Lenalidomide (Revlimid)
Lenalidomide, also known as Revlimid, is a prescription medicine that belongs to a class of drugs called immunomodulatory agents. It is used to treat various types of blood cancers, such as multiple myeloma, smoldering myeloma, and myelodysplastic syndromes (MDS).
What is Multiple Myeloma?
Multiple myeloma is a type of cancer that affects plasma cells, which are a type of white blood cell that produce antibodies to fight infections. In multiple myeloma, abnormal plasma cells grow and multiply uncontrollably in the bone marrow, crowding out normal blood cells and producing abnormal antibodies that can cause various problems, such as kidney damage, bone pain, infections, and anemia.
How Does Lenalidomide Work?
Lenalidomide works by affecting the immune system and the tumor microenvironment in multiple ways. It can:
- Stimulate the activity of natural killer cells and T cells, which are immune cells that can kill cancer cells
- Inhibit the growth of new blood vessels that supply oxygen and nutrients to the tumor
- Reduce the production of inflammatory substances that promote tumor growth and survival
- Induce apoptosis, or programmed cell death, in cancer cells
- Enhance the effects of other anti-cancer drugs, such as dexamethasone
How is Lenalidomide Used?
Lenalidomide is taken orally as a capsule once a day, usually for 21 days of a 28-day cycle. The dose and duration of treatment depend on the type and stage of cancer, the response to therapy, and the side effects experienced. Lenalidomide is often used in combination with other drugs, such as dexamethasone, bortezomib, or daratumumab, to increase the chances of achieving a complete or partial response.
Lenalidomide is also used as a maintenance therapy after autologous stem cell transplantation (ASCT), which is a procedure that involves collecting and storing the patient’s own stem cells, giving high doses of chemotherapy to kill the remaining cancer cells, and then infusing the stem cells back into the patient to restore the bone marrow function. Maintenance therapy with lenalidomide can help prevent or delay the recurrence of multiple myeloma after ASCT.
What are the Side Effects of Lenalidomide?
Lenalidomide can cause serious side effects, such as:
- Low blood counts, which can increase the risk of infections, bleeding, and anemia
- Blood clots, which can cause strokes, heart attacks, or pulmonary embolism
- Second primary cancers, such as acute leukemia or lymphoma
- Birth defects or death of an unborn baby if taken during pregnancy
Therefore, lenalidomide is only available through a restricted program called Lenalidomide REMS (Risk Evaluation and Mitigation Strategy), which requires patients and doctors to register and follow certain rules to ensure safe use of the drug. Patients who take lenalidomide must have regular blood tests to monitor their blood counts and clotting factors, use effective contraception to prevent pregnancy, and report any signs or symptoms of side effects to their doctor.
Other common side effects of lenalidomide include:
- Diarrhea
- Rash
- Fatigue
- Nausea
- Constipation
- Muscle or joint pain
- Fever
- Headache
- Trouble sleeping
Most of these side effects are mild to moderate and can be managed with supportive care or dose adjustments. However, some patients may need to stop or interrupt their treatment if they experience severe or intolerable side effects.
What is the Price of Lenalidomide in Different Countries?
Lenalidomide is an expensive drug that may not be covered by all insurance plans or health systems. The price of lenalidomide may vary depending on the country, the supplier, the dosage, and the availability of generic versions. The following table shows some examples of the average price per capsule of lenalidomide in different countries as of October 2023.
| Country | Price per capsule (USD) | Reference |
|---|---|---|
| USA | $719 | Drugs.com |
| Canada | $515 | PharmacyChecker.com |
| UK | $388 | NICE |
| Australia | $283 | PBS |
| India | $5 | Medindia.net |
What are the Top 5 Global Brands of Lenalidomide?
Lenalidomide is marketed under various brand names by different pharmaceutical companies around the world. The following are some of the top 5 global brands of lenalidomide based on their sales revenue in 2022.
- Revlimid: The original and most widely used brand of lenalidomide, developed and marketed by Celgene, a subsidiary of Bristol Myers Squibb. It is approved in more than 70 countries for multiple myeloma, smoldering myeloma, and MDS.
- Lenmid: A generic version of lenalidomide, manufactured and marketed by Cipla, a leading Indian pharmaceutical company. It is available in India and other developing countries at a lower cost than Revlimid.
- Lenangio: Another generic version of lenalidomide, manufactured and marketed by Dr. Reddy’s Laboratories, another major Indian pharmaceutical company. It is also available in India and other emerging markets at an affordable price.
- Lenome: A biosimilar version of lenalidomide, developed and marketed by Mabion, a Polish biotechnology company. It is the first biosimilar of lenalidomide to be approved in Europe for multiple myeloma and MDS.
- Lenzilix: A novel formulation of lenalidomide, developed and marketed by Pharmaxis, an Australian pharmaceutical company. It is designed to improve the bioavailability and tolerability of lenalidomide by using a proprietary technology that enhances the solubility and stability of the drug.
Conclusion
Lenalidomide is a powerful drug that can help treat multiple myeloma and other blood cancers by modulating the immune system and the tumor microenvironment. It can improve the response rate, survival, and quality of life of patients with these diseases. However, it can also cause serious side effects, such as low blood counts, blood clots, second cancers, and birth defects. Therefore, it is important to use lenalidomide under the guidance of a doctor and follow the rules of the Lenalidomide REMS program to ensure safe and effective use of the drug. Lenalidomide is an expensive drug that may not be accessible to all patients due to its high price and limited availability. However, there are some generic and biosimilar versions of lenalidomide that can offer more affordable options for patients in different countries. Lenalidomide is also available under different brand names by different manufacturers around the world.