mogamulizumab (Rx)

Brand and Other Names:Poteligeo, mogamulizumab-kpkc
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/5mL, single-dose vial (4mg/mL)

Mycosis Fungoides or Sézary Syndrome

CC chemokine receptor type 4 (CCR4)-directed monoclonal antibody indicated for adults with relapsed or refractory mycosis fungoides or Sézary syndrome after at least 1 prior systemic therapy

First cycle

  • Days 1, 8, 15, and 22: 1 mg/kg IV over at least 60 min; THEN  

Subsequent cycles

  • Days 1 and 15: 1 mg/kg IV over at least 60 min
  • Continue until disease progression or unacceptable toxicity

Dosage Modifications

Dermatologic toxicity

  • Grade 1: Consider topical steroids
  • Grade 2 or 3: Interrupt treatment and administer at least 2 weeks of topical corticosteroids; if rash improves to Grade ≤1, resume treatment
  • Life-threatening (Grade 4) rash or for any Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN): Permanently discontinue treatment
  • If SJS or TEN is suspected, stop treatment, and do not resume unless SJS or TEN has been excluded and cutaneous reaction has resolved to Grade ≤1

Infusion reactions

  • If an infusion reaction occurs, administer premedication (eg, diphenhydramine, acetaminophen) for subsequent infusions
  • Grades 1 to 3: Temporarily interrupt infusion and treat symptoms; after symptoms resolve, restart infusion at a reduced infusion rate (by at least 50%); if reaction recurs and is unmanageable, discontinue infusion
  • Grade 4: Permanently discontinue

Renal impairment

  • CrCl <90 mL/min: No clinically significant pharmacokinetic changes observed

Hepatic impairment

  • Mild (total bilirubin ≤3x ULN and any AST): No dosage adjustment necessary
  • Severe (total bilirubin >3x ULN and any AST): Pharmacokinetics of mogamulizumab is unknown

Safety and efficacy not established

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Interactions

Interaction Checker

and mogamulizumab

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (7)

              • axicabtagene ciloleucel

                mogamulizumab, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • brexucabtagene autoleucel

                mogamulizumab, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • ciltacabtagene autoleucel

                mogamulizumab, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • idecabtagene vicleucel

                mogamulizumab, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • lisocabtagene maraleucel

                mogamulizumab, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • palifermin

                palifermin increases toxicity of mogamulizumab by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hr before, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • tisagenlecleucel

                mogamulizumab, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              Monitor Closely (6)

              • dengue vaccine

                mogamulizumab decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • efgartigimod alfa

                efgartigimod alfa will decrease the level or effect of mogamulizumab by receptor binding competition. Use Caution/Monitor. Coadministration of efgartigimod with medications that bind to the human neonatal Fc receptor may lower systemic exposures and effectiveness of such medications. Closely monitor for reduced effectiveness of medications that bind to the human neonatal Fc receptor. If long-term use of such medications is essential, consider discontinuing efgartigimod and using alternative therapies.

              • ponesimod

                ponesimod and mogamulizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • siponimod

                siponimod and mogamulizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • trastuzumab

                trastuzumab, mogamulizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, mogamulizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              Minor (0)

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                Adverse Effects

                All grades of severity listed unless otherwise indicated

                >10%

                Decreased CD4 lymphocytes (63%)

                Hyperglycemia (52%)

                Decreased CD4 lymphocytes, Grade 3 or more (43%)

                Rash, including drug eruption (35%)

                Anemia (35%)

                Decreased albumin (34%)

                Infusion-related reaction (33%)

                Decreased white blood cells (33%)

                Decreased lymphocytes (31%)

                Fatigue (31%)

                Decreased calcium (30%)

                Thrombocytopenia (29%)

                Uric acid increased (29%)

                Phosphate decreased (27%)

                Diarrhea (28%)

                Aspartate transaminase (AST) increased (25%)

                Drug eruption (24%)

                Upper respiratory tract infection (22%)

                Musculoskeletal pain (22%)

                Skin infection (19%)

                Alanine transaminase (ALT) increased (18%)

                Alkaline phosphatase increased (17%)

                Pyrexia (17%)

                Magnesium decreased (17%)

                Decreased lymphocytes, Grade 3 or more (16%)

                Edema (16%)

                Nausea (16%)

                Thrombocytopenia (14%)

                Decreased glucose (14%)

                Headache (14%)

                Constipation (13%)

                Increased calcium (12%)

                Anemia (12%)

                Mucositis (12%)

                Cough (11%)

                1-10%

                Hypertension (10%)

                Neutropenia (10%)

                Candidiasis (9%)

                Urinary tract infection (9%)

                Renal insufficiency (9%)

                Hyperglycemia (9%)

                Insomnia (9%)

                Hyperuricemia (8%)

                Increased weight (8%)

                Folliculitis (8%)

                Xerosis (8%)

                Dizziness (8%)

                Decreased appetite (8%)

                Dyspnea (7%)

                Chills (7%)

                Vomiting (7%)

                Peripheral neuropathy (7%)

                Alopecia (7%)

                Depression (7%)

                Decreased weight (6%)

                Hypomagnesemia (6%)

                Pneumonia (6%)

                Falls (6%)

                Muscle spasms (5%)

                Phosphate decreased, Grade 3 or more (5%)

                Arrhythmia (5%)

                Conjunctivitis (5%)

                Otitis (5%)

                Abdominal pain (5%)

                Herpes virus infection (5%)

