For doctors

What is it?

Vidaza is a powder to be made up into a suspension for injection. It contains the active substance azacitidine.

What is it used for?

Vidaza is used for the treatment of adults with the following diseases, if they cannot have a bone marrow transplant:
- myelodysplastic syndromes, a group of conditions where too few blood cells are produced by the bone marrow. In some cases, myelodysplastic syndromes can lead to the development of acute myeloid leukaemia (AML, a type of cancer affecting white blood cells called myeloid cells). Vidaza is used in patients with an intermediate to high risk of progressing to AML or death; - chronic myelomonocytic leukaemia (CMML, a type of cancer affecting white blood cells called monocytes). Vidaza is used when the bone marrow consists of 10 to 29% abnormal cells and the bone marrow is not producing large numbers of white blood cells;
- AML that has developed from a myelodysplastic syndrome. Vidaza is only used when the bone marrow consists of 20 to 30% abnormal cells.
Because the number of patients with these diseases is low, the diseases are considered ‘rare’, and Vidaza was designated an ‘orphan medicine’ (a medicine used in rare diseases) on 6 February 2002 for myelodysplastic syndromes and on 29 November 2007 for AML. At the time of orphan medicine designation, CMML was classified as a type of myelodysplastic syndrome.
The medicine can only be obtained with a prescription.

How is it used?

Vidaza treatment should be started and monitored under the supervision of a doctor who has experience in the use of chemotherapy. Patients should receive medicines to prevent nausea (feeling sick) and vomiting before Vidaza treatment.
The recommended starting dose of Vidaza is 75 mg per square metre body surface area (calculated using the patient’s height and weight). It is given as an injection under the skin of the upper arm, thigh or abdomen (tummy) every day for one week, followed by three weeks with no treatment. This four-week period is one ‘cycle’. Treatment continues for at least six cycles and then for as long as it benefits the patient. The liver, kidneys and blood should be checked before each cycle. If the blood counts fall too low or if the patient develops kidney problems, the next treatment cycle should be delayed or a lower dose should be used. Patients who have severe liver problems should be carefully monitored for side effects, but Vidaza must not be used in patients with advanced liver cancer.

See the Summary of Product Characteristics (also part of the EPAR) for full details.

How does it work?

The active substance in Vidaza, azacitidine, is a medicine belongs to the group ‘anti-metabolites’. Azacitidine is an analogue of cytidine, which means that it is incorporated into the genetic material of cells (RNA and DNA). It is thought to work by altering the way the cell turns genes on and off and also by interfering with the production of new RNA and DNA. These actions are thought to correct the problems with the maturation and growth of young blood cells in the bone marrow that cause myelodysplastic disorders, and to kill cancerous cells in leukaemia.

How has it been studied?

The effects of Vidaza were first tested in experimental models before being studied in humans. Vidaza has been studied in one main study involving 358 adults with intermediate to high-risk myelodysplastic syndromes, CMML or AML, who were unlikely to go on to have a bone marrow transplant. The patients’ bone marrow contained 10 to 29% abnormal cells and their white blood cell counts were not too high. The study compared Vidaza with conventional care (treatment chosen for each patient based on local practice and the patient’s condition). All of the patients also received ‘best supportive care’ (any medicines or techniques to help patients, such as antibiotics, painkillers and transfusions), with some patients also receiving other anticancer medicines such as cytarabine with or without an anthracycline. The main measure of effectiveness was how long the patients survived. The study lasted 44 months.

What benefits has it shown during the studies?

Vidaza was more effective than conventional care in extending survival. Patients receiving Vidaza survived for an average of 24.5 months, compared with 15.0 months in patients receiving conventional care. The effect of Vidaza was similar in all three diseases.

What is the risk associated?

The most common side effects with Vidaza (seen in more than 60% of patients) are blood reactions including thrombocytopenia (low platelet counts), neutropenia (low levels of neutrophils, a type of white blood cell) and leucopenia (low white blood cell counts), side effects affecting the stomach and gut including nausea and vomiting, and injection site reactions. For the full list of all side effects reported with Vidaza, see the Package Leaflet.
Vidaza should not be used in people who may be hypersensitive (allergic) to azacitidine or any of the other ingredients. It must not be used in patients with advanced liver cancer or in women who are breast-feeding.

Why has it been approved?

The Committee for Medicinal Products for Human Use (CHMP) decided that Vidaza’s benefits are greater than its risks for the treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with intermediate-2 and high-risk myelodysplastic syndromes, CMML with 10-29% abnormal blasts without myeloproliferative disorder or AML with 20-30% blasts and multilineage dysplasia. The Committee recommended that Vidaza be given marketing authorisation.

Further information

The European Commission granted a marketing authorisation valid throughout the European Union for Vidaza to Celgene Europe Ltd on 17 December 2008.

The records of Vidaza’s designations as an orphan medicine are available here (myelodysplastic syndromes) and here (AML).

Name

Vidaza 25 mg/ml powder for suspension for injection

Composition

Each vial contains 100 mg azacitidine. After reconstitution, each ml suspension contains 25 mg azacitidine.

For a full list of excipients, see section 6.1.

Pharmaceutical Form

Powder for suspension for injection.

White lyophilised powder.