Onureg (azacitidine) vs Ezharmia (valemetostat tosilate)

Onureg (azacitidine) vs Ezharmia (valemetostat tosilate)

Onureg (azacitidine) is a nucleoside metabolic inhibitor approved by the FDA for the continued treatment of adult patients with acute myeloid leukemia (AML) who achieved first complete remission (CR) or complete remission with incomplete blood count recovery (CRi) following intensive induction chemotherapy and are not able to complete intensive curative therapy. Ezharmia (valemetostat tosilate), on the other hand, is an investigational, orally bioavailable, selective dual inhibitor of the EZH1 and EZH2 histone methyltransferases, which are being studied for the treatment of various malignancies, including adult T-cell leukemia/lymphoma (ATL), but as of the knowledge cutoff in 2023, it has not been approved for any indication. When deciding between the two, it is crucial to consider the specific type of cancer being treated, the approval status of the medication, and the guidance of a healthcare professional who can assess the individual's overall health condition and treatment goals.

Difference between Onureg and Ezharmia

Metric Onureg (azacitidine) Ezharmia (valemetostat tosilate)
Generic name Azacitidine Valemetostat tosilate
Indications Acute myeloid leukemia (AML) T-cell lymphoma
Mechanism of action Hypomethylating agent EZH1/2 dual inhibitor
Brand names Onureg Ezharmia
Administrative route Oral Unknown
Side effects Nausea, vomiting, constipation, fatigue, etc. Currently under investigation
Contraindications Advanced malignant hepatic tumors, hypersensitivity to azacitidine or mannitol Unknown
Drug class Nucleoside metabolic inhibitor Epigenetic modifier
Manufacturer Bristol Myers Squibb Daiichi Sankyo

Efficacy

Onureg (Azacitidine) Efficacy in Leukemia

Onureg (azacitidine) is a hypomethylating agent that has shown efficacy in treating acute myeloid leukemia (AML), particularly in patients who are in remission but unable to undergo intensive induction chemotherapy. Azacitidine is a chemical analog of cytidine, which integrates into RNA and DNA, causing hypomethylation of DNA and cytotoxic effects on abnormal hematopoietic cells in the bone marrow. The efficacy of Onureg in AML was demonstrated in a pivotal phase III clinical trial, which showed that maintenance therapy with azacitidine significantly improved overall survival compared to placebo in patients with AML in first remission following induction chemotherapy.

Patients treated with Onureg experienced a median overall survival of 24.7 months compared to 14.8 months for those receiving placebo. Additionally, azacitidine has been associated with a delay in relapse of AML, underlining its role in prolonging the duration of remission. These results have established Onureg as a valuable treatment option for AML patients who are not candidates for stem cell transplantation.

Ezharmia (Valemetostat Tosilate) Efficacy in Leukemia

Ezharmia (valemetostat tosilate) is an investigational agent that is being studied for its efficacy in treating various types of leukemia, including acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Valemetostat tosilate is a dual inhibitor of EZH1 and EZH2, which are enzymes involved in histone methylation, a key process in the regulation of gene expression. By inhibiting these enzymes, valemetostat tosilate is thought to exert anti-tumor effects by reactivating silenced tumor suppressor genes and inducing apoptosis in malignant cells.

While clinical data on valemetostat tosilate is still emerging, early-phase trials have indicated potential efficacy in the treatment of relapsed or refractory hematological malignancies, including leukemia. The agent has shown a manageable safety profile and signs of anti-leukemic activity in these patient populations. However, more extensive clinical trials are required to fully establish the efficacy and safety of Ezharmia in the treatment of leukemia, and it remains an investigational drug at this stage.

Regulatory Agency Approvals

Onureg
  • Food and Drug Administration (FDA), USA
Ezharmia
  • Pharmaceuticals and Medical Devices Agency (PMDA), Japan

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If Onureg or Ezharmia are not approved or available in your country (e.g. due to supply issues), you can access them via Everyone.org.

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