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In PERSIST-2, VONJO was generally well tolerated.1,2

Among patients on VONJO, 15% discontinued treatment due to an adverse reaction, with the most frequent reasons being anemia (3%) and thrombocytopenia (2%).1

  • The most common adverse reactions in ≥20% of patients (n=106) were diarrhea, thrombocytopenia, nausea, anemia, and peripheral edema
  • The most frequent reasons for drug interruption in ≥2% of patients receiving VONJO 200 mg twice daily were anemia (5%), thrombocytopenia (4%), diarrhea (3%), nausea (3%), cardiac failure (3%), neutropenia (2%), and pneumonia (2%)
  • Adverse reactions requiring dosage reduction in ≥2% of patients who received VONJO 200 mg twice daily included thrombocytopenia (2%), neutropenia (2%), conjunctival hemorrhage (2%), and epistaxis (2%)

Most cases of diarrhea with VONJO were low grade and rarely led to treatment interruption.1,2

  • VONJO caused diarrhea in approximately 48% of patients compared to 15% of patients treated with BAT1
    • Of the 48% that experienced diarrhea (any grade), most were Grade 1 (29%) and Grade 2 (15%)3
  • No patients on VONJO reported diarrhea that resulted in treatment discontinuation1
  • Most cases (41%) occurred in the first 8 weeks1
  • The incidence of reported diarrhea decreased over time with 15% of patients reporting diarrhea in Weeks 8 through 16, and 8% in Weeks 16 through 241
  • Median time to resolution of diarrhea was 2 weeks1
  • Serious diarrhea occurred in 2% of patients treated with VONJO compared to no such adverse reactions with BAT1

Management of diarrhea1

  • Control preexisting diarrhea before starting VONJO
  • In patients with Grade 3 or 4 diarrhea:
    • Hold VONJO until it resolves to Grade ≤1 or baseline, and restart VONJO at the last given dose
    • Intensify antidiarrheal regimen and provide fluid replacement
    • For recurrent diarrhea, hold VONJO until the diarrhea resolves to Grade ≤1 or baseline, and restart VONJO at 50% of the last given dose once the toxicity has resolved
    • Concomitant antidiarrheal treatment is required for patients restarting VONJO

Adverse reactions in PERSIST-21

Important baseline hematologic characteristics to consider

  • The median baseline platelet count was 55 x 109/L
    • 45% of patients had Grade ≥3 thrombocytopenia (plt <50 x 109/L)
  • The median baseline hemoglobin level was 9.5 g/dL
    • 59% of patients were anemic (Hgb <10 g/dL) in the VONJO arm (vs 57% in the BAT arm) at study entry4
    • 23% of patients were RBC transfusion dependent at study entry
Adverse Reactions Reported in ≥10% of Patients With Platelet Counts ≤100 x 109/L Receiving VONJO or BAT1
Table: Adverse reactions in PERSIST-2 study of VONJO (pacritinib) vs best available therapy
  • *Grade by CTCAE Version 4.03.
  • BAT=best available therapy; CTCAE=Common Terminology Criteria for Adverse Events; Hgb=hemoglobin; plt=platelet counts; RBC=red blood cell.
  • References: 1. VONJO. Prescribing information. CTI BioPharma Corp.; 2023. 2. Mascarenhas J, et al. JAMA Oncol. 2018;4(5):652-659.

Indication

VONJO® (pacritinib) is a kinase inhibitor indicated for the treatment of adults with intermediate or high-risk primary or secondary (post-polycythemia vera [PPV] or post-essential thrombocythemia [PET]) myelofibrosis (MF) with a platelet count below 50 × 109/L. This indication is approved under accelerated approval based on spleen volume reduction. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).

Important Safety Information

Contraindication

VONJO is contraindicated in patients concomitantly using strong CYP3A4 inhibitors or inducers.

Indication

VONJO® (pacritinib) is a kinase inhibitor indicated for the treatment of adults with intermediate or high-risk primary or secondary (post-polycythemia vera [PPV] or post-essential thrombocythemia [PET]) myelofibrosis (MF) with a platelet count below 50 × 109/L. This indication is approved under accelerated approval based on spleen volume reduction. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).

Important Safety Information

Contraindication

VONJO is contraindicated in patients concomitantly using strong CYP3A4 inhibitors or inducers.

Warnings and Precautions:

  • Hemorrhage: Serious (11%) and fatal (2%) hemorrhages have occurred in VONJO-treated patients with platelet counts <100 x 109/L. Serious (13%) and fatal (2%) hemorrhages have occurred in VONJO-treated patients with platelet counts <50 x 109/L. Grade ≥3 bleeding events (defined as requiring transfusion or invasive intervention) occurred in 15% of patients treated with VONJO compared to 7% of patients treated on the control arm. Due to hemorrhage, VONJO dose reductions, dose interruptions, or permanent discontinuations occurred in 3%, 3%, and 5% of patients, respectively.

    Avoid use of VONJO in patients with active bleeding and hold VONJO 7 days prior to any planned surgical or invasive procedures. Assess platelet counts periodically, as clinically indicated. Manage hemorrhage using treatment interruption and medical intervention.

  • Diarrhea: VONJO causes diarrhea in approximately 48% of patients compared to 15% of patients treated on the control arm. The median time to resolution in VONJO-treated patients was 2 weeks. The incidence of reported diarrhea decreased over time with 41% of patients reporting diarrhea in the first 8 weeks of treatment, 15% in Weeks 8 through 16, and 8% in Weeks 16 through 24. Diarrhea resulted in treatment interruption in 3% of VONJO-treated patients. None of the VONJO-treated patients reported diarrhea that resulted in treatment discontinuation. Serious diarrhea adverse reactions occurred in 2% of patients treated with VONJO compared to no such adverse reactions in patients in the control arm.

