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    Pooled safety, including long-term extension, in 1623 patients1,2*

    A long-term extension (LTE) safety study evaluating adults and adolescents aged 12 and older with moderate-to-severe AD who are taking CIBINQO, with or without Rx topical therapies.1
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    At least 1 year of exposure in 634 patients​​​​​​​

    Specific adverse reactions in all patients with moderate-to-severe AD treated with CIBINQO 100 mg or 200 mg, including pooled phase 2b, phase 3, and the LTE study, July 2020 (N=1623) (all exposure)

    • Following completion of the qualifying JADE parent study, patients taking placebo were eligible to enroll in JADE EXTEND; therefore, no patient received placebo after week 16

    Limitations and Biases

    Limitations include, but are not limited to AE frequencies and incidence rates subject to change over time due to patient entry/exit; dose changes or study drug interruptions influenced by both investigator and patient; the number of patients and exposure for a specific safety event possibly differing depending on the timing of censored events; the number of observed patients with longer exposure times becoming lower. 
    ​​​​​​​
    ​​​​​​​LTE studies may provide useful data on low-frequency, long-latency AEs, risk factor analysis, and trends over exposure time. However, conduct of LTE studies in which both treatment and dose are known to both investigator and patient is subject to certain biases and limitations, and therefore data should be interpreted with caution. Biases include, but are not limited to: patient selection (patient willingness or ineligibility to enroll, which may be due to prior serious AE); prior treatment; investigator/patient expectation; volunteer; responder/survivor; observer; study duration; initial dose of study drug. 
    ​​​​​​​

    To report SUSPECTED ADVERSE REACTIONS, contact Pfizer Inc. at 1-800-438-1985 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch 
    While subjects aged 12 to 17 years were included in MONO-1 and MONO-2 trials, CIBINQO is not approved for use in pediatric subjects.

    Exposure adjusted incidence rates were adjusted by trial for all the adverse reactions reported in this section. 
    ​​​

    Patient-year is defined as the aggregate total follow-up time calculated for each event, censored at the time of first event for any given patient, subject to a risk period of up to 28 days beyond the last dose or to the data cutoff date.

     *The study population comprises 1623 patients treated with CIBINQO within the JADE clinical trial program, including one phase 2b trial, three phase 3 trials, and one LTE trial, which is ongoing. ​​​​​​​

      ​​​​​​​†A total of 6 subjects had malignancy (4 were taking CIBINQO 100 mg and 2 were taking CIBINQO 200 mg)

       ‡MACE included 1 event of cardiac failure and 1 event of myocardial infarction in the CIBINQO 200 mg arm and 1 event of  sudden death in the CIBINQO 100 mg arm. 

       ​​​​​​​§Confidence intervals (CIs) reflect the uncertainty around an estimated number; therefore, the upper limit (UL) is non-zero, reflecting that there is a chance that the true underlying IR could be slightly greater than zero but with only a 2.5% chance (due to 95% CI) to be >0.47, for CIBINQO 100 mg, or >0.54, for CIBINQO 200 mg (UL of 95% CI).

    ​​​​​​​​​​​​​AD=atopic dermatitis; LTE=long-term extension; MACE=major adverse cardiovascular event; PE=pulmonary embolism; DVT=deep venous thrombosis; AE=adverse event; IR=incidence rate

    ​​​​​​​JADE EXTEND study design1

    A long-term extension (LTE) safety study evaluating adults and adolescents aged 12 and older with moderate-to-severe AD who are taking CIBINQO, with or without Rx topical therapies.

    ​​​​​​​||Subjects could continue to receive CIBINQO in the LTE trial until availability of commercial CIBINQO or until the study was terminated in their respective country.​​​​​​​
    ​​​​​​​
    • Patients assessed in JADE EXTEND were allowed to use topical medications as needed
    • Pediatric subjects 12 years of age and older were included in the trial population; however, CIBINQO is not approved for use in pediatric patients​​​​​​​

    Biases

    • LTE studies may provide useful data on low-frequency, long-latency AEs, risk factor analysis, and trends over exposure time. However, conduct of LTE studies in which both treatment and dose are known to both investigator and patient is subject to certain biases and limitations, and therefore data should be interpreted with caution
    • Biases include, but are not limited to: 
      • patient selection (patient willingness or ineligibility to enroll, which may be due to prior serious      AEs)  
      • prior treatment and investigator/patient expectation
      • volunteer, observer, and responder/survivor effects
      • initial dose of study drug
      • study duration

    Limitations

    • Limitations include, but are not limited to: 
      • AE frequencies and incidence rates subject to change over time due to patient entry/exit 
      • dose changes or study drug interruptions influenced by both investigator and patient 
      • the number of patients and exposure for a specific safety event possibly differing depending on the timing of censored events 
      • the number of observed patients with longer exposure times becoming lower

    Primary (safety) endpoint:

