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Post-marketing pharmacovigilance study of gilteritinib and midostaurin from the FAERS database

By Haimanti Mandal

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Feb 10, 2025

Learning objective: After reading this article, learners will be able to cite a new clinical development in acute myeloid leukemia.



The FLT3 inhibitors midostaurin and gilteritinib are approved for treatment of patients with FLT3-mutant R/R AML. However, real-world safety data from large sample populations are incomplete.1Jiang et al.1 published an article in the Therapeutic Advances in Drug Safety, discussing a retrospective, observational, pharmacovigilance study using data from the FAERS database to assess the real-world safety profile of midostaurin and gilteritinib. A total of 2,091 case reports for midostaurin and 1,887 for gilteritinib were included.


Key learnings
A total of 46 safety signals were identified for midostaurin and 53 for gilteritinib.
The common AEs of both drugs were in line with findings from clinical trials. Midostaurin was most frequently associated with nausea, vomiting, diarrhea, pyrexia, and febrile neutropenia, while gilteritinib was associated with febrile neutropenia, pyrexia, anemia, and thrombocytopenia.
Both drugs produced unexpected AEs not listed on the label. Midostaurin exhibited 24 signals, including neutropenic colitis, neutropenic sepsis, septic shock, and hepatotoxicity. Gilteritinib exhibited 29 signals, including septic shock, neutropenic sepsis, cerebral hemorrhage, subdural hematoma, tumor lysis syndrome, and interstitial lung disease.
Limitations of the spontaneous report database, including reporting bias, lack of causal relationship between the drug and the AE, inability to calculate incidence and severity of AEs, and other confounding factors, highlight the need for further studies to validate the findings.

Abbreviations: AE, adverse event; AML, acute myeloid leukemia; FAERS, Food and Drug Administration Adverse Event Reporting System; R/R, relapsed/refractory.

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Approximately what proportion of your patients with FLT3-mutations also have NPM1 and DNMT3A co-mutations?