June 01, 2004

The First and Only lgG1 Monoclonal Antibody That Binds Specifically to the EGF Receptor (HER1 or c-ErbB-1) on Both Normal and Tumor Cells

ImClone Systems Incorporated and Bristol-Myers Squibb Compan are pleased to announce the approval of ERBITUX (Cetuximab), the first and only Monoclonal Antibody That Binds Specifically to the epidermal growth factor receptor (EGFR, HER1 or c-ErbB-1) on both normal and tumor cells.

ERBITUX, used in combination with irinotecan, is indicated for the treatment of EGFR-expressing, metastatic colorectal carcinoma in patients who are refractory to irinotecan-based chemotherapy.

ERBITUX administered as a single agent is indicated for the treatment of EGFR-expressing, metastatic colorectal carcinoma in patients who are intolerant to irinotecan-based chemotherapy.

The effectiveness of ERBITUX is based on objective response rates.  Currently, no data available that demonstrate an improvement in disease-related symptoms or increased survival with ERBITUX.

The recommended dose of ERBITUX, in combination with irinotecan or as a single agent is 400 mg/m as an initial loading dose (first infusion) administered as a 120-minute IV infusion (maximum infusion rate 5 mL/min).  The recommended weekly maintenance dose (all other infusions) is 250 mg/m infused over 60 minutes (maximum infusion rate 5 mL/min).  Premedication with H antagonist (eg 50 mg of diphenhydramine IV) is recommended.

In clinical trials, grade 3/4 infusion reactions, rarely with fatal outcome ( < 1 in 1,000), occured in approximately 3% (17/633) of patients receiving ERBITUX.  Reactions were characterized by rapid onset of airway obstruction (bronchospasm, stridor, hoarseness), urticaria, and hypotension.

Caution must be exercsed with every ERBITUX infusion, as there were patients who experienced their first severe infusion reaction during later infusions.  Following the ERBITUX infusion, a 1-hour observation period is recommended.

Most reactions (90%) were associated with the first infusion of ERBITUX despite the use of prophylactic antihistamines.  Severe infusion reactions require immediate and permanent discontinuation of ERBITUX therapy.  Premedication with an H, antagonist (eg, 50 mg diphenhydramine IV) is recommended.  Appropriate medical therapy including epinephrine, corticosteroids, intravenous antihistamines, bronchodilators, and oxygen should be available for use in the treatment of such reactions.  Patients should be carefully observed until the complete resolution of all signs and symptoms, Mild-to-moderate (grade 1/2) infusion reactions are managed by permanently slowing the infusion rate by 50% and by continued use of antihistamine medications (eg diphenhydramine) in subsequent doses.

Severe cases of interstitial lung disease (ILD), which was fatal in one case, occured in < 0.5% of patients (3/633) with advanced colorectal cancer receiving ERBITUX.  In the event of acute onset or worsening pulmonary symptoms, ERBITUX therapy should be interrupted and a prompt investigation of these symptoms should occur.  If ILD is confirmed, ERBITUX should be discontinued and the patients should be treated appropriately.

In clinical studies of ERBITUX (Cetuximab), dernatologic toxicities, including acneform rash, skin drying and fisuring, and inflammatory and infectious sequelae (eg, blephartis, cheilitis, cellulitis, cyst), were reported.  Acneform rash mostly commonly occured on the face, upper chest, and back; however, it may extend to the extremities.  The onset of acneform rash generally occurs within the first 2 weeks of therapy.  An acneform shin rash of any grade occured during treatment in 88% and 90% of patients receiving ERBITUX in combination with irinotecan and ERBITUX as a single agent, respectively (14% and 10% grade 3 respectively).  Subsequent to the development of severe dermatologic toxicities, complications including S aureus sepsis and abscesses requiring incision and drainage were reported.  Patients developing dermatologic toxicities while receiving ERBITUX should be monitored for the development of inflammatory or infectious sequalae, and appropriate treatment of these symptoms initiated.