    • Long-term safety
      • incidence of treatment-emergent AEs
      • incidence of serious AEs and AEs leading to discontinuation         
      • incidence of clinical abnormalities and change from baseline in clinical laboratory values, ECG        measurements, and vital signs
    Inclusion criteria
    •  ≥12 years of age*
    • Body weight ≥88 lbs if applicable from qualifying JADE parent study
    • Completed the full treatment or full rescue treatment of a qualifying parent study, or completed the full open-label run-in on REGIMEN but did not meet response criteria
    ​​​​​​​​​​​​​​Exclusion criteria
    • Active forms of other inflammatory skin diseases
    • Presence of other medical conditions at the discretion of the investigator
    • Pregnant or breastfeeding women
    • Women of childbearing potential who are unwilling to use contraception
    • Discontinued from treatment (or rescue treatment) early in a qualifying parent study 
    • Ongoing adverse event in qualifying parent study

    JADE EXTEND inclusion/exclusion criteria1

    *Adolescent subjects below the age of 18 years old (or country-specific age of majority) will only be enrolled in this study if instructed by the sponsor and approved by the country or regulatory/health authority. If these approvals have not been granted, only subjects aged 18 years (or country-specific age of majority) and older will be enrolled. While subjects aged 12 to 17 years were included in these trials, CIBINQO is not approved for use in pediatric subjects. 

    AE= adverse event; ECG=electrocardiogram.

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    References:
    1. Data on file. Pfizer Inc; New York, NY.
    2. CIBINQO Package insert. Pfizer Inc; 2022.
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    CIBINQO (abrocitinib) is indicated for the treatment of adults with refractory, moderate-to-severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of those therapies is inadvisable.
    ​​​​​​​

    INDICATION

    Limitations of Use: CIBINQO is not recommended for use in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants.

    WARNING: SERIOUS INFECTIONS, MORTALITY, MALIGNANCY, MAJOR ADVERSE CARDIOVASCULAR EVENTS, AND THROMBOSIS

    SERIOUS INFECTIONS
    Patients treated with CIBINQO may be at increased risk for developing serious infections that may lead to hospitalization or death. The most frequent serious infections reported with CIBINQO were herpes simplex, herpes zoster, and pneumonia.


    If a serious or opportunistic infection develops, discontinue CIBINQO and control the infection.

    Reported infections from Janus kinase (JAK) inhibitors used to treat inflammatory conditions: 
    • Active tuberculosis, which may present with pulmonary or extrapulmonary disease. Test for latent TB before and during therapy; treat latent TB prior to use. Monitor all patients for active TB during treatment, even patients with initial negative, latent TB test.
    • Invasive fungal infections, including cryptococcosis and pneumocystosis. Patients with invasive fungal infections may present with disseminated, rather than localized, disease. 
    • Bacterial, viral (including herpes zoster), and other infections due to opportunistic pathogens.
    ​​​​​​​Avoid use of CIBINQO in patients with an active, serious infection, including localized infections. The risks and benefits of treatment with CIBINQO should be carefully considered prior to initiating therapy in patients with chronic or recurrent infections or those who have resided or traveled in areas of endemic tuberculosis or endemic mycoses.

    Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with CIBINQO, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.

    Consider yearly screening for patients in highly endemic areas for TB. CIBINQO is not recommended for use in patients with active TB. For patients with a new diagnosis of latent TB or prior untreated latent TB, or for patients with a negative test for latent TB but who are at high risk for TB infection, start preventive therapy for latent TB prior to initiation of CIBINQO. 

    Viral reactivation, including herpes virus reactivation (eg, herpes zoster, herpes simplex), was reported in clinical studies with CIBINQO. If a patient develops herpes zoster, consider interrupting CIBINQO until the episode resolves. Hepatitis B virus reactivation has been reported in patients receiving JAK inhibitors. Perform viral hepatitis screening and monitoring for reactivation in accordance with clinical guidelines before starting therapy and during therapy with CIBINQO. CIBINQO is not recommended for use in patients with active hepatitis B or hepatitis C.

    MORTALITY
    In a large, randomized postmarketing safety study in rheumatoid arthritis (RA) patients 50 years of age and older with at least one cardiovascular risk factor comparing another JAK inhibitor to TNF blocker treatment, a higher rate of all-cause mortality (including sudden cardiovascular death) was observed with the JAK inhibitor. CIBINQO is not approved for use in RA patients.


    MALIGNANCIES
    Malignancies, including non-melanoma skin cancer (NMSC), were reported in patients treated with CIBINQO. Lymphoma and other malignancies have been observed in patients receiving JAK inhibitors used to treat inflammatory conditions.
    Perform periodic skin examination for patients who are at increased risk for skin cancer. Exposure to sunlight and UV light should be limited by wearing protective clothing and using broad-spectrum sunscreen.

    In a large, randomized postmarketing safety study of another JAK inhibitor in RA patients, a higher rate of malignancies (excluding non-melanoma skin cancer [NMSC]) was observed in patients treated with the JAK inhibitor compared to those treated with TNF blockers. CIBINQO is not approved for use in RA patients. A higher rate of lymphomas was observed in patients treated with the JAK inhibitor compared to those treated with TNF blockers. A higher rate of lung cancers was observed in current or past smokers treated with the JAK inhibitor compared to those treated with TNF blockers. Patients who are current or past smokers are at additional increased risk.


