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Drug Interactions between budesonide / formoterol and dostarlimab

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

budesonide dostarlimab

Applies to: budesonide / formoterol and dostarlimab

Consumer information for this interaction is not currently available.

ADJUST DOSING INTERVAL: Corticosteroids may affect the pharmacodynamic effects and efficacy of immune checkpoint inhibitors (ICI) such as programmed cell death-1 (PD-1) or programmed death ligand-1 inhibitors (PD-L1). The mechanism of this interaction is unknown; however, it has been theorized that the immunosuppressive properties of corticosteroids and the potential effect on T-cell function may decrease the efficacy of ICIs. In a retrospective study in patients with advanced NSCLC (n=640), oral or intravenous corticosteroid use at doses of at least 10 mg prednisone equivalent per day at the time of or within 30 days of starting PD-1/PD-L1 blockade with either pembrolizumab, nivolumab, atezolizumab, or durvalumab (n=90) was associated with decreased response and overall poorer outcomes, compared to those who received and discontinued corticosteroid treatment prior to commencing PD-1/PD-L1 therapy. However, it is difficult to determine whether the corticosteroid use had unfavorable effects on patients starting ICI blockade or if corticosteroid use reflected a subgroup of patients with poorer prognosis. Significantly, the use of corticosteroids to manage immune related adverse effects after starting immune checkpoint blockade therapy has not shown negative effects on outcome survival or time to treatment failure.

MANAGEMENT: The manufacturers' product labeling should be consulted for specific recommendations. If clinically possible, the use of systemic corticosteroids (>=10 mg prednisone equivalent/day) should be avoided at the time of or within 30 days of starting therapy with an ICI, e.g., durvalumab, nivolumab, pembrolizumab, ipilimumab, cemiplimab, or atezolizumab. Corticosteroids may be used for the treatment of immune-mediated reactions after starting an ICI. Some manufacturers advise that corticosteroids may be used as premedication, when the ICI is used in combination with chemotherapy, as antiemetic prophylaxis, and/or to alleviate chemotherapy-related adverse effects.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  4. Cerner Multum, Inc. "Canadian Product Information." O 0 (2015):
  5. Cerner Multum, Inc "ANVISA Bulário Eletrônico." O 0 (2015):
  6. Arbour KC, Mezquita L, Long N, et al. "Impact of Baseline Steroids on Efficacy of Programmed Cell Death-1 and Programmed Death-Ligand 1 Blockade in Patients With Non-Small-Cell Lung Cancer." J Clin Oncol 36 (2018): 2872-2878
  7. Horvat TZ, Adel NG, Dand TO, et al. "Immune-related adverse events, need for systemic immunosuppression, and effects on survival and time to treatment failure in patients with melanoma treated with ipilimumab at Memorial Sloan Kettering Cancer Center." J Clin Oncol 33 (2015): 3193-8
  8. Jove M, Vilarino N, Nadal E "Impact of baseline steroids on efficacy of programmed cell death-1 (PD-1) and programmed death-ligand 1 (PD-L1) blockade in patients with advanced non-small cell lung cancer." Transl Lung Cancer Res 8 (2019): S364-8
  9. Scott SC, Pennell NA "Early use of systemic corticosteroids in patients with advanced NSCLC treated with nivolumab." J Thorac Oncol 13 (2018): 1771-5
  10. Fuca G, Galli G, Poggi M, et al. "Modulation of peripheral blood immune cells by early use of steroids and its association with clinical outcomes in patients with metastatic non-small cell lung cancer treated with immune checkpoint inhibitors." ESMO Open 4 (2019): e000457
View all 10 references
Minor

budesonide formoterol

Applies to: budesonide / formoterol and budesonide / formoterol

Information for this minor interaction is available on the professional version.

Drug and food interactions

Moderate

budesonide food

Applies to: budesonide / formoterol

You should avoid the regular consumption of large amounts of grapefruits and grapefruit juice while taking budesonide. Grapefruit can raise the levels of budesonide in your body and lead to increased side effects. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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