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The following adverse drug reactions are discussed in greater detail in other sections of the label:
- Hemorrhage [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
- Arterial Thromboembolic Events [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
- Hypertension [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
- Infusion Related Reactions [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
- Gastrointestinal Perforation [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
- Impaired Wound Healing [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
- Patients with Child-Pugh B or C Cirrhosis [see WARNINGS AND PRECAUTIONS].
- Reversible Posterior Leukoencephalopathy Syndrome [see WARNINGS AND PRECAUTIONS].
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The safety of CYRAMZA as a single agent was evaluated in 570 patients, including patients in Study 1 who received CYRAMZA. Study 1 randomized patients (2:1) to receive CYRAMZA 8 mg/kg intravenously every two weeks (n=236) versus placebo every two weeks (n=115) in a double-blind, placebo-controlled trial in previously treated gastric cancer.
In Study 1, patients with an ECOG performance status of 2 or greater, bilirubin greater than or equal to 1.5 mg/dL, uncontrolled hypertension, major surgery within 28 days, or receiving chronic anti-platelet therapy other than once daily aspirin were excluded. Patients received a median of 4 doses of CYRAMZA; the median duration of exposure was 8 weeks, and 32 (14% of 236) patients received CYRAMZA for at least six months.
In Study 1, the most common adverse reactions (all grades) observed in CYRAMZA-treated patients at a rate of ≥ 10% and ≥ 2% higher than placebo were hypertension and diarrhea. The most common serious adverse events with CYRAMZA were anemia (3.8%) and intestinal obstruction (2.1%). Red blood cell transfusions were given to 11% of CYRAMZA-treated patients versus 8.7% of patients who received placebo.
Table 1 provides the frequency and severity of adverse reactions in Study 1.
Table 1: Adverse Reactions Occurring at Incidence Rate
≥ 5% and a ≥ 2% Difference Between Arms in Patients Receiving
CYRAMZA in Study 1
|Adverse Reactions (MedDRA)a System Organ Class||CYRAMZA (8 mg/kg)
|All Grades (Frequency %)||Grade 3-4 (Frequency %)||All Grades (Frequency %)||Grade 3-4 (Frequency %)|
|Metabolism and Nutrition Disorders|
|Nervous System Disorders|
|a MedDRA Version 15.0.|
Clinically relevant adverse reactions reported in ≥ 1% and < 5% of CYRAMZA-treated patients in Study 1 were: neutropenia (4.7% CYRAMZA versus 0.9% placebo), epistaxis (4.7% CYRAMZA versus 0.9% placebo), rash (4.2% CYRAMZA versus 1.7% placebo), intestinal obstruction (2.1% CYRAMZA versus 0% placebo), and arterial thromboembolic events (1.7% CYRAMZA versus 0% placebo) [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
Across clinical trials of CYRAMZA administered as a single agent, clinically relevant adverse reactions (including Grade ≥ 3) reported in CYRAMZA-treated patients included proteinuria, gastrointestinal perforation, and infusion related reactions.
In Study 1, according to laboratory assessment, 8% of CYRAMZA-treated patients developed proteinuria versus 3% of placebo-treated patients. Two patients discontinued CYRAMZA due to proteinuria. The rate of gastrointestinal perforation in Study 1 was 0.8% and the rate of infusion related reactions was 0.4% [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS].
As with all therapeutic proteins, there is the potential for immunogenicity. In clinical trials, 33/443 (7.4%) of CYRAMZA-treated patients with post baseline serum samples tested positive for anti-ramucirumab antibodies using an enzyme-linked immunosorbent assay (ELISA). However, this assay has limitations in detecting anti-ramucirumab antibodies in the presence of ramucirumab; therefore, the incidence of antibody development may not have been reliably determined. Neutralizing antibodies were detected in 1 of the 33 patients who tested positive for anti-ramucirumab antibodies.
The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of incidence of antibodies to CYRAMZA with the incidences of antibodies to other products may be misleading.
Read the Cyramza (ramucirumab solution for intravenous infusion) Side Effects Center for a complete guide to possible side effects
No formal drug interaction studies have been conducted.
Last reviewed on RxList: 5/1/2014
This monograph has been modified to include the generic and brand name in many instances.
Additional Cyramza Information
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