    Consider the benefits and risks for the individual patient prior to initiating or continuing therapy with CIBINQO, particularly in patients with a known malignancy (other than a successfully treated NMSC), patients who develop a malignancy when on treatment, and patients who are current or past smokers.

    MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE)  
    Major adverse cardiovascular events were reported in patients treated with CIBINQO. In RA patients 50 years of age and older with at least one cardiovascular risk factor treated with another JAK inhibitor, a higher rate of major adverse cardiovascular events (MACE) (defined as cardiovascular death, myocardial infarction, and stroke), was observed when compared with TNF blockers.
    CIBINQO is not approved for use in RA patients. Patients who are current or past smokers are at additional increased risk. Discontinue CIBINQO in patients that have experienced a myocardial infarction or stroke.


    Consider the benefits and risks for the individual patient prior to initiating or continuing therapy with CIBINQO, particularly in patients who are current or past smokers and patients with other cardiovascular risk factors. Patients should be informed about the symptoms of serious cardiovascular events and the steps to take if they occur. 

    THROMBOSIS
    Deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in patients treated with CIBINQO. Thrombosis, including PE, DVT, and arterial thrombosis have been reported in patients receiving JAK inhibitors used to treat inflammatory conditions. Many of these adverse reactions were serious and some resulted in death. In RA patients 50 years of age and older with at least one cardiovascular risk factor treated with another JAK inhibitor, a higher rate of overall thrombosis, DVT, and PE were observed when compared with TNF blockers.
    CIBINQO is not approved for use in RA patients.

    Avoid CIBINQO in patients that may be at increased risk of thrombosis. If symptoms of thrombosis occur, discontinue CIBINQO and treat patients appropriately.


    CONTRAINDICATION
    CIBINQO is contraindicated in patients taking antiplatelet therapies, except for low-dose aspirin (≤81 mg daily), during the first 3 months of treatment.


    LABORATORY ABNORMALITIES
    Hematologic Abnormalities: Treatment with CIBINQO was associated with an increased incidence of thrombocytopenia and lymphopenia. Prior to CIBINQO initiation, perform a complete blood count (CBC). CBC evaluations are recommended at 4 weeks after initiation and 4 weeks after dose increase of CIBINQO. Discontinuation of CIBINQO therapy is required for certain laboratory abnormalities. 

    Lipid Elevations: Dose-dependent increase in blood lipid parameters were reported in patients treated with CIBINQO. Lipid parameters should be assessed approximately 4 weeks following initiation of CIBINQO therapy, and thereafter patients should be managed according to clinical guidelines for hyperlipidemia. The effect of these lipid parameter elevations on cardiovascular morbidity and mortality has not been determined. 


    IMMUNIZATIONS
    Prior to initiating CIBINQO, complete all age-appropriate vaccinations as recommended by current immunization guidelines, including prophylactic herpes zoster vaccinations. Avoid vaccination with live vaccines immediately prior to, during, and immediately after CIBINQO therapy.


    RENAL IMPAIRMENT
    Avoid use in patients with severe renal impairment or end stage renal disease, including those on renal replacement therapy.

    HEPATIC IMPAIRMENT
    Avoid use in patients with severe hepatic impairment.

    ADVERSE REACTIONS
    Most common adverse reactions (≥1%) in subjects receiving 100 mg and 200 mg include: nasopharyngitis, nausea, headache, herpes simplex, increased blood creatinine phosphokinase, dizziness, urinary tract infection, fatigue, acne, vomiting, oropharyngeal pain, influenza, gastroenteritis. 

    Most common adverse reactions (≥1%) in subjects receiving either 100 mg or 200 mg also include: impetigo, hypertension, contact dermatitis, upper abdominal pain, abdominal discomfort, herpes zoster, and thrombocytopenia.

    Inform patients that retinal detachment has been reported in CIBINQO clinical trials. Advise patients to immediately inform their healthcare provider if they develop any sudden changes in vision.

    DRUG INTERACTIONS
    Monitor appropriately or dose titrate P-gp substrate where small concentration changes may lead to serious or life-threatening toxicities when coadministered with CIBINQO. See Prescribing Information for clinically relevant drug interactions.

    USE IN PREGNANCY
    Available data from pregnancies reported in clinical trials with CIBINQO are not sufficient to establish a drug-associated risk for major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Advise females of reproductive potential that CIBINQO may impair fertility.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to CIBINQO during pregnancy. Pregnant women exposed to CIBINQO and health care providers are encouraged to call 1-877-311-3770. 

    LACTATION
    Advise women not to breastfeed during treatment with CIBINQO and for one day after the last dose.


    Please see full Prescribing Information, including BOXED WARNING, and Medication Guide. 

    CIBINQO is indicated for the treatment of adults with refractory, moderate-to-severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of those therapies is inadvisable.

    Limitations of Use: CIBINQO is not recommended for use in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants.