Version May 2024
Ulcerative colitis: Note: Prior to initiation, age-appropriate vaccinations should be up to date; in general, do not administer live vaccines within 4 weeks prior to starting therapy. Before, during, and after treatment, specific testing and monitoring is advised.
Oral: 2 mg once daily.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Hepatic impairment prior to treatment initiation
Child-Turcotte-Pugh Class A and B: No dosage adjustment necessary.
Child-Turcotte-Pugh Class C: Use not recommended.
Acute hepatotoxicity during treatment
Discontinue treatment if etrasimod-related significant liver injury is confirmed.
Macular edema: Discontinue treatment if macular edema develops.
Posterior reversible encephalopathy syndrome: Discontinue treatment if posterior reversible encephalopathy syndrome is suspected.
Progressive multifocal leukoencephalopathy: Discontinue treatment if progressive multifocal leukoencephalopathy is confirmed.
Serious infection: Consider interrupting therapy if serious infection occurs.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults.
>10%: Infection: Infection (14% to 25%)
1% to 10%:
Cardiovascular: Bradycardia (≤3%), hypertension (3%)
Endocrine & metabolic: Hypercholesterolemia (3%)
Gastrointestinal: Nausea (3% to 4%)
Genitourinary: Urinary tract infection (3%)
Hematologic & oncologic: Lymphocytopenia (≤6%)
Hepatic: Increased liver enzymes (5% to 6%; including cholestasis, hyperbilirubinemia, increased gamma-glutamyl transferase, increased serum alanine aminotransferase [3% to 5%], increased serum aspartate aminotransferase)
Infection: Herpes virus infection (2%; herpes zoster infection: <1%)
Nervous system: Dizziness (5%), headache (6% to 9%)
Neuromuscular & skeletal: Arthralgia (4%)
Ophthalmic: Decreased visual acuity (3%)
<1%: Cardiovascular: First-degree atrioventricular block, Mobitz type I second-degree atrioventricular block
Frequency not defined: Respiratory: Reduced forced expiratory volume
History of myocardial infarction, unstable angina pectoris, stroke, transient ischemic attack, decompensated heart failure requiring hospitalization, or class III or IV heart failure in the last 6 months; history or presence of Mobitz type II second-degree or third-degree atrioventricular block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemaker.
Concerns related to adverse effects:
• Immune reconstitution inflammatory syndrome: Immune reconstitution inflammatory syndrome (IRIS) has been reported in patients with multiple sclerosis receiving sphingosine 1-phosphate (S1P) modulators who subsequently discontinued treatment due to progressive multifocal leukoencephalopathy (PML). Onset occurred within a few months of discontinuation. IRIS presents as a clinical neurological decline and complications, which may be rapid and life-threatening.
• Increased BP: Patients receiving etrasimod had an average increase in systolic BP of 1 to 4 mm Hg and diastolic of 1 to 2 mm Hg, which occurred at around 2 weeks of therapy.
• Infections: Etrasimod reduces peripheral blood lymphocyte counts by ~45% from baseline secondary to sequestering of cells in lymphoid tissues, which may persist up to 5 weeks after discontinuation and can increase the risk of life-threatening and rare fatal infections.
- Opportunistic fungal infections: Cases of fatal cryptococcal meningitis and disseminated cryptococcus have been reported with S1P modulators.
- Opportunistic viral infections: Patients receiving etrasimod are at an increased risk of activation of latent viral infections, including John Cunningham virus (JCV), herpes simplex, and varicella zoster. Activation of JCV may result in PML, a rare and potentially fatal condition affecting the CNS. Herpes simplex encephalitis, varicella zoster meningitis, and localized herpes viral infections have been reported in patients using S1P receptor modulators.
• Liver injury: Elevations in alanine transaminase (3 × ULN) have occurred in patients who received etrasimod.
• Macular edema: S1P receptor modulators have been associated with an increased risk of macular edema. Macular edema can, over an extended period of time (eg, 6 months), lead to permanent visual loss.
• Malignancy: Cases of malignancies have been reported in patients treated with S1P receptor modulators. Specifically, cases of skin cancer have been reported with the use of S1P receptor modulators.