                Grade 3 or more

                • Rash, including drug eruption (5%)
                • Drug eruption (5%)
                • Hyperglycemia (5%)
                • Skin infection (3%)
                • Infusion-related reaction (2%)
                • Decreased white blood cells (2%)
                • Anemia (2%)
                • AST increased (2%)
                • Mucositis (1%)
                • ALT increased (1%)

                <1%

                Musculoskeletal pain

                Pyrexia

                Tumor lysis syndrome

                Myocardial ischemia or infarction

                Cardiac failure

                Increased calcium, Grade 3 or more

                Cytomegalovirus infection

                Postmarketing Reports

                Infections: Hepatitis B virus reactivation

                Cardiac disorders: Stress cardiomyopathy

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                Warnings

                Contraindications

                None

                Cautions

                Fatal and life-threatening skin adverse reactions, including SJS and TEN, have occurred; onset of drug eruption, affected areas, and appearance varies; more common presentations reported included papular or maculopapular rash, lichenoid, spongiotic, or granulomatous dermatitis, and morbilliform rash; monitor for rash throughout treatment course

                Fatal and life-threatening infusion reactions reported; most reactions (~90%) occur during or shortly after the first infusion; infusion reactions can also occur with subsequent infusions; most common reported signs include chills, nausea, fever, tachycardia, rigors, headache, and vomiting

                Fatal and life-threatening infections, including sepsis, pneumonia, and skin infection occurred; monitor for signs and symptoms of infection and treat promptly

                Increased risks of transplant complications reported in patients who receive allogeneic HSCT after mogamulizumab ,including severe (Grade 3 or 4) acute graft-versus-host disease (GVHD), steroid-refractory GVHD, and transplant-related death; a higher risk of transplant complications reported if mogamulizumab is given within a shorter time frame (~50 days) before HSCT; closely monitor for early evidence of transplant-related complications

                Autoimmune complications

                • Fatal and life-threatening immune-mediated complications reported; Grade 3 or higher immune-mediated or possibly immune-mediated reactions have included myositis, myocarditis, polymyositis, hepatitis, pneumonitis, glomerulonephritis, and a variant of Guillain Barre syndrome
                • Use of systemic immunosuppressants for immune-mediated reactions reported in 1.9% of recipients of mogamulizumab in Trial 1, including for a case of Grade 2 polymyalgia rheumatica
                • New-onset hypothyroidism (Grade 1 or 2) reported and managed with observation or levothyroxine
                • Interrupt or permanently discontinue treatment as appropriate for suspected immune-mediated adverse reactions
                • Consider if benefits outweigh the risks in patients with a history of autoimmune disease
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                Pregnancy

                Pregnancy

                There are no available data on use in pregnant women to inform a drug-associated risk of major birth defects and miscarriage

                In general, IgG molecules are known to cross the placental barrier and in the monkey reproduction study mogamulizumab-kpkc was detected in fetal plasma

                Therefore, drug may potentially be transmitted from the mother to the developing fetus

                Not recommended during pregnancy or in women of childbearing potential not using contraception

                For females of reproductive potential, verify pregnancy status prior to initiation

                Animal data

                • In an animal reproduction study, administration to pregnant cynomolgus monkeys from the start of organogenesis through delivery did not show a potential for adverse developmental outcomes at maternal systemic exposures 27 times the exposure in patients at the recommended dose, based on AUC

                Contraception

                • Advise females of reproductive potential to use effective contraception during treatment and for at least 3 months following the last dose

                Lactation

                There is no information regarding the presence of mogamulizumab-kpkc in human milk, the effects on the breastfed child, or the effects on milk production

                Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Recombinant humanized monoclonal antibody that targets CCR4-expressing cell, inhibiting CCR4-mediated signaling may mitigate chemokine-mediated cellular migration, T cell proliferation, and chemokine-mediated angiogenesis

                CCR4 (also known as CD194) may be overexpressed on adult T-cell lymphoma and peripheral T-cell lymphoma

                Absorption

                Peak plasma concentration: 32 mcg/mL

                Minimum plasma concentration: 11 mcg/mL

                AUC (steady-state): 5577 mcg·hr/mL

                Distribution

                Vd: 3.6 L

                Elimination

                Half-life: 17 days

                Clearance: 12 mL/hr

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                Administration

                IV Compatibilities

                0.9% NaCl

                Diluted solution is compatible with polyvinyl chloride (PVC) or polyolefin (PO) infusion bag

                IV Preparation

                Visually inspect solution for particulate matter and discoloration prior to administration

                Solution should appear clear to slightly opalescent colorless; discard vial if cloudiness, discoloration, or particulates are observed

                Calculate dose (mg/kg) and number of vials needed to prepare the infusion solution based on patient weight

                Aseptically withdraw required volume and transfer into an IV bag containing 0.9% NaCl

                Final concentration of the diluted solution should be between 0.1-3 mg/mL

                Mix diluted solution by gentle inversion; do not shake

                Discard any unused portion left in the vial

                IV Administration

                Infuse over at least 60 minutes through an IV line containing a sterile, low protein binding, 0.22 micron (or equivalent) in-line filter

                Do not mix with other drugs

                Do not coadminister other drugs through the same IV line

                Administer within 2 days of scheduled dose

                Missed dose: If a dose is missed, administer the next dose as soon as possible and resume dosing schedule

                Premedications

                • Administer diphenhydramine and acetaminophen prior to the first infusion

                Storage

                Unused vials

                • Refrigerate at 2-8°C (36-46°F) in original package to protect from light until time of use
                • Do not freeze; do not shake

                Diluted solutions

                • After preparation, infuse immediately or refrigerate at 2-8°C (36-46°F) for up to 24 hr
                • Do not freeze; do not shake
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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Poteligeo intravenous
                -
                4 mg/mL vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.