Setting expectations for your patients
Current multiple myeloma strategies are moving toward a long-term treatment approach9-12
- Although multiple myeloma is not curable, it is treatable13
- Multiple myeloma is a complex disease characterized by periods of remission and relapse14
- Extending the remission period/delaying the disease from progressing is an important treatment goal9,15
When speaking with your patients, identify factors that may play an important role in selecting treatment
Some considerations are:
Help set expectations with your patients
- Establish and reinforce treatment and lifestyle goals
- Explain potential adverse reactions at the start
- Emphasize the need to take their medicines as prescribed
Managing patients receiving treatment with
NINLARO is an effective,* sustainable† therapy for your patients' long-term‡ treatment plan7
NINLARO is indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least 1 prior therapy.
NINLARO is not recommended for use in the maintenance setting or in newly diagnosed multiple myeloma in combination with lenalidomide and dexamethasone outside of controlled clinical trials.
Before patients begin treatment with NINLARO, identify any medical conditions, including whether or not the patients:
- Have hepatic impairment
- Have renal impairment or are on dialysis
- Are pregnant or plan to become pregnant. Patients should use effective birth control during treatment and for 90 days after the last dose of NINLARO. If patients are using hormonal contraceptives (for example, the pill), an additional barrier method of contraception (for example, diaphragm or condom) must be used
- Are breastfeeding or plan to breastfeed. It is not known if NINLARO passes into breast milk. Patients should not breastfeed during treatment with NINLARO and for 90 days after their last dose of NINLARO
Ask your patients about all the medicines they take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Be sure that patients speak with their healthcare provider before starting any new medicines during treatment with NINLARO.
For more information on managing patients receiving NINLARO, see dosage modifications.
- *Median PFS: 20.6 months with the NINLARO regimen vs 14.7 months with the placebo regimen; HR=0.74 (95% CI, 0.59-0.94); P=0.012.1,2
- †Discontinuation rates of the placebo regimen and the NINLARO regimen were 11% and 13%, respectively; 80% of patients receiving the NINLARO regimen in TOURMALINE-MM1 continued on their starting NINLARO dose.7
- ‡Used herein to refer to treatment to disease progression or unacceptable toxicity.
Use the following patient-friendly information to educate your patients about side effects of NINLARO
- Low platelet counts (thrombocytopenia) are common with NINLARO and can sometimes be serious. Consider platelet transfusions if counts are too low. Speak with patients about the low platelet counts, including bleeding and easy bruising.
- Stomach and intestinal (gastrointestinal) problems. Diarrhea, constipation, nausea, and vomiting are common with NINLARO and can sometimes be severe. Ask patients to call you if they get any of these symptoms and they do not go away during treatment with NINLARO. Tell your patients that you may prescribe medicine to help treat their symptoms.
- Nerve problems are common with NINLARO and may also be severe. Ask patients to tell you if they get any new or worsening symptoms including: tingling, numbness, pain, a burning feeling in their feet or hands, or weakness in their arms or legs.
- Swelling is common with NINLARO and can sometimes be severe. Ask patients to tell you if they develop swelling in their arms, hands, legs, ankles, or feet, or if they gain weight from swelling.
- Skin reactions. Rashes are common with NINLARO. NINLARO can cause rashes and other skin reactions that can be serious and can lead to death. Ask patients to tell you right away if they get a new or worsening rash, severe blistering or peeling of the skin, or mouth sores.
- Thrombotic microangiopathy (TMA). This is a condition involving blood clots and injury to small blood vessels that may cause harm to your patients' kidneys, brain, and other organs, and may lead to death. Tell your patients to get medical help right away if they get any of the following signs or symptoms during treatment with NINLARO: fever, bruising, nose bleeds, tiredness, or decreased urination.
- Liver problems. Ask patients to tell you if they get these signs of a liver problem: yellowing of their skin or the whites of their eyes; pain in their right upper-stomach area (abdomen).
Other common side effects of NINLARO include neutropenia and bronchitis. Ask your patients to inform you if they get new or worsening signs or symptoms of the following during treatment with NINLARO: skin rash and pain (shingles) due to reactivation of the chicken pox virus (herpes zoster), blurred vision or other changes in vision, dry eye and pink eye (conjunctivitis).
These are not all the possible side effects of NINLARO. Patients should call their doctor for medical advice about side effects. Patients may report side effects to Takeda at 1-844-217-6468 or the FDA at 1-800-FDA-1088.
Help manage patients if a side effect occurs with NINLARO treatment
- IDENTIFY AND REPORT: Identify the adverse reaction, determine if it's a result of the treatment or the disease, and report as required
- ASSESS: Use appropriate diagnostic and physical evaluations to monitor the severity of the symptom
- MANAGE: Implement the appropriate pharmacologic or nonpharmacologic intervention
For information on dose modification guidelines for thrombocytopenia, neutropenia, peripheral neuropathy, rash, and other nonhematologic toxicities, click here.
Speaking with your patients about
NINLARO® (ixazomib) administration
Per the clinical trial for NINLARO, talk to your patients about the importance of remaining on therapy until disease progression or unacceptable toxicity
Factors that may impact patient adherence include17,18:
- Poor communication between patient and healthcare team
- Patient belief that the drugs were not needed or not working
- Side effects