• Posterior reversible encephalopathy syndrome: Rare cases of posterior reversible encephalopathy syndrome (PRES) have been reported with the use of S1P receptor modulators. PRES symptoms include neurologic or psychologic symptoms (eg cognitive deficits, behavioral changes, cortical visual disturbances, other neurological cortical signs/symptoms) consistent with increased intracranial pressure or accelerated neurological deterioration. Symptoms are usually reversible but may progress to an ischemic stroke, cerebral hemorrhage, or permanent neurological sequelae.
• Progressive multifocal leukoencephalopathy and associated sequelae: Cases of PML have been reported in patients with multiple sclerosis taking S1P receptor modulators. Symptoms of PML include progressive weakness on one side of the body, clumsiness of the limbs, disturbance of vision, thinking, memory, or orientation leading to confusion and personality changes. IRIS has been reported in patients with multiple sclerosis receiving S1P modulators who subsequently discontinued treatment due to PML. Onset occurred within a few months of discontinuation. IRIS presents as a clinical neurological decline and complications, which may be rapid and life-threatening.
• Respiratory effects: Reduction in FEV1 was observed during use of etrasimod. Reduction in FEV1 occurred as early as 3 months after treatment initiation; it is unknown if this reduction is reversible with etrasimod discontinuation.
Concurrent drug therapy issues:
• Prior or concurrent treatment with antineoplastic, immune-modulating, or noncorticosteroid immunosuppressive therapy: Etrasimod use has not been evaluated in combination with other immunosuppressive agents and use should be avoided in the weeks following use of etrasimod secondary to the additive immunosuppressive effects.
Special populations:
• Cardiovascular: Initiation of etrasimod may result in a transient decrease in heart rate or atrioventricular (AV) conduction delays. Consult with a cardiologist before initiating therapy in individuals with preexisting QT prolongation (QTcF ≥450 msec in males; ≥470 msec in females); arrhythmias requiring treatment with class Ia or class III antiarrhythmic drugs or other QT-prolonging drugs; history of resting heart rate <50 beats per minute or symptomatic bradycardia, recurring cardiogenic syncope, or severe untreated sleep apnea; history of unstable ischemic heart disease, class I or II heart failure, history of cardiac arrest, cerebrovascular disease, or uncontrolled hypertension; or individuals with Mobitz type I second-degree AV block without a functioning pacemaker.
• CYP2C9 poor metabolizers: CYP2C9 poor metabolizers are expected to have increased exposure to etrasimod; concomitant use of moderate to strong inhibitors of CYP2C8 or CYP3A4 will further increase etrasimod exposure and should be avoided.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral, as arginine:
Velsipity: 2 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c blue #2 (indigo carm) aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake]
No
Tablets (Velsipity Oral)
2 mg (per each): $246.58
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Swallow whole, with or without food.
An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:
Velsipity: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/216956s000lbl.pdf#page=24
Ulcerative colitis: Treatment of moderately to severely active ulcerative colitis in adults.
Substrate of CYP2C19 (minor), CYP2C8 (minor), CYP2C9 (minor), CYP2J2 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Adagrasib: May increase the serum concentration of Etrasimod. Risk X: Avoid combination
Baricitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination
BCG Products: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination
Bradycardia-Causing Agents: Etrasimod may enhance the bradycardic effect of Bradycardia-Causing Agents. Risk C: Monitor therapy
Brincidofovir: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy
Brivudine: May enhance the adverse/toxic effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Ceritinib: Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Risk D: Consider therapy modification
Chikungunya Vaccine (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Chikungunya Vaccine (Live). Risk X: Avoid combination
Cladribine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination
Coccidioides immitis Skin Test: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing therapeutic immunosuppressants several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification
Corticosteroids (Systemic): May enhance the immunosuppressive effect of Etrasimod. Risk C: Monitor therapy
COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification
COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy
COVID-19 Vaccine (mRNA): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification
COVID-19 Vaccine (Subunit): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy
COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy
Dengue Tetravalent Vaccine (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination
Denosumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Denosumab. Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and immunosuppressants. If combined, monitor for signs/symptoms of serious infections. Risk D: Consider therapy modification
Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Fexinidazole: Bradycardia-Causing Agents may enhance the arrhythmogenic effect of Fexinidazole. Risk X: Avoid combination
Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Fluconazole: May increase the serum concentration of Etrasimod. Risk X: Avoid combination
