Daratumumab (Darzalex) is a targeted and highly potent medicine for the treatment of multiple myeloma. It binds to CD 38 positive myeloma cells and inhibits the growth of these cancer cells.

Daratumumab is available under the brand name Darzalex. 

Because it is one of the potent novel biological medicine and highly targeted therapy, it is associated with a better treatment response compared to conventional therapy.

Darzalex is costly and most people in Pakistan can not afford it. Even the ex-president of Pakistan, President Pervaiz Musharraf, had to get it from Dubai.

Daratumumab (Darzalex) Uses and Dosing:

It is available as an injection in dosage concentrations of:

• 100 mg/5 ml injection vial
• 400 mg/20 ml injection vial

Daratumumab (Darzalex) is indicated in the treatment of multiple myeloma at all the stages in different regimens and combinations as:

• Newly diagnosed multiple myeloma with melphalan, prednisone, and bortezomib in patients not candidates for HSCT.
• In retreatment, relapsed, or refractory cases.

In refractory or relapsed cases, the treatment regimens depend on how many treatment regimens have been tried before initiating Daratumumab treatment.

In patients previously treated with one kind of myeloma treatment regimen:

• Daratumumab
• Dexamethasone
• Bortezomib or Lenalidomide

In patients who have been treated and failed two prior therapies:

• Daratumumab
• Pomalidomide
• Dexamethasone 

In patients who have failed three prior therapies:

• Daratumumab as monotherapy

Daratumumab (Darzalex) is administered in doses of 16 mg/kg.

The dosing interval depends on the treatment regimen and is given in detail here: How to administer Daratumumab (Darzalex).

Daratumumab Precautions:

It is important to pre-medicate all patients before the infusion is started. In addition, Daratumumab (Darzalex) is not indicated in patients with liver dysfunction.

Daratumumab (Darzalex) also causes bone marrow suppression.

It is important to watch for cytopenias and practice barrier nursing so as to prevent the patient from opportunistic infections.

Infusion reactions may occur while the drug is infused. These reactions may be serious and life-threatening. Pre-medication and close monitoring is recommended while the drug is administered. In addition, the patient should also be monitored after the infusion as delayed reactions may occur.

The concomitant use of Cladribine, Deferiprone, and Dipyrone is also contraindicated while on Daratumumab (Darzalex) therapy.

Daratumumab (Darzalex) in Pakistan:

Daratumumab (Darzalex) is not registered in Pakistan. However, people who are highly in need of this medicine and for whom it can be life-saving, arrange it from other countries. 

Until the government allows its registration, people have to face difficulties in arranging it. It can be arranged on a humanitarian basis after writing to DRAP for highly needy persons.