    Control preexisting diarrhea before starting VONJO treatment. Treat diarrhea with anti-diarrheal medications promptly at the first onset of symptoms. Interrupt or reduce VONJO dose in patients with significant diarrhea despite optimal supportive care.

  • Thrombocytopenia: VONJO can cause worsening thrombocytopenia. VONJO dosing was reduced due to worsening thrombocytopenia in 2% of patients with preexisting moderate to severe thrombocytopenia (platelet count <100 x 109/L). VONJO dosing was reduced due to worsening thrombocytopenia in 2% of patients with preexisting severe thrombocytopenia (platelet count <50 x 109/L).

    Monitor platelet count prior to VONJO treatment and as clinically indicated during treatment. Interrupt VONJO in patients with clinically significant worsening of thrombocytopenia that lasts for more than 7 days. Restart VONJO at 50% of the last given dose once the toxicity has resolved. If toxicity recurs, hold VONJO. Restart VONJO at 50% of the last given dose once the toxicity has resolved.

  • Prolonged QT Interval: VONJO can cause prolongation of the QTc interval. QTc prolongation of >500 msec was higher in VONJO-treated patients than in patients in the control arm (1.4% vs 1%). QTc increase from baseline by 60 msec or higher was greater in VONJO-treated patients than in control arm patients (1.9% vs 1%). Adverse reactions of QTc prolongation were reported for 3.8% of VONJO-treated patients and 2% of control arm patients. No cases of torsades de pointes were reported.

    Avoid use of VONJO in patients with a baseline QTc of >480 msec. Avoid use of drugs with significant potential for QTc prolongation in combination with VONJO. Correct hypokalemia prior to and during VONJO treatment. Manage QTc prolongation using VONJO interruption and electrolyte management.

  • Major Adverse Cardiac Events (MACE): Another Janus associated kinase (JAK)-inhibitor has increased the risk of MACE, including cardiovascular death, myocardial infarction, and stroke (compared to those treated with TNF blockers) in patients with rheumatoid arthritis, a condition for which VONJO is not indicated.

    Consider the benefits and risks for the individual patient prior to initiating or continuing therapy with VONJO particularly in patients who are current or past smokers and patients with other cardiovascular risk factors. Patients should be informed about the symptoms of serious cardiovascular events and the steps to take if they occur.

  • Thrombosis: Another JAK-inhibitor has increased the risk of thrombosis, including deep venous thrombosis, pulmonary embolism, and arterial thrombosis (compared to those treated with TNF blockers) in patients with rheumatoid arthritis, a condition for which VONJO is not indicated.

    Patients with symptoms of thrombosis should be promptly evaluated and treated appropriately.

  • Secondary Malignancies: Another JAK-inhibitor has increased the risk of lymphoma and other malignancies excluding non-melanoma skin cancer (NMSC) (compared to those treated with TNF blockers) in patients with rheumatoid arthritis, a condition for which VONJO is not indicated. Patients who are current or past smokers are at additional increased risk.

    Consider the benefits and risks for the individual patient prior to initiating or continuing therapy with VONJO, particularly in patients with a known malignancy (other than a successfully treated NMSC), patients who develop a malignancy, and patients who are current or past smokers.

  • Risk of Infection: Another JAK-inhibitor increased the risk of serious infections (compared to best available therapy) in patients with myeloproliferative neoplasms. Serious bacterial, mycobacterial, fungal and viral infections may occur in patients treated with VONJO. Delay starting therapy with VONJO until active serious infections have resolved.

    Observe patients receiving VONJO for signs and symptoms of infection and manage promptly. Use active surveillance and prophylactic antibiotics according to clinical guidelines.

  • Interactions With CYP3A4 Inhibitors or Inducers: Avoid concomitant use of VONJO with moderate CYP3A4 inhibitors or inducers.

Adverse Reactions

The most frequent serious adverse reactions occurring in ≥3% patients receiving VONJO 200 mg twice daily were anemia (8%), thrombocytopenia (6%), pneumonia (6%), cardiac failure (4%), disease progression (3%), pyrexia (3%), and squamous cell carcinoma of skin (3%).

Fatal adverse reactions among patients treated with VONJO 200 mg twice daily included events of disease progression (3%), and multiorgan failure, cerebral hemorrhage, meningorrhagia, and acute myeloid leukemia in <1% of patients, respectively.

The most common adverse reactions (reported in ≥20% of patients) include diarrhea, thrombocytopenia, nausea, anemia, and peripheral edema.

Use in Specific Populations

Pregnancy: Advise pregnant women of the potential risk to a fetus. Consider the benefits and risks of VONJO for the mother and. possible risks to the fetus when prescribing VONJO to a pregnant woman.

Lactation: It is not known whether VONJO is excreted in human milk. Because of the potential for serious adverse reactions in the breastfed child, advise patients that breastfeeding is not recommended during treatment with VONJO, and for 2 weeks after the last dose.

Infertility: Pacritinib reduced male mating and fertility indices in BALB/c mice. Pacritinib may impair male fertility in humans.

Hepatic Impairment: Avoid use of VONJO in patients with moderate [Child-Pugh B] or severe hepatic impairment [Child-Pugh C].

Renal Impairment: Avoid use of VONJO in patients with eGFR <30 mL/min.

Please see the full Prescribing Information for VONJO.