| Cushing Syndrome
Korlym vs Recorlev
Side-by-side clinical, coverage, and cost comparison for cushing syndrome.Deep comparison between: Korlym vs Recorlev with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsRecorlev has a higher rate of injection site reactions vs Korlym based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Recorlev but not Korlym, including UnitedHealthcare
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Category
Korlym
Recorlev
At A Glance
Oral
Once daily
Glucocorticoid receptor antagonist
Oral
Twice daily
Cortisol synthesis inhibitor
Indications
- Cushing Syndrome
- Hyperglycemia
- Cushing Syndrome
Dosing
Cushing Syndrome, Hyperglycemia Starting dose 300 mg orally once daily with a meal; titrate in 300 mg increments no more frequently than every 2-4 weeks to a maximum of 1200 mg once daily (not to exceed 20 mg/kg per day); maximum 600 mg in renal or mild-to-moderate hepatic impairment; maximum 900 mg with concomitant strong CYP3A inhibitors.
Cushing Syndrome Initiate at 150 mg orally twice daily; titrate by 150 mg daily no more frequently than every 2-3 weeks based on 24-hour urine free cortisol levels and tolerability; maximum 1200 mg per day (600 mg twice daily).
Contraindications
- Pregnancy
- Concomitant use of CYP3A substrates with narrow therapeutic ranges, including simvastatin, lovastatin, cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus
- Concurrent systemic corticosteroids required for lifesaving purposes (e.g., immunosuppression after organ transplantation)
- History of unexplained vaginal bleeding or endometrial hyperplasia with atypia or endometrial carcinoma
- Known hypersensitivity to mifepristone or any product component
- Cirrhosis, acute liver disease, poorly controlled chronic liver disease, baseline AST or ALT >3x ULN, recurrent symptomatic cholelithiasis, prior drug-induced liver injury due to ketoconazole or any azole antifungal requiring discontinuation, or extensive metastatic liver disease
- Concomitant use of drugs that cause QT prolongation associated with ventricular arrhythmias, including torsades de pointes
- QTcF interval >470 msec at baseline, or history of torsades de pointes, ventricular tachycardia, ventricular fibrillation, or long QT syndrome (including first-degree family history)
- Known hypersensitivity to levoketoconazole, ketoconazole, or any excipient in RECORLEV
- Concomitant use of certain sensitive substrates of CYP3A4 or CYP3A4 and P-gp
Adverse Reactions
Most common (>=20%) nausea, fatigue, headache, decreased blood potassium, arthralgia, vomiting, peripheral edema, hypertension, dizziness, decreased appetite, endometrial hypertrophy
Postmarketing angioedema
Most common (>=10%) Nausea/vomiting, hypokalemia, systemic hypertension, hemorrhage/contusion, headache, abnormal uterine bleeding, arrhythmia, fatigue, upper respiratory infection, abdominal pain/dyspepsia, dizziness, diarrhea, decreased appetite, dry mouth, dry skin, adrenal insufficiency
Serious Hepatotoxicity, QT prolongation, hypocortisolism, hypersensitivity reactions, decreased testosterone
Postmarketing Thrombocytopenia, adrenocortical insufficiency, serious hepatotoxicity (hepatitis cholestatic, hepatic necrosis, cirrhosis, hepatic failure), anaphylactic shock, anaphylactic reaction, angioneurotic edema, reversible intracranial pressure increased, erectile dysfunction, azoospermia, acute generalized exanthematous pustulosis, photosensitivity
Pharmacology
Glucocorticoid receptor (GR-II) antagonist; mifepristone selectively blocks GR-II, antagonizing cortisol effects at the receptor level while driving compensatory increases in circulating cortisol via HPA axis feedback, and also acts as a progesterone receptor antagonist at lower doses.
Levoketoconazole is a cortisol synthesis inhibitor that blocks key steroidogenic enzymes (CYP11B1, CYP11A1, CYP17A1) involved in cortisol and testosterone biosynthesis; it is the 2S,4R-enantiomer of racemic ketoconazole and a strong CYP3A4 inhibitor and P-gp, OCT2, and MATE1 transporter inhibitor in vivo.
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Most Common Insurance
Anthem BCBS
Korlym
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (9/12)
Recorlev
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (9/12)
UnitedHealthcare
Korlym
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Recorlev
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Korlym
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Recorlev
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Cushing's Disease or Cushing's Syndrome
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
Cost estimate not availableHealthWell: Cushing's Disease or Cushing's Syndrome
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.