Inqovi (decitabine and cedazuridine) vs Bosulif (bosutinib)

Inqovi (decitabine and cedazuridine) is a combination of two drugs used for the treatment of myelodysplastic syndromes (MDS), a group of bone marrow disorders, and chronic myelomonocytic leukemia (CMML), whereas Bosulif (bosutinib) is a tyrosine kinase inhibitor indicated for the treatment of chronic myelogenous leukemia (CML), a different type of blood and bone marrow cancer. Inqovi is administered orally as a tablet, providing a convenient at-home treatment option that was previously available only as an intravenous therapy, while Bosulif is also an oral medication but specifically targets the BCR-ABL tyrosine kinase that is characteristic of CML. The choice between Inqovi and Bosulif would depend on the specific diagnosis and genetic characteristics of the patient's leukemia, as well as other individual health factors, and should be made in consultation with a healthcare provider who specializes in hematologic malignancies.

Difference between Inqovi and Bosulif

Metric	Inqovi (decitabine and cedazuridine)	Bosulif (bosutinib)
Generic name	Decitabine and cedazuridine	Bosutinib
Indications	Treatment of myelodysplastic syndromes (MDS) including chronic myelomonocytic leukemia (CMML)	Chronic myelogenous leukemia (CML)
Mechanism of action	Hypomethylating agent (decitabine) and cytidine deaminase inhibitor (cedazuridine)	Tyrosine kinase inhibitor
Brand names	Inqovi	Bosulif
Administrative route	Oral	Oral
Side effects	Fatigue, constipation, hemorrhage, myalgia, mucositis, arthralgia, nausea, dyspnea, diarrhea, rash, dizziness, febrile neutropenia, edema, headache, cough, decreased appetite, upper respiratory tract infection, pneumonia, and transaminase increased	Diarrhea, nausea, thrombocytopenia, rash, increased alanine aminotransferase, abdominal pain, fever, fatigue, vomiting, cough, and edema
Contraindications	Known hypersensitivity to decitabine or cedazuridine	Hypersensitivity to bosutinib or any component of the formulation
Drug class	Hypomethylating agent, Cytidine deaminase inhibitor	Tyrosine kinase inhibitor
Manufacturer	Astellas Pharma US, Inc.	Pfizer Inc.

Efficacy

Inqovi (decitabine and cedazuridine) for Leukemia

Inqovi, which combines decitabine and cedazuridine, is a treatment specifically approved for adult patients with myelodysplastic syndromes (MDS), including previously treated and untreated, de novo and secondary MDS with various French-American-British (FAB) classifications, and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System (IPSS) groups. MDS can be considered a form of cancer that often progresses to acute myeloid leukemia (AML). The efficacy of Inqovi was established based on the results of two open-label, randomized, crossover trials. These trials demonstrated that Inqovi was equivalent to intravenous decitabine in terms of drug exposure and pharmacokinetic parameters, with the added benefit of oral administration.

Patients treated with Inqovi showed hematologic improvement and transfusion independence in clinical trials. The treatment's efficacy is measured by complete remission (CR) rates, duration of CR, and overall survival. In clinical studies, Inqovi has shown to induce CR in a significant proportion of patients with MDS, which is an important factor in improving patient outcomes and potentially delaying the progression to AML.

Bosulif (bosutinib) for Leukemia

Bosulif, also known as bosutinib, is a tyrosine kinase inhibitor approved for the treatment of adult patients with chronic, accelerated, or blast phase Philadelphia chromosome-positive chronic myelogenous leukemia (Ph+ CML) with resistance or intolerance to prior therapy. The efficacy of Bosulif for chronic phase CML was demonstrated in a single-arm trial that enrolled patients with resistance or intolerance to previous treatments. The primary efficacy endpoint was the major cytogenetic response (MCyR) rate at 24 weeks, and Bosulif achieved this endpoint in a significant percentage of patients.

In the accelerated and blast phases of CML, Bosulif's efficacy was evaluated based on hematologic and cytogenetic response rates. The drug has shown to induce hematologic and cytogenetic responses in a subset of patients, which are critical for disease control and progression. The duration of these responses and overall survival are important measures of efficacy in these more advanced stages of CML. Overall, Bosulif has been a valuable addition to the treatment options for patients with Ph+ CML, especially for those who have not responded to or cannot tolerate other therapies.

Regulatory Agency Approvals

Inqovi

Food and Drug Administration (FDA), USA
Health Canada

Bosulif

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

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