ASH Clinical News ACN_4.13_full issue_Web | Page 55

FEATURE a clinician is practicing medicine) and three are internal factors (related to personal skills, abilities, and roles). 6 See a detailed diagram of the NAM’s framework in the FIGURE on page 55. Many organizations have shifted their approach to burnout to address its external causes, like sociocultural, regulatory, business, payer, and organizational factors. Hospitals also are providing more on-site oppor- tunities for clinicians to practice self-care, like exercise machines, time-out rooms, and gardens. Dr. Singavi, for one, is searching for alternatives to resilience training and an approach that avoids the implication that individual practitioners need “fixing.” “If you keep punching me, but then you give me Tylenol for the pain and tell me, ‘This is how it’s going to get better,’ I don’t think that’s the answer,” he said. “The answer is you need to stop punching me. Prevention is worth way more than treatment.” Literature on the topic of burnout tends to focus on the efficacy and application of individual interventions, such as communication-skills training; facilitated and nonfacilitated small-group curricula; and mindfulness, “If you look at things from a policy standpoint, it’s scary that physicians are not feeling happy or healthy.” Important Safety Information Warnings and Precautions • Hypertension can occur with TAVALISSE treatment. Patients with pre-existing hypertension may be more susceptible to the hypertensive effects. Monitor blood pressure every 2 weeks until stable, then monthly, and adjust or initiate antihypertensive therapy for blood pressure control maintenance during therapy. If increased blood pressure persists, TAVALISSE interruption, reduction, or discontinuation may be required. • Elevated liver function tests (LFTs), mainly ALT and AST, can occur with TAVALISSE. Monitor LFTs monthly during treatment. If ALT or AST increase to >3 x upper limit of normal, manage hepatotoxicity using TAVALISSE interruption, reduction, or discontinuation. • Diarrhea occurred in 31% of patients and severe diarrhea occurred in 1% of patients treated with TAVALISSE. Monitor patients for the development of diarrhea and manage using supportive care measures early after the onset of symptoms. If diarrhea becomes severe (≥Grade 3), interrupt, reduce dose or discontinue TAVALISSE. • Neutropenia occurred in 6% of patients treated with TAVALISSE; febrile neutropenia occurred in 1% of patients. Monitor the ANC monthly and for infection during treatment. Manage toxicity with TAVALISSE interruption, reduction, or discontinuation. • TAVALISSE can cause fetal harm when administered to pregnant women. Advise pregnant women the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment and for at least 1 month after the last dose. Verify pregnancy status prior to initiating TAVALISSE. It is unknown if TAVALISSE or its metabolite is present in human milk. Because of the potential for serious adverse reactions in a breastfed child, advise a lactating woman not to breastfeed during TAVALISSE treatment and for at least 1 month after the last dose. Drug Interactions • Concomitant use of TAVALISSE with strong CYP3A4 inhibitors increases exposure to the major active metabolite of TAVALISSE (R406), which may increase the risk of adverse reactions. Monitor for toxicities that may require a reduction in TAVALISSE dose. • It is not recommended to use TAVALISSE with strong CYP3A4 inducers, as concomitant use reduces exposure to R406. • Concomitant use of TAVALISSE may increase concentrations of some CYP3A4 substrate drugs and may require a dose reduction of the CYP3A4 substrate drug. • Concomitant use of TAVALISSE may increase concentrations of BCRP substrate drugs (eg, rosuvastatin) and P-Glycoprotein (P-gp) substrate drugs (eg, digoxin), which may require a dose reduction of the BCRP and P-gp substrate drug. Adverse Reactions TAVALISSE presents an opportunity to provide your patients with a targeted defense • Serious adverse drug reactions in the ITP double-blind studies were febrile neutropenia, diarrhea, pneumonia, and hypertensive crisis, which occurred in 1% of TAVALISSE patients. In addition, severe adverse reactions occurred including dyspnea and hypertension (both 2%), neutropenia, arthralgia, chest pain, diarrhea, dizziness, nephrolithiasis, pain in extremity, toothache, syncope, and hypoxia (all 1%). • Common adverse reactions (≥5% and more common than placebo) from FIT-1 and FIT-2 included: diarrhea, hypertension, nausea, dizziness, ALT and AST increased, respiratory infection, rash, abdominal pain, fatigue, chest pain, and neutropenia. Please see Brief Summary of full Prescribing Information on following page or visit TAVALISSE.com for full Prescribing Information. To report side effects of prescription drugs to the FDA, visit www.fda.gov/medwatch or call 1-800-FDA-1088 (1-800-332-1088). Reference: 1. TAVALISSE™ [package insert]. South San Francisco, CA: Rigel Pharmaceuticals, Inc.; 2018. A novel agent that addresses an unmet need in chronic ITP treatment 1 Clinical benefi t demonstrated in pivotal trials 1 Convenience of an oral medication that can be taken with or without food 1 © 2018 Rigel Pharmaceuticals, Inc. All rights reserved. TAVA_ITP-18342 0918 TAVALISSE is a trademark of Rigel Pharmaceuticals, Inc. PROTECTING PLATELETS. DEFENDING PATIENTS. —NISHA MEHTA, MD