Thalidomide Celgene is a medicine containing the active substance thalidomide. It is available as capsules (50 mg).
|Table of Contents|
|What is it used for?|
|How is it used?|
|How does it work?|
|How has it been studied?|
|What benefits has it shown during the studies?|
|What is the risk associated?|
|Why has it been approved?|
Thalidomide Celgene is used to treat multiple myeloma (a cancer of the bone marrow) in combination with melphalan and prednisone (anticancer medicines) in patients who have not been treated for multiple myeloma before. It is used in patients aged over 65 years, and in younger patients if they cannot be treated with high-dose chemotherapy (anticancer treatments).
Thalidomide Celgene must be prescribed and dispensed according to a special programme put in place to prevent the exposure of unborn children to the medicine.
Because the number of patients with multiple myeloma is low, the disease is considered ?rare?, and Thalidomide Celgene was designated an ?orphan medicine? (a medicine used in rare diseases) on 20 November 2001.
The medicine can only be obtained with a prescription.
Treatment with Thalidomide Celgene must be started and monitored under the supervision of a doctor who is skilled in using medicines that modulate the immune system or anticancer medicines. The doctor must also understand the risks of thalidomide and the ways in which the use of the medicine must be monitored.
The recommended dose of Thalidomide Celgene is four capsules a day, taken at the same time, preferably at bedtime. The capsules can be taken with or without food. Thalidomide Celgene can be used for a maximum of 12 treatment cycles, with each cycle lasting six weeks. The doctor may delay, reduce or stop doses if the patient experiences certain side effects, including blood clots, nerve damage, rash, low heart rate, fainting or sleepiness. Each patient should also receive an anticoagulant (a medicine to prevent the formation of blood clots) for at least the first five months of treatment, after careful assessment of the patient?s individual risk.
Patients who have severe problems with their kidneys or liver should be carefully monitored for side effects. Thalidomide Celgene is not recommended for use in patients below 18 years of age because of a lack of information on safety and effectiveness in this age group.
The active substance in Thalidomide Celgene, thalidomide, is thought to work by blocking the development of cancer cells, and by stimulating some of the specialised cells of the immune system (the body?s defence mechanism) to attack the cancer cells. This can help to slow down the progression of multiple myeloma.
The effects of Thalidomide Celgene were first tested in experimental models before being studied in humans.
The effectiveness of Thalidomide Celgene was studied in one main study involving 447 patients with multiple myeloma. The study included patients over 65 years of age, as well as younger patients who could not be treated with high-dose chemotherapy. The study compared the effect of melphalan and prednisone, with or without Thalidomide Celgene, on survival times.
The company also presented the results of a study looking at the combination of Thalidomide Celgene and dexamethasone as ?induction? treatment for multiple myeloma for use before high-dose chemotherapy. However, it withdrew this application during the assessment of the medicine.
Survival times were longer in the patients receiving Thalidomide Celgene in addition to melphalan and prednisone. Patients receiving melphalan and prednisone survived for an average of 33.2 months from the start of the study, compared with 51.6 months when the treatment also included Thalidomide Celgene.
Most patients taking thalidomide experience side effects. The most common side effects (seen in more than 1 patient in 10) are neutropenia (low levels of neutrophils, a type of white blood cell), leucopenia (low white blood cell counts), anaemia (low red blood cell counts), lymphopenia (low levels of lymphocytes, another type of white blood cell), thrombocytopenia (low levels of platelets in the blood), peripheral neuropathy (nerve damage causing tingling, pain and numbness in the hands and feet), tremor (shaking), dizziness, paraesthesia (unusual sensations like pins and needles), dysaesthesia (reduced sense of touch), somnolence (sleepiness), constipation and peripheral oedema (swelling, usually in the legs). For the full list of all side effects reported with Thalidomide Celgene, see the Package Leaflet.
Thalidomide is a powerful human ?teratogen?, meaning that it has a harmful effect on the unborn child, causing severe and life-threatening birth defects. The strict conditions put in place to prevent pregnancies and the exposure of unborn children to thalidomide must be met by all men and women taking the medicine.
Thalidomide Celgene must never be used by the following groups:
- women who are pregnant;
- women who could become pregnant, unless they take all of the necessary steps to ensure that they are not pregnant before treatment and that they do not become pregnant during or soon after treatment;
- patients who are unable to follow or to comply with the requirement to use contraceptives. Thalidomide Celgene should also not be used in people who may be hypersensitive (allergic) to thalidomide or any of the other ingredients. For the full list of restrictions, see the Package Leaflet.
The Committee for Medicinal Products for Human Use (CHMP) concluded that, provided that very strict measures are put in place to avoid exposure of unborn children to thalidomide, Thalidomide Celgene?s benefits are greater than its risks, in combination with melphalan and prednisone as first line treatment of patients with untreated multiple myeloma, aged greater than or equal to 65 years or ineligible for high dose chemotherapy. The Committee recommended that Thalidomide Celgene be given marketing authorisation.