What is INQOVI?

When treating MDS and CMML, consider whether patients prefer an oral option

In a noninterventional survey of patients with MDS (n=184),

76.6%

of patients would prefer to switch to oral
treatment when offered alongside other options2

A forecast of predicted treatment choices among patients with MDS found2:

  • Only 4.3% to 5.6% would choose IV administration based on the number of infusion visits
  • Only 11.3% would choose SC administration if a decitabine and cedazuridine oral combination tablet was an option

STUDY DESIGN: A noninterventional, cross-sectional, mixed-methods study of patients with MDS using qualitative and quantitative methods to develop a survey and analyze responses. The objective of the study was to show preferences of patients with MDS in the United States and Canada for hypomethylating agents' benefits, risks, and burden of administration through an online and discrete-choice experiment. Statistical significance was defined with a threshold of 5% of type I error. The survey was completed by 184 of the 275 individuals who initially responded to the invitation.2

Receiving treatment can be challenging

Some require travel to and from chemotherapy infusion centers or hospitals for IV infusions or SC injections

  • Visits may be long and frequent for multiple cycles (5–7 days/cycle)3

Venous access and parenteral administration4-6

Premature treatment discontinuation may be a concern for MDS patients

Of 664 higher-risk patients, 295 (44.4%) were nonpersistent with HMA treatment (nonpersistence is defined by the investigators as <4 cycles or a gap of ≥90 days between cycles)6

  • This finding is based on a retrospective analysis of the SEER* database and did not measure treatment outcomes. Therefore, these data should be interpreted with caution
  • Additional steps (such as closer care management and follow-up) may be needed to help improve patient continuation on HMA treatment in the higher-risk patient population6,7
    • Alternative treatment schedules, home care management, and/or availability of oral HMAs could be effective in preventing HMA dosing delays6

*Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database between 2010 and 2016.

Cedazuridine enables oral delivery of decitabine1

INQOVI tablets are 1 pill taken once daily for 5 days out of a 28-day cycle. See full dosing information here. INQOVI is a fixed-dose combination of decitabine (35 mg) and cedazuridine (100 mg), a cytidine deaminase (CDA) inhibitor that enhances oral bioavailability of decitabine and increases its systemic exposure.

  • Decitabine is a nucleoside metabolic inhibitor that is believed to exert its effects by causing DNA hypomethylation. This may restore normal function to genes that are critical for the control of cellular differentiation and proliferation
  • Nonproliferating cells are relatively insensitive to decitabine
  • CDA is an enzyme responsible for degradation of nucleosides such as decitabine into inactive metabolites, thus limiting their oral bioavailability
  • Administration of cedazuridine with decitabine increases systemic exposure of decitabine

CMML=chronic myelomonocytic leukemia; DNMT=DNA methyltransferase; HMA=hypomethylating agent; IPSS-R=Revised International Prognostic Scoring System; MDS=myelodysplastic syndromes.

References: 1. INQOVI [package insert]. Princeton, NJ: Taiho Oncology, Inc.; 2022. 2. Zeidan AM, Tsai J-H, Karimi M, et al. Patient preferences for benefits, risks, and administration route of hypomethylating agents in myelodysplastic syndromes. Clin Lymphoma Myeloma Leuk. 2022;22(9):e853-e866. 3. Savona MR, Odenike O, Amrein PC, et al. An oral fixed-dose combination of decitabine and cedazuridine in myelodysplastic syndromes: a multicentre, open-label, dose-escalation, phase 1 study. Lancet Haematol. 2019;6(4): e194-e203. 4. Steensma DP, Komrokji RS, Stone RM, et al. Disparity in perceptions of disease characteristics, treatment effectiveness, and factors influencing treatment adherence between physicians and patients with myelodysplastic syndromes. Cancer. 2014;120(11):1670-1676. 5. Leveque D. Subcutaneous administration of anticancer agents. Anticancer Res. 2014;34(4):1579-1586. 6. Joshi N, Kale H, Corman S, et al. Direct medical costs associated with treatment nonpersistence in patients with higher-risk myelodysplastic syndromes receiving hypomethylating agents: a large retrospective cohort analysis. Clin Lymphoma Myeloma Leuk. 2021;21(3):e248-e254. 7. Kini V, Ho PM. Interventions to improve medication adherence: a review. JAMA. 2018;320(23):2461-2473.

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