Drug Interaction Report

GENERALLY AVOID: Prophylactic use of systemic corticosteroids prior to CD19- or BCMA-directed genetically modified autologous T cell immunotherapy may interfere with the therapeutic effects of such drugs as axicabtagene ciloleucel, brexucabtagene autoleucel, idecabtagene vicleucel, ciltacabtagene autoleucel and lisocabtagene maraleucel. The mechanism for this interaction has not been delineated. Administration of systemic corticosteroids in an effort to manage the toxicities associated with these drugs does not affect the expansion and persistence of CAR T cells.

MANAGEMENT: The prophylactic use of systemic corticosteroids prior to CD19- or BCMA-directed genetically modified autologous T cell immunotherapy with drugs such as axicabtagene ciloleucel, brexucabtagene autoleucel, idecabtagene vicleucel, ciltacabtagene autoleucel and lisocabtagene maraleucel is not recommended. However, systemic corticosteroids may be used for the management of adverse effects associated with these drugs, such as cytokine release syndrome and neurological-related toxicities, without affecting the expansion and persistence of CAR T cells.

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the potential significance is unknown. Patients who are receiving systemic or nebulized formulations of beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be at a greater risk of developing hypokalemia.