The most serious adverse reactions (n = 633) associated with ERBITUX were infusion reaction (3%), dermatologic toxicity (1%), interstitial lung disease (<0.5%), sepsis (3%), fever (5%), kidney failure (2%), pulmonary embolus (1%), dehydration (5% in patients receiving ERBITUX in combination with irinotecan, 2% in patients receiving ERBITUX as a single agent), and diarrhea (6% in patients receiving ERBITUX in combination with irinotecan, 0% in patients receving ERBITUX as a single agent).

The most common adverse events in patients receiving ERBITUX in combination with irinotecan (n = 354) were acneform rash (88%), asthenia/malaise (73%), diarrhea (72%), nausea (55%), abdominal pain (45%), and vomiting (41%).  The most common adverse events in patients receiving ERBITUX as a single agent (n = 279) were acneform rash (90%), asthenia/malaise (49%) fever (33%), nausea (29%), consitpation (28%), and diarrhea (28%).

If a patient experiences severe acneform rash, ERBITUX dosage adjustments should be made as follows:

ERRBITUX Dose Modification Guidelines        

Severe Acneform Rash

 ERBITUX

 Outcome

ERBITUX Dose Modification

Ist Occurence

Delay Infusion

1 to 2 Weeks

Improvement

No Improvement

Continue at 250 mg / m

Discontinue ERBITUX

2nd Occurence

Delay Infusion

1 to 2 Weeks

Improvement

No Improvement

Reduce Dose to 200 mg / m

Discontinue ERBITUX

3rd Occurence

Delay Infusion

1 to 2 Weeks

Improvement

No Improvement

Reduce Dose to 150 mg / m

Discontinue ERBITUX

4th Occurence 

Discontinue ERBITUX

In patients with mild and moderate skin toxicity, treatment should continue without dose modification.

Treatment with topical and/or oral antibiotics should be considered; topical corticosteroids are not recommended.  Sunlight can exacerbate any skin reactions, therefore, it is recommended that patients wear sunscreen and hats, and limit sun exposure.

Nail disorder was observed in 14% of patients, any grade (0.3% to grade 3), and was characterized as a paronychial inflammation with associated swelling of the lateral nail folds of the toes and fingers, with the great toes and thumbns as the most commonly affected digits.

ERBITUX must be administered with the use of a low protein binding 0.22-micrometter in-line filter.

ERBITUX is supplied as a 5--mL, single-use vial containing 100 mg of Cetuximab at a concentration of 2 mg /mL in phosphate-buffered saline.  The solution should be clear and colorless and may contain a small amount of easily visible, white, amorphois Cetuximab particulates.  DO NOT SHAKE OR DILUTE.  DO NOT ADMINISTER ERBITUX AS AN IV PUSH OR BOLUS.

ERBITUX can be administered bia an infusion pump or a syringe pump and should be piggybacked to the patient's infusion line.  For more information on these two infusion alternatives, please see the enclosed full presribing information.

We at ImClone Systems Incorporated and Bristol-Myers Squibb Company are proud to offer ERBITUX (Cetuximab) as a new treatment option in the fight against EGFR-expressing metastatic colorectal cancer.

For more information on ERBITUX, please visit our website at www.ERBITUX.com or call 1-888-ERBITUX (372-4889).

 

Source: Imclone Systems Incorporated

           Bristol-Myers Squibb Company

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05/26/2004

We would like to take this opportunity to update you on some recent milestones for out statin CRESTOR (rosuvastatin calcium).  CRESTOR was launched in the US in September 2003 as an adjunct to diet to reduce elevated cholesterol, low-density lipoprotein cholesterol, triglycerides, and other atherohenic lipid measures and to increase high-density lipoprotein cholesterol in patients with dyslipidemia.  Worldwide, more than 1 million patients have been treated with CRESTOR, with over 2 million prescriptions dispensed.  The most recent safety revire of CRESTOR has just been completed and was submitted on March 4, 2004, to the FDA.  A review of this data by AstraZeneca internal drug safety concluded that the safety profile od CRESTOR was found to be consistent with our original FDA-approved label.  The overall safety profile of CRESTOR is consistent with that of other marketed statins.  In addition, CRESTOR continues to demonstrate an impressive efficacy profile.

