What Is Inqovi?
Inqovi (decitabine and cedazuridine) is a prescription medicine used to treat certain blood cancers, including myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). It contains two active ingredients, decitabine and cedazuridine, and provides an oral alternative to intravenous (IV) decitabine therapy.
How Does It Work?
Decitabine and cedazuridine work together to treat CMML or MDS. Decitabine is a hypomethylating agent that is believed to help restore normal gene activity by reducing abnormal DNA methylation. This slows the growth of abnormal bone marrow cells and may cause cancer cells to die.
Cedazuridine blocks an enzyme in the gut and liver that normally breaks down decitabine before it can be absorbed. This allows enough decitabine to enter the bloodstream after being taken by mouth, making oral treatment possible.
Treatment of MDS and CMML
MDS can present in several different ways, and as a result, a number of different treatments can be used, either alone or in combination. These include:
- Supportive care
- Blood product transfusions
- Antibiotics to treat infections
- Medicines that increase the number of red blood cells
- Medicines that specifically treat MDS or CMML, such as Inqovi
- Bone marrow and stem cell transplants
Doctors may recommend Inqovi for adults with certain types of MDS or CMML who are candidates for hypomethylating therapy. Because it is taken by mouth, Inqovi offers an alternative to receiving IV decitabine in a clinic or infusion center.
There are other treatments under development that may provide additional benefits for patients with MDS.
Before receiving FDA approval, Inqovi was evaluated in clinical studies to determine its safety, effectiveness, recommended dosage, and potential side effects.
Uses of Inqovi
Inqovi is FDA-approved to treat adults with certain types of myelodysplastic syndromes (MDS), including previously treated and untreated MDS, as well as chronic myelomonocytic leukemia (CMML).
Side Effects
Like all cancer medicines, Inqovi can cause side effects. The most common side effects reported during clinical trials include:
- Low blood cell counts
- Cough
- Problems breathing
- Problems swallowing
- Headache
- Poor appetite
- Nausea
- Runny nose
- Chills
- Fever
- Upper respiratory tract infection
- Pneumonia
- Bleeding problems
- Pain upon passing urine
- Sneezing
- Red patches on the skin
- Black stools
- Constipation
- Trouble sleeping
- Abnormal liver tests (measured on blood tests)
Let your doctor know if you have any of these problems after taking Inqovi. Seek immediate medical attention if you develop a fever, severe bleeding, signs of infection, difficulty breathing, bruising more easily than usual, or any other serious or worsening symptoms while taking Inqovi.
Precautions When Taking Inqovi
- Allergic reactions: A few patients who take Inqovi will have an allergy to it. This most often presents as a skin rash or wheezing. If you have an allergic reaction, you should not take further Inqovi until you have discussed this with your doctor.
- Decreased blood counts: Inqovi commonly lowers red blood cells, white blood cells, and platelets, which can increase the risk of infections, anemia, and bleeding. This usually happens 7-10 days after starting treatment. Your doctor should monitor your blood counts after you start Inqovi.
- Nausea: Some patients will have nausea after taking Inqovi. Your doctor can give you some medicines to take before taking Inqovi, which will prevent nausea.
- Breastfeeding: It is not known whether Inqovi passes into human breast milk. Because of the potential risk of serious adverse reactions in a breastfed child, breastfeeding is not recommended during treatment and for at least 2 weeks after the last dose.
- Pregnancy: Inqovi can harm an unborn baby and should not be used during pregnancy. Tell your healthcare provider immediately if you become pregnant during treatment.
- Contraception: Females who can become pregnant should use effective birth control during treatment and for 6 months after the last dose. Males with female partners who can become pregnant should use effective contraception during treatment and for 3 months after the last dose.
- Children under the age of 16: Inqovi has not yet been tested in people under the age of 16 and should not be taken by patients in this age group.
- Drugs that interfere with Inqovi: Some medicines may interact with Inqovi and affect how well it works or increase the risk of side effects. Tell your healthcare provider about all prescription medications, over-the-counter medicines, vitamins, and herbal supplements you take.
Dosage
The dose of Inqovi is one tablet by mouth each day for 5 days on the first 5 days of each treatment cycle. Each tablet contains 35 mg of decitabine and 100 mg of cedazuridine. Each treatment cycle lasts 28 days. Courses may be repeated as often as every 4 weeks. Your healthcare provider may delay treatment or adjust your dose based on your blood counts or side effects. Many patients receive multiple treatment cycles, and treatment may continue as long as it remains effective and is well tolerated.
You should not eat for two hours before or two hours after taking Inqovi. You should not chew or crush Inqovi tablets. Inqovi should be taken at about the same time each day. If you miss a dose, follow your healthcare provider’s instructions or the prescribing information. Do not take extra doses to make up for a missed dose.
Your healthcare provider will perform regular blood tests during treatment to monitor your blood cell counts and determine whether any dose adjustments are needed.
Cost and Copay Assistance
The cost of Inqovi varies depending on your insurance coverage, pharmacy, and eligibility for financial assistance programs. If you need help paying for your prescription, contact AmeriPharma® Specialty Care. Using advanced software, AmeriPharma® will review all available funding sources and match you with a program that fits your needs. A copay specialist will help you with the application process.
