Question: COVID-19 FAQ #18: Is Ninlaro® a safe treatment alternative for myeloma patients during the pandemic?
Continuing his COVID-19 FAQ series, Dr. Brian G.M. Durie discusses if myeloma patients should consider switching to an orally administered treatment during the COVID-19 crises.
BOTTOM LINE:
Discuss with your doctor to see if switching to the orally administered drug can be a safe and effective treatment option while the COVID-19 infection is still a risk.
This week’s “Ask Dr. Durie” comes from a patient who wants to know about this use of ixazomib which is the trade name, Ninlaro®, which is an oral proteasome inhibitor.
And so, we have three proteasome inhibitors. We have bortezomib, which is Velcade® and comes as a subcutaneous shot, and then, we have carfilzomib, a trade name Kyprolis®, which comes as an intravenous infusion/injection, and then, we have ixazomib, which is Ninlaro, which is a by-mouth injection, a by-mouth medication.
So, the question is: Can this be a reasonable substitute? Is Ninlaro by-mouth something that can be considered, particularly right now in this time of COVID-19 concerns, when patients are anxious about going into the medical center or the doctor’s office to get an IV infusion, or to get a subcutaneous shot?
And so, the answer to this question is, in fact, we do have data using Ninlaro in the front-line setting, and for maintenance, and also, in the relapse setting, and, these data are really quite encouraging.
Now, Ninlaro is not approved in the front-line setting, it’s approved in the relapse setting. However, the data are sufficiently strong, for example, a study was conducted comparing Ninlaro, Revlimid®, and dex, versus Revlimid and dex, and the results showed significantly better remissions and survival with Ninlaro three-drug combination.
And so, as an alternative, as an alternative which is by-mouth, which means that you don’t need to go into the doctor’s office to get an injection or infusion, this is something to talk to your doctor about.
And, the Ninlaro is available. And so, it is definitely an option to switch out and use the Ninlaro as part of an induction, maybe after the first few injections, the Ninlaro could be used as an alternative, certainly, in the maintenance setting, where we actually have data indicating that Ninlaro does definitely prolong remissions, and obviously, in the relapse setting.
And so, whatever the situation might be, the data are strong enough such that it is very, very, reasonable to talk to your doctor and say: “Is this something that could be a safe alternative for me? That can work and that can be effective and can be well-tolerated, and means that I don’t need to come into the hospital or office as often and risk getting exposure to the COVID-19 virus?” And so, I think, very, very, important and potentially helpful discussion.
Please note that Ask Dr. Durie has been discontinued, and it was designed to address myeloma questions of the broadest possible audience interest. If you have a question of a personal nature, please contact our InfoLine Coordinators at 800.452.2873 or [email protected] (Please do not send email attachments or lab reports.).
Dr. Brian G.M. Durie (1942-2025) was the co-founder of the IMF. He was a Professor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels.
