Colesevelam for lenalidomide associated diarrhea in patients with multiple myeloma - Scorecard - MDSpire

Colesevelam for lenalidomide associated diarrhea in patients with multiple myeloma

  • By

  • Malin Hultcrantz

  • Hani Hassoun

  • Neha Korde

  • Kylee MacLachlan

  • Sham Mailankody

  • Dhwani Patel

  • Urvi A. Shah

  • Carlyn Rose Tan

  • David J. Chung

  • Oscar B. Lahoud

  • Heather J. Landau

  • Michael Scordo

  • Gunjan L. Shah

  • Sergio A. Giralt

  • Matthew J. Pianko

  • Miranda Burge

  • Kelly Barnett

  • Meghan Salcedo

  • Julia Caple

  • Linh Tran

  • Jenna Blaslov

  • Tala Shekarkhand

  • Selena Hamid

  • David Nemirovsky

  • Andriy Derkach

  • Oluwatobi Arisa

  • Cody J. Peer

  • William D. Figg

  • Saad Z. Usmani

  • Ola Landgren

  • Alexander M. Lesokhin

  • September 19, 2024

  • 0 min

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Clinical Scorecard: Colesevelam's Role in Managing Lenalidomide-Induced Diarrhea in Multiple Myeloma Patients

At a Glance

CategoryDetail
ConditionLenalidomide-associated diarrhea in multiple myeloma patients
Key MechanismsBile acid malabsorption contributing to diarrhea; colesevelam binds bile acids in the gut
Target PopulationMultiple myeloma patients on single-agent lenalidomide maintenance experiencing grade 1 or higher diarrhea
Care SettingOncology outpatient setting, clinical trial environment

Key Highlights

  • Lenalidomide maintenance improves survival but commonly causes diarrhea impacting quality of life.
  • Colesevelam, a bile acid binder, was studied in a phase 2 trial showing 88% response rate in reducing diarrhea severity.
  • Colesevelam did not affect lenalidomide pharmacokinetics and was well tolerated over 12 weeks.

Guideline-Based Recommendations

Diagnosis

  • Exclude infectious causes of diarrhea (viral, bacterial, parasitic) before attributing to lenalidomide.
  • Grade diarrhea severity using CTCAE v5.0 criteria.

Management

  • Consider colesevelam starting at 1250 mg daily, titrating up to 3750 mg daily based on response and tolerability.
  • Administer colesevelam in the morning and lenalidomide in the evening with at least 4 hours interval.
  • Standard anti-diarrheal agents like loperamide may have limited efficacy.

Monitoring & Follow-up

  • Assess diarrhea severity and patient-reported gastrointestinal symptoms regularly (baseline, weeks 1, 2, 4, and 12).
  • Monitor lenalidomide pharmacokinetics if clinically indicated to rule out drug interaction.
  • Evaluate patient quality of life and symptom impact using PRO-CTCAE questionnaires.

Risks

  • Potential for non-response in a minority of patients (12% in trial).
  • Dose adjustments of colesevelam may be required based on adverse events or treatment response.

Patient & Prescribing Data

25 multiple myeloma patients on lenalidomide maintenance with diarrhea (median age 60, both genders).

88% responded to colesevelam with at least 1 grade improvement in diarrhea; 68% had complete resolution; no impact on lenalidomide PK observed.

Clinical Best Practices

  • Rule out infectious diarrhea before initiating bile acid binder therapy.
  • Start colesevelam at a moderate dose and titrate based on clinical response.
  • Separate dosing times of colesevelam and lenalidomide by at least 4 hours to avoid potential interactions.
  • Use validated patient-reported outcome tools to monitor symptom burden and quality of life.
  • Maintain lenalidomide therapy dose and monitor disease response during diarrhea management.

References

Original Source(s)

Colesevelam for lenalidomide associated diarrhea in patients with multiple myeloma

  • by Malin Hultcrantz, Hani Hassoun, Neha Korde, Kylee MacLachlan, Sham Mailankody, Dhwani Patel, Urvi A. Shah, Carlyn Rose Tan, David J. Chung, Oscar B. Lahoud, Heather J. Landau, Michael Scordo, Gunjan L. Shah, Sergio A. Giralt, Matthew J. Pianko, Miranda Burge, Kelly Barnett, Meghan Salcedo, Julia Caple, Linh Tran, Jenna Blaslov, Tala Shekarkhand, Selena Hamid, David Nemirovsky, Andriy Derkach, Oluwatobi Arisa, Cody J. Peer, William D. Figg, Saad Z. Usmani, Ola Landgren, Alexander M. Lesokhin

  • September 19, 2024

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