 

As you may already know:

  • The safety and eddicacy of CRESTOR were evaluated in over 10,000 patients in clinical trials, more than any other statin at the time of FDA approval.

  • Of these patients, over 2,000 were treated for 2 years longer.

  • Overall, more than 40,000 patients have takes CRESTOR in clinical trials, including ongoing trials in the GALAXY Program.

  • CRESTOR is now approved in 51 countries and is available in pharmacies across the US.

 

Furthermore, in the CRESTOR clinical program:

  • CRESTOR reduced LDL-C by more than 50% at a low 10-mg dose ( vs 7% with placebo)

  • In comparisons of doese-response curves, CRESTOR reduced LDL-C significantly more than atorvastatin

  • CRESTOR 5 mg to 40 mg increased HDL-C between 8% and 14% (vs 3% with placebo)

 

The following supports the need for a product of greater LDL-C efficacy such as CRESTOR:

  • The National Cholesterol Education Program (NCEP) guidelines currently recommend that the goall of treatment in patients with established coronary artery disease should be an LDL cholesterol level of less than 100mg per deciliter.

  • Recent and emerging data from clinical trials such as PROVE-IT and the ALLIANCE Trials demonstrate that patients benefited from early and continued lowering of LDL cholesterol to levels substantially below current larger levels.

 

As you counsel your customers who have been prescribed CRESTOR (rosuvastatin calcium), we want you to be completely informed of the facts. The facts for CRESTOR are reflected in the prescribing information for this product and are fully supported by substantial postmarketing experience.  These facts clearly indicate that CRESTOR is an excellent first-line option for a wide range of adult patients with dyslipidemia.  You can feel confident in the knowledge that AstraZeneca maintains a thorough pharmacovigilence program, anad we are committed to accurately reporting the safety profile of all of our products.

 

Thank you for your continued interest in, and support of, CRESTOR.   If you have any additional questions concerning CRESTOR, please refer to the prescribing information for CRESTOR or call the AstraZeneca Information center at 1-800-236-9933.  Further information is also available at www.astrazeneca-us.com and www.crestor.com.

 

Source: AstraZeneca

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From: WellPoint NextRx

July 13, 2006 

Important Notice: Please share this information with all Pharmacists on your Staff

Effective August 15, 2006, Wellpoint NextRx, is pleased to introduce its newest client, HealthSytems. HealthSystems represents more than 1.1 million eligible members nationwide.  Reimburstment will be in accordance with the WellPoint NextRx network rate.  For your convenience, all HealthSystems' processing information is listed on the attached payer sheet. This program will require a new payer setup, including a unique BIN number in your Pharmacy system for appropriate transaction routing / processing.  Please route the payer sheet to the appropriate individual for setup in your system at your earliest convinience. 

Members will be presenting a prescription card or a representative from HealthSystems will be contactting you if one of their members will be utilizing your Pharmacy. They will provide guidance on how to submit a claim and will be providing you with additional information about the program.

Please note the following important information.  HealthSystems will be responsible for all claims processing, customer service questions, and payment to Pharmacies.

All claims should be submitted to BIN # 012874 (unique for this client)

All Pharmacy service calls should be reffered to 800-758-5779

If you should have any questions that are not related to claims transmittal details for HealthSystems, please contact WellPoint NextRx network department at 800-230-8635, option 1.

Sincerely,

Keith A. Dostal, RPh  Staff V.P. Pharmacy Provider Networks  WellPoint NextRx

Wellpoint NextRx is a service mark of WellPoint, Inc. Services are provided by a WellPoint PBM (either Professional Claim Services Inc. doig business as WellPoint Pharmacy Management, or Anthem Prescription Management, LLC, as appropriate).


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