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Prescribing Information Important Safety Information

For adults with newly diagnosed FLT3+ AML
RYDAPT: SIGNIFICANT AND SUSTAINED SURVIVAL BENEFITS IN COMBINATION WITH STANDARD CHEMOTHERAPY¹

For more information on overall survival, visit w‌w‌w‌.‌ryd‌apt.c‌o‌m

RATIFY: A phase 3, randomized, double-blind, placebo-controlled, international study of 717 patients with newly diagnosed FLT3+ AML that compared RYDAPT^® (midostaurin) capsules plus standard cytarabine and daunorubicin induction and high-dose cytarabine consolidation chemotherapy (n=360) vs standard chemotherapy plus placebo (n=357), followed by continuous RYDAPT or placebo treatment according to initial assignment for up to 12 additional 28-day cycles. The primary end point was overall survival, measured from the date of randomization until death by any cause. There was no re-randomization at the start of postconsolidation therapy. Patients who proceeded to hematopoietic stem cell transplantation stopped receiving study treatment. All patients were followed for survival.^1,2

We are committed to providing the most up-to-date, accurate, and timely medical information to health care professionals. For additional details regarding RYDAPT, please call Medical Information at 1‑8‌44‑O‌NC‑INFO (6‌62‑46‌36), Mond‌ay through Fri‌day, 8‌:30 am to 5:0‌0 pm E‌T.

INDICATION
RYDAPT is indicated, in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation chemotherapy, for the treatment of adult patients with newly diagnosed acute myeloid leukemia (AML) who are FLT3 mutation-positive, as detected by an FDA-approved test.

LIMITATIONS OF USE
RYDAPT is not indicated as a single-agent induction therapy for the treatment of patients with AML.

IMPORTANT SAFETY INFORMATION for RYDAPT^® (midostaurin) capsules

CONTRAINDICATIONS
•		Do not use in patients with hypersensitivity to midostaurin or its excipients. Hypersensitivity reactions have included anaphylactic shock, dyspnea, flushing, chest pain, and angioedema

WARNINGS AND PRECAUTIONS Embryofetal Toxicity
•		Do not use during pregnancy. Midostaurin caused severe embryofetal abnormalities and death in animal studies
•		Verify pregnancy status of females of reproductive potential within 7 days prior to initiating RYDAPT
•		Advise females of reproductive potential to use effective contraception during treatment and for at least 4 months after the last dose
•		Males taking RYDAPT should use effective contraception with females of reproductive potential and pregnant women and for at least 4 months after the last dose
•		Pregnancy exposure registry to monitor pregnancy outcomes: Females who may have been exposed to RYDAPT during pregnancy, directly or through a male partner receiving RYDAPT, should contact Novartis Pharmaceuticals Corporation at 1-888-669-6682 and/or at https://psi.novartis.com

Pulmonary Toxicity
•		Cases of interstitial lung disease and pneumonitis, some fatal, have occurred in patients treated with RYDAPT as monotherapy or with chemotherapy
•		Monitor patients for pulmonary symptoms. Discontinue RYDAPT in patients who experience signs or symptoms of interstitial lung disease or pneumonitis without an infectious etiology

ADDITIONAL CONSIDERATIONS Lactation
•		Because of the potential for serious adverse reactions in breastfed infants from RYDAPT, advise women not to breastfeed during treatment with RYDAPT and for at least 4 months after the last dose

Infertility
•		Based on findings in animals, RYDAPT may impair fertility in females and males of reproductive potential. It is unknown whether these effects on fertility are reversible

Drug Interactions
•		Strong CYP3A4 Inducers: Avoid concomitant use as strong CYP3A4 inducers decrease exposure to midostaurin and may reduce efficacy
•		Strong CYP3A4 Inhibitors: Coadministration with strong CYP3A4 inhibitors may increase midostaurin concentrations and may increase the risk of toxicity. Monitor patients for increased risk of adverse reactions, especially during the first week of RYDAPT use in each chemotherapy cycle and the first week of consecutive RYDAPT administration. Consider alternative therapies that do not strongly inhibit CYP3A4 activity

ADVERSE REACTIONS Acute Myeloid Leukemia
•		Most common adverse reactions (≥20%) were febrile neutropenia (83%), nausea (83%‍), mucositis (66%), vomiting (61%), headache (46%), petechiae (36%), musculoskeletal pain (33%), epistaxis (28%), device-related infection (24%), hyperglycemia (20%), and upper respiratory tract infection (20%)
•		Most frequent grade 3/4 adverse reactions (≥10%) were febrile neutropenia (84%), device-related infection (16%), and mucositis (11%)
•		Most common (≥10%) lab abnormalities were alanine aminotransferase increase (71%), hypernatremia (21%), and hypocalcemia (74%)

Please see full Prescribing Information for RYDAPT^® (midostaurin) capsules.

FMS-like tyrosine kinase 3; HR, hazard ratio.

References: 1. Rydapt [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2018. 2. Data on file. Study no. CPKC412A2301. Novartis Pharmaceuticals Corp; 2016.

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