Drug Interaction Report

GENERALLY AVOID: The use of systemic corticosteroids may reduce the efficacy of afamitresgene autoleucel, an autologous T-cell immunotherapy agent. The exact mechanism by which corticosteroids exert this effect is not clearly described; however, it may involve corticosteroid-induced T lymphocyte apoptosis. The clinical trial that evaluated the efficacy of afamitresgene autoleucel excluded patients who were on systemic corticosteroids for at least 14 days prior to leukapheresis and lymphodepletion. Therefore, clinical data examining the use of systemic corticosteroids prior to or during an infusion of afamitresgene autoleucel are not available.

MANAGEMENT: The manufacturer of afamitresgene autoleucel recommends avoiding the prophylactic use of systemic corticosteroids. Consultation with institutional protocols, national guidelines, and package labeling may be helpful.

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations and systemic effects of orally administered budesonide. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. According to the manufacturer, the systemic exposure of oral budesonide approximately doubles after extensive intake of grapefruit juice.

MANAGEMENT: Patients receiving budesonide should avoid the regular consumption of grapefruits and grapefruit juice to prevent undue increases in plasma budesonide levels and systemic effects.