Adverse reactions reported in ADAKVEO® patients:
Very common (≥10% of patients)
- Abdominal pain*
- Back pain
These adverse drug reactions, along with myalgia, musculoskeletal chest pain and diarrhoea, may be signs and symptoms of an infusion related reaction when observed during infusion or within 24 hours of an infusion
Common (1 to 10% of patients)
- Oropharyngeal pain
- Musculoskeletal chest pain
- Infusion site reaction*
- Infusion related reaction
Severe events were less common1
- Arthralgia and pyrexia (each 0.9%)
Two patients on ADAKVEO® discontinued treatment due to adverse reactions vs. three patients on placebo in the SUSTAIN study2
Adverse drug reactions reported in ≥5% of ADAKVEO® patients in a pooled safety analysis3,4
Monitoring of patients1
ADAKVEO® patients should be monitored for and advised of signs and symptoms of infusion-related reactions.
These may include the following:
- Pain in various locations
- Shortness of breath or wheezing
In the event of a severe infusion-related reaction, ADAKVEO® should be discontinued and appropriate therapy should be instituted
Caution should be exercised with corticosteroids in patients with sickle cell disease unless clinically indicated (e.g. treatment of anaphylaxis)
Recommendations for managing infusion-related reactions: Mild (Grade 1) to moderate (Grade 2) infusion‑related reactions - temporarily interrupt or reduce the infusion rate, initiate symptomatic treatment, for subsequent infusions, consider premedication. Severe (≥ Grade 3) infusion‑related reactions - Discontinue treatment with Adakveo and initiate symptomatic treatment.
In the post-marketing setting, cases of infusion-related reactions were reported, including severe pain events, differing in location, severity, and/or nature from patient’s baseline and requiring hospitalisation in several cases. The majority of these infusion-related reactions occurred during infusion or within a few hours of the completion of the first or second infusion. However, later onset of severe pain events has also been reported, following previous well-tolerated infusions. Some patients have also experienced subsequent complications such as acute chest syndrome and fat embolism, particularly those treated with steroids.
Fertility, pregnancy and lactation1
Fertility and pregnancy
- There are no data on the effect of ADAKVEO® on human fertility. Available non-clinical data do not suggest an effect on fertility under ADAKVEO® treatment
- ADAKVEO® has the potential to cause foetal losses when administered to a pregnant woman so should be avoided during pregnancy and in women hoping to conceive
- All pregnancy cases and complications should be reported to Novartis
- Patients will be monitored through the PRegnancy outcomes Intension Monitoring programme (PRIM)
- It is unknown if ADAKVEO® is excreted in human milk. There are no data on the effects of the treatment on breast-fed newborns/infants or milk production
- A decision may be needed to discontinue breast-feeding or ADAKVEO® therapy
Effects on ability to drive and use machines1
ADAKVEO® may have a minor influence on the ability to drive and use machines. Dizziness, fatigue and somnolence may occur following administration
Reporting suspected adverse reactions after authorisation of ADAKVEO® is important to understand the safety profile of the treatment for sickle cell disease (SCD) patients
ADAKVEO® is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. Reporting suspected adverse reactions after authorisation of ADAKVEO® is important to understand the safety profile of the treatment for SCD patients.
Indication: ADAKVEO® (crizanlizumab) is indicated for the prevention of recurrent VOCs in patients with SCD who are aged 16 years and over. It can be given as an add-on therapy to hydroxyurea/hydroxycarbamide (HU/HC) or as monotherapy in patients for whom HU/HC is inappropriate or inadequate.1
ADAKVEO® has a conditional marketing authorisation and further evidence is awaited.
*The following groupings contain the following MedDRA preferred terms:1
- Abdominal pain: abdominal pain, abdominal pain upper, abdominal pain lower, abdominal discomfort, and abdominal tenderness
- Pruritus: pruritus and vulvovaginal pruritus
- Infusion site reaction: infusion site extravasation, infusion site pain and infusion site swelling
Abbreviations: HC, hydroxycarbamide; HU, hydroxyurea; PRIM, PRegnancy outcomes Intension Monitoring programme; SCD, sickle cell disease; VOC, vaso-occlusive crisis.
- ADAKVEO® Summary of Product Characteristics.
- Kutlar A, et al. Am J Hematol. 2019;94(1):55–61.
- Ataga KI, et al. N Engl J Med. 2017;376(5):429–439.
- ADAKVEO® EPAR CHMP assessment report. 2020.