2020. Retrieved 19 July 2020.
  13. 1 2 "Inqovi Orphan Drug Designations and Approvals". U.S. Food and Drug Administration (FDA). 21 August 2019. Archived from the original on 12 July 2020. Retrieved 7 July 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  14. ↑ "Astex Pharmaceuticals announces U.S. Food and Drug Administration (FDA) acceptance for review of an NDA for the combination oral hypomethylating agent cedazuridine and decitabine (ASTX727 or oral C-DEC), for the treatment of MDS and CMML". Astex (Press release). 11 February 2020. Archived from the original on 7 July 2020. Retrieved 7 July 2020.
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