| Leukemia, Myelocytic, Acute
Nivestym vs Trisenox
Side-by-side clinical, coverage, and cost comparison for leukemia, myelocytic, acute.Deep comparison between: Nivestym vs Trisenox 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 signalsTrisenox has a higher rate of injection site reactions vs Nivestym based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Trisenox but not Nivestym, including UnitedHealthcare
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Category
Nivestym
Trisenox
At A Glance
SC injection or IV infusion
Daily
G-CSF analog
Intravenous
Daily
Arsenical antineoplastic
Indications
- Leukemia, Myelocytic, Acute
- Severe congenital neutropenia
- Cyclic neutropenia
- Idiopathic neutropenia
- Leukemia, Myelocytic, Acute
Dosing
Cancer receiving myelosuppressive chemotherapy, Leukemia, Myelocytic, Acute 5 mcg/kg/day SC injection, short IV infusion (15-30 min), or continuous IV infusion; administer at least 24 hours after cytotoxic chemotherapy; continue daily for up to 2 weeks or until ANC reaches 10,000/mm3 after the expected nadir.
Cancer undergoing bone marrow transplantation 10 mcg/kg/day IV infusion no longer than 24 hours; administer first dose at least 24 hours after cytotoxic chemotherapy and at least 24 hours after bone marrow infusion; titrate against neutrophil response per dosage adjustment table.
Autologous peripheral blood progenitor cell mobilization 10 mcg/kg/day SC injection; administer at least 4 days before first leukapheresis and continue until last leukapheresis; discontinue if WBC rises above 100,000/mm3.
Severe congenital neutropenia 6 mcg/kg SC injection twice daily; individualize based on clinical course and ANC with chronic daily administration.
Cyclic neutropenia, Idiopathic neutropenia 5 mcg/kg SC injection once daily; individualize based on clinical course and ANC with chronic daily administration.
Acute Promyelocytic Leukemia (newly-diagnosed low-risk) Induction: 0.15 mg/kg/day IV daily in combination with tretinoin until bone marrow remission, not to exceed 60 days. Consolidation: 0.15 mg/kg/day IV daily for 5 days per week during weeks 1-4 of each 8-week cycle for 4 cycles in combination with tretinoin.
Acute Promyelocytic Leukemia (relapsed or refractory) Induction: 0.15 mg/kg/day IV daily until bone marrow remission, not to exceed 60 days. Consolidation: 0.15 mg/kg/day IV daily for 25 doses over a period of up to 5 weeks, beginning 3 to 6 weeks after completion of induction.
Contraindications
- History of serious allergic reactions to human granulocyte colony-stimulating factors such as filgrastim products or pegfilgrastim products
- Hypersensitivity to arsenic
Adverse Reactions
Most common (>=5% higher incidence vs placebo) Pyrexia, nausea, fatigue, thrombocytopenia, back pain, bone pain, rash, dizziness, dyspnea, cough, chest pain, arthralgia, pain in extremity, increased blood alkaline phosphatase, increased blood lactate dehydrogenase
Serious Splenic rupture, acute respiratory distress syndrome, serious allergic reactions, sickle cell disorders, glomerulonephritis, alveolar hemorrhage and hemoptysis, capillary leak syndrome, myelodysplastic syndrome, acute myeloid leukemia, thrombocytopenia, leukocytosis, cutaneous vasculitis, aortitis
Postmarketing Anaphylaxis, splenomegaly, Sweet's syndrome, decreased bone density and osteoporosis (pediatric chronic use), extramedullary hematopoiesis
Most common (>=30%) Nausea, cough, fatigue, pyrexia, headache, abdominal pain, vomiting, tachycardia, diarrhea, dyspnea, hypokalemia, leukocytosis, hyperglycemia, hypomagnesemia, insomnia, dermatitis, edema, QTc prolongation, rigors, sore throat, arthralgia, paresthesia, pruritus
Serious Differentiation syndrome, cardiac conduction abnormalities, QTc prolongation, encephalopathy, hepatotoxicity, hyperleukocytosis, atrial dysrhythmias, hyperglycemia
Postmarketing Ventricular tachycardia, torsade de pointes, atrioventricular block, congestive heart failure, deafness, pancytopenia, bone marrow necrosis, peripheral neuropathy, seizures, confusion, encephalopathy, Wernicke's encephalopathy, posterior reversible encephalopathy syndrome, toxic epidermal necrolysis, rhabdomyolysis, melanoma, pancreatic cancer, squamous cell carcinoma
Pharmacology
Filgrastim-aafi is a recombinant G-CSF analog that binds to specific cell surface receptors on hematopoietic cells, stimulating neutrophil progenitor proliferation, differentiation, and end-cell functional activation; its activity is selective for the neutrophil lineage with minimal effects on other hematopoietic cell types.
The mechanism of action is not completely understood. Arsenic trioxide causes morphological changes and DNA fragmentation characteristic of apoptosis in promyelocytic leukemia cells and causes damage or degradation of the PML-RAR-alpha fusion protein.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Nivestym
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (7/12) · Qty limit (0/12)
Trisenox
- Covered on 5 commercial plans
- PA (9/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Nivestym
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Trisenox
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Nivestym
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (1/3) · Qty limit (1/3)
Trisenox
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableAssistance Fund: Acute Myeloid Leukemia
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
Cost estimate not availableHealthWell: Acute Myeloid Leukemia
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.