Drug Interactions between deucravacitinib and Kisqali Femara Co-Pack

GENERALLY AVOID: Coadministration of deucravacitinib with other immunosuppressive agents may potentiate the risk of infections as well as lymphoma and other malignancies. Serious infections have been reported in patients with psoriasis who received deucravacitinib. The most common serious infections reported with deucravacitinib included pneumonia and COVID-19. Herpes zoster and herpes simplex viral reactivation were also reported during clinical studies with deucravacitinib, as well as malignancies including lymphoma.

MANAGEMENT: The safety and efficacy of deucravacitinib in combination with immunosuppressive agents has not been evaluated. The manufacturer recommends that the concomitant use of deucravacitinib with potent immunosuppressants (e.g., azathioprine, cyclosporine) should be avoided. Patients receiving deucravacitinib should be closely monitored for the development of signs and symptoms of infection during and after treatment, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy. If a serious infection develops, deucravacitinib should be interrupted until the infection is controlled.

MONITOR: Coadministration with ribociclib may increase the plasma concentrations and pharmacologic effects of drugs that are substrates of CYP450 3A4. The proposed mechanism is decreased clearance due to ribociclib-mediated inhibition of CYP450 3A4 metabolism. In healthy study subjects, administration of midazolam, a sensitive CYP450 3A4 substrate, with multiple 400 mg daily doses of ribociclib increased the midazolam peak plasma concentration (Cmax) and systemic exposure (AUC) by 2.1-fold and 3.8-fold, respectively, compared to midazolam administered alone. When given at a clinically relevant dose of 600 mg daily, ribociclib is predicted to increase midazolam Cmax and AUC by 2.4-fold and 5.2-fold, respectively.

MANAGEMENT: Caution is advised when ribociclib is used concomitantly with drugs that undergo metabolism by CYP450 3A4, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever ribociclib is added to or withdrawn from therapy.