Leukemias, lymphomas, and other hematologic cancers:
Indications for: BESREMI
Not already on hydroxyurea: Initially 100mcg by SC inj every 2 weeks. Transitioning from hydroxyurea: Initially 50mcg by SC inj every 2 weeks in combination with hydroxyurea; gradually taper off hydroxyurea by reducing the total biweekly dose by 20–40% every 2 weeks during weeks 3–12 and discontinue hydroxyurea by week 13. Both: Increase Besremi dose by 50mcg every 2 weeks (up to max 500mcg) until hematological parameters are stabilized (hematocrit <45%, platelets <400×109/L, and leukocytes <10×109/L). Dosing interval may be expanded to every 4 weeks after achieving hematological stability for at least 1 year on a stable Besremi dose. Dose modifications for adverse reactions: see full labeling.
Existence of, or history of severe psychiatric disorders, particularly severe depression, suicidal ideation or suicide attempt. Moderate or severe hepatic impairment (Child-Pugh B or C). History or presence of active serious or untreated autoimmune disease. Immunosuppressed transplant recipients.
Risk of serious disorders.
May cause or exacerbate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, or infectious disorders: monitor closely, discontinue if they worsen. Avoid use in active serious or untreated endocrine disorders associated with autoimmune disease, severe or unstable cardiovascular disease (eg, uncontrolled hypertension, CHF [≥ NYHA class 2], serious cardiac arrhythmia, significant coronary artery stenosis, unstable angina), recent stroke or MI, or eGFR <30mL/min. Uncontrolled thyroid abnormalities. Diabetes. History of cardiovascular disorders; monitor closely. Pulmonary disease. Interrupt treatment if pancreatitis is suspected; consider discontinuing if confirmed. Discontinue if colitis, pulmonary infiltrates/dysfunction, new or worsening eye disorders, evidence of hepatic decompensation (eg, jaundice, ascites, hepatic encephalopathy, hepatorenal syndrome, variceal hemorrhage), or severe renal impairment develops. Consider discontinuing if significant dermatologic toxicity occurs. Obtain eye exams before and during therapy, especially in those with retinopathy-associated disease (eg, diabetes, hypertension). Monitor CBCs at baseline, every 2 weeks during titration phase, then every 3–6 months during maintenance phase, and as clinically indicated. Monitor for infection or bleeding. Monitor serum triglycerides, creatinine, thyroid, visual, and liver function at baseline and during therapy. Dental and periodontal disorders. Have regular dental exams. Elderly. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception during and for at least 8 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 8 weeks after the last dose).
Avoid concomitant myelosuppressive agents, narcotics, hypnotics, or sedatives; if unavoidable, monitor for excessive effects. Concomitant drugs that are CYP450 substrates with a narrow therapeutic index; monitor.
Influenza-like illness, arthralgia, fatigue, pruritus, nasopharyngitis, musculoskeletal pain, headache, diarrhea, hyperhidrosis, nausea, upper RTI, liver enzyme elevations, leukopenia, neutropenia, thrombocytopenia; depression, suicide, hypersensitivity reactions (discontinue if occurs), pancreatitis, colitis, hyperlipidemia, cardiovascular toxicity, endocrine toxicity, ophthalmologic toxicity, pulmonary toxicity, renal toxicity, hepatotoxicity.
Generic Drug Availability:
Single-dose prefilled syringe—1 (w. safety needle)