Names and pronunciation
(a-broe-SYE-ti-nib) Cibinqo
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Drug reference
(a-broe-SYE-ti-nib) Cibinqo
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Func. class.: Antineoplastic/immu- nomodulating agent
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Chem. class.: Janus-associated kinase (JAK) inhibitor
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ACTION: Janus kinases are intracel- lular enzymes that transmit signals arising from cytokine interactions on the cellular membrane to influence cellular processes of immune cell function
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USES: Refractory, moderate to severe atopic dermatitis in those not controlled with other therapies
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CONTRAINDICATIONS Hypersensitivity, antiplatelets (excluding low-dose aspirin) Precautions: HIV/AIDS, breastfeeding, pregnancy, hepatitis, hepatitis exacerba- tion, cardiac/renal/pulmonary disease, infertility, immunosuppression, throm- bocytopenia
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Black Box Warning: Infection, stroke, thrombosis, MI, new primary malignancy DOSAGES AND ROUTES Adults: PO 100 mg once daily, if an ade- quate response is not achieved after 12 wk, may increase to 200 mg once daily Adults who are poor CYP2C19 metabo- lizers: PO 50 mg once daily. If an ade- quate response is not achieved after 12 wk, may increase dose to 100 mg once daily
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SIDE EFFECTS CNS: Headache, dizziness, fatigue GI: Nausea, vomiting, upper abdominal pain, gastroenteritis INTEG: Acne, impetigo, contact dermati- tis, acne EENT: Nasopharyngitis, herpes simplex HEMA: Thrombocytopenia GU: UTI CV: Hypertension, MI MISC: Increased CK, oropharyngeal pain, herpes zoster, influenzae
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INTERACTIONS Decreased abrocitinib effect: Strong inhibitors of CYP2C19: give 50 mg daily or 100 mg once daily for those patients who are not responding to 50 mg once daily Increased bleeding: Moderate-strong inhibitors of both CYP2C19 and CYP2C9 or strong CYP2C19 or CYP2C9 inducers: Avoid concomitant use Increased serious toxicity: P-gp sub- strates, monitor dosage of P-gp substrate
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Available forms: Tablets 50, 100, 200 mg APPENDIX A
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Assess: • TB: Obtain a TB before starting prod- uct, latent TB should be treated before starting this product • Monitor CBC with differential, hemo- globin/hematocrit • Hepatitis: Monitor hepatitis B serol- ogy, LFTs, plasma hepatitis C RNA base- line and periodically • Monitor serum cholesterol profile, serum creatinine/BUN, skin cancer screening exam baseline and periodically
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Evaluate: • Therapeutic response: resolution of moderate-severe atopic dermatitis
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Advise the patient to read the medica- tion guide • Herpes zoster: advise patients that is increased and may be serious • New primary cancer: inform patients to check the skin often, as the risk of certain cancers, including skin cancers, may occur; to stay out of the sun or use protective clothing and sunscreen • To report immediately and seek medi- cal attention for signs/symptoms of MI, stroke, DVT, PE, retinal changes • That vaccinations with live vaccines is not recommended during treatment, to bring vaccinations up to date before treatment • Not to chew, crush, or split tablets • To notify clinicians of treatment and all prescription, OTC drugs, and herbals • Infections: inform patients that they may develop infections when taking abrocitinib. Instruct patients to tell their health care provider if they develop any signs or symptoms of an infection • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected, or if breastfeeding; advise patients to report pregnancy to 877-311-3770 and not to breastfeed; that this product may impair fertility
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PHARMACOKINETICS Half-life 3-5 hr, affected cytochrome P450 (CYP450) isoenzymes and drug transporters: CYP2C19, CYP2C9, CYP3A4, CYP2B6, P-glycoprotein (P- gp), organic anion transporter (OAT3), organic cation transporter (OCT1)
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