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Darzalex

Active Substance: daratumumab
Common Name: daratumumab
ATC Code: L01XC24
Marketing Authorisation Holder: Janssen-Cilag International N.V.
Active Substance: daratumumab
Status: Authorised
Authorisation Date: 2016-05-20
Therapeutic Area: Multiple Myeloma
Pharmacotherapeutic Group: Antineoplastic agents, monoclonal antibodies

Therapeutic Indication

Darzalex as monotherapy is indicated for the treatment of adult patients with relapsed and refractory multiple myeloma, whose prior therapy included a proteasome inhibitor and an immunomodulatory agent and who have demonstrated disease progression on the last therapy.

What is Darzalex and what is it used for?

Darzalex is a cancer medicine used on its own to treat adults with multiple myeloma (a cancer of the bone marrow). It is used when the disease has come back after treatment with cancer medicines (including medicines known as proteasome inhibitors) and immunomodulatory medicines (that act on the immune system), or when the disease has not improved with these medicines.

Because the number of patients with multiple myeloma is low, the disease is considered ‘rare’, and Darzalex was designated an ‘orphan medicine’ (a medicine used in rare diseases) on 17 July 2013.

Darzalex contains the active substance daratumumab.

How is Darzalex used?

Darzalex is available as a concentrate to be made into a solution for infusion (drip) into a vein. The recommended dose is 16 mg per kilogram body weight, which is given once a week for the first 8 weeks. From week 9 to week 24, Darzalex is given every 2 weeks, and then every 4 weeks. Treatment continues for as long as the patient benefits from it. Before and after the infusion, patients should receive medicines to reduce the risk of infusion-related reactions. The doctor may need to reduce the infusion rate or stop treatment in case of severe infusion-related reactions.

Darzalex can only be obtained with a prescription and should be given by a healthcare professional in a place where facilities for resuscitating patients are readily available. For further information, see the summary of product characteristics (also part of the EPAR).

How does Darzalex work?

The active substance in Darzalex, daratumumab, is a monoclonal antibody (a type of protein) that has been designed to recognise and attach to the protein CD38, which is found in high amounts on multiple myeloma cells. By attaching to CD38 on the multiple myeloma cells, daratumumab activates the immune system to kill the cancer cells.

What benefits of Darzalex have been shown in studies?

Darzalex has been investigated in two main studies involving a total of 196 multiple myeloma patients whose disease came back after, or did not respond to, at least two previous treatments including a proteasome inhibitor and an immunomodulatory agent. The main measure of effectiveness was the proportion of patients who responded completely or partially to treatment (as measured by the disappearance of or at least a 50% reduction in a protein found in excess in multiple myeloma cells). Around 29% of the patients receiving Darzalex at a dose of 16 mg/kg (31 out of 106 patients) responded completely or partially to treatment in one study and 36% (15 out of 42 patients) in the second study. In these studies Darzalex was not compared with any other treatment.

What are the risks associated with Darzalex?

The most common side effects with Darzalex (which may affect around 1 in 2 people) are infusion-related reactions such as breathing problems, cough, runny or blocked nose and chills. Other frequent side effects (affecting at least 1 in 5 patients) are tiredness, pyrexia (fever), nausea (feeling sick), back pain, upper respiratory tract infections (such as colds), anaemia (low red blood cell counts), neutropenia (low levels of neutrophils, a type of white blood cell) and thrombocytopenia (low blood platelet counts). For the full list of all side effects and restrictions with Darzalex, see the package leaflet.

Why is Darzalex approved?

Darzalex has been shown to be effective at treating multiple myeloma in patients whose disease had progressed despite at least two previous treatments. These patients have limited treatment options and Darzalex, which works in a different way to existing treatments, represents an alternative. Darzalex’s safety profile is considered acceptable and manageable.

Although there were limitations in the studies, including lack of control group and low number of patients, the Agency’s Committee for Medicinal Products for Human Use (CHMP) decided that Darzalex’s benefits are greater than its risks and recommended that it be approved for use in the EU.

Darzalex has been given ‘conditional approval’. This means that there is more evidence to come about the medicine, which the company is required to provide. Every year, the European Medicines Agency will review any new information that becomes available and this summary will be updated as necessary.

What information is still awaited for Darzalex?

Since Darzalex has been granted a conditional approval, the company that markets Darzalex will provide the results of two studies comparing the effect of Darzalex used in combination with other cancer treatments (i.e. lenalidomide and dexamethasone, or bortezomib and dexamethasone) with that of these other treatments given on their own.

What measures are being taken to ensure the safe and effective use of Darzalex?

A risk management plan has been developed to ensure that Darzalex is used as safely as possible. Based on this plan, safety information has been included in the summary of product characteristics and the package leaflet for Darzalex, including the appropriate precautions to be followed by healthcare professionals and patients.

In addition, the company that markets Darzalex will provide educational material to all healthcare professionals expected to use the medicine, to inform them that the medicine can affect the result of a blood test (indirect Coombs test) used to determine suitability for blood transfusions. Patients who are prescribed Darzalex will be provided with a patient alert card with similar information.

Other information about Darzalex

The European Commission granted a marketing authorisation valid throughout the European Union for Darzalex on 20 May 2016.

For more information about treatment with Darzalex, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

Source: European Medicines Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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