Basic Information
ID DDInter2032 and DDInter2259
Interaction Concomitant use of efgartigimod alfa may decrease the plasma concentrations and therapeutic effects of medications that bind to the human neonatal Fc receptor (FcRn) such as immune globulins, monoclonal antibodies, or antibody derivates containing the human Fc domain of the IgG subclass (e.g., abatacept, aflibercept, asfotase alfa, belatacept, dulaglutide, etanercept, luspatercept, rilonacept, romiplostim, and some recombinant coagulation factors). Efgartigimod alfa blocks the human FcRn, a widely expressed receptor that plays a critical role in recycling and maintaining homeostatic levels of circulating IgG and other antibodies by preventing their cellular degradation.
Management The potential for reduced effectiveness of medications that bind to the human neonatal Fc receptor should be considered during concomitant treatment with efgartigimod alfa. When long-term use of such medications is required, consider discontinuing efgartigimod alfa and using alternative therapies.
References [1] "Product Information. Vyvgart (efgartigimod alfa)." argenx US Inc. (2022):
Alternative for Efgartigimod alfa -
Alternative for Erenumab N02C
Frovatriptan Dihydroergotamine Rimegepant Lasmiditan Atogepant Eletriptan
Rizatriptan Ubrogepant Ergotamine Clonidine Naratriptan
More
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.