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.

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.