Haloperidol: QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of Haloperidol. Risk C: Monitor therapy
Immunosuppressants (Cytotoxic Chemotherapy): Etrasimod may enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Immunosuppressants (Miscellaneous Oncologic Agents): Etrasimod may enhance the immunosuppressive effect of Immunosuppressants (Miscellaneous Oncologic Agents). Risk X: Avoid combination
Immunosuppressants (Therapeutic Immunosuppressant Agents): Etrasimod may enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Influenza Virus Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating immunosuppressants if possible. If vaccination occurs less than 2 weeks prior to or during therapy, revaccinate 2 to 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification
Ivabradine: Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. Risk C: Monitor therapy
Lacosamide: Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide. Risk C: Monitor therapy
Methotrexate: Etrasimod may enhance the immunosuppressive effect of Methotrexate. Risk X: Avoid combination
Midodrine: May enhance the bradycardic effect of Bradycardia-Causing Agents. Risk C: Monitor therapy
MiFEPRIStone: May increase the serum concentration of Etrasimod. Risk X: Avoid combination
Nadofaragene Firadenovec: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid combination
Natalizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination
Pidotimod: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy
Pimecrolimus: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Pimecrolimus. Risk X: Avoid combination
Pneumococcal Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy
Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination
Polymethylmethacrylate: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification
QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy
Rabies Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification
RifAMPin: May decrease the serum concentration of Etrasimod. Risk X: Avoid combination
Ritlecitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Ritlecitinib. Risk X: Avoid combination
Ruxolitinib (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination
Sipuleucel-T: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification
Tacrolimus (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination
Talimogene Laherparepvec: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination
Tertomotide: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination
Tofacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Tofacitinib. Management: Coadministration of tofacitinib with potent immunosuppressants is not recommended. Use with non-biologic disease-modifying antirheumatic drugs (DMARDs) was permitted in psoriatic arthritis clinical trials. Risk X: Avoid combination
Typhoid Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination
Upadacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination
Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider therapy modification
Vaccines (Live): Etrasimod may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Etrasimod may diminish the therapeutic effect of Vaccines (Live). Risk X: Avoid combination
Yellow Fever Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination
Patients who may become pregnant should use effective contraception during therapy and for 1 week after the last etrasimod dose; patients should be counseled on the potential for serious risks to the fetus should pregnancy occur during therapy.
Agents other than etrasimod are preferred to treat inflammatory bowel disease in patients planning to become pregnant. Disease management should be optimized prior to pregnancy (Mahadevan 2019).
Based on data from animal reproduction studies, in utero exposure to etrasimod may cause fetal harm.
Inflammatory bowel disease is associated with adverse pregnancy outcomes, including an increased risk of miscarriage, premature delivery, delivery of a low-birth-weight infant, and poor maternal weight gain. Management of maternal disease should be optimized prior to pregnancy. When treatment for inflammatory bowel disease is needed in pregnant patients, agents other than etrasimod are preferred (Mahadevan 2019).
Data collection to monitor pregnancy and infant outcomes following exposure to etrasimod is ongoing. Health care providers are encouraged to enroll patients exposed to etrasimod during pregnancy in the pregnancy registry (1-800-616-3791).
It is not known if etrasimod is present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother (Mahadevan 2019).
Before initiating therapy: Obtain an EKG and cardiology assessment if needed, CBC with differential within the last 6 months or after discontinuation of prior ulcerative colitis therapy; varicella zoster antibodies and appropriate vaccination if needed to ensure active immunity; administer age-appropriate vaccinations; if live attenuated vaccines are needed, these should be administered at least 4 weeks prior to initiation of therapy, liver chemistries within the last 6 months; baseline eye exam with fundus and macula evaluation; vital signs; baseline assessment for presence of malignancies, especially skin cancer.
While on therapy: Monitor for signs and symptoms of infections, including opportunistic infections; obtain liver chemistries if hepatic dysfunction suspected; periodic eye exams and assessment for macular edema if vision changes occur; vital signs; periodic assessment for malignancies (eg, skin cancer); respiratory function tests if clinically indicated.
After therapy completion: Monitor for signs and symptoms of infection as circulating lymphocyte count can take ~5 weeks to be restored; immune reconstitution inflammatory syndrome can occur within a few months of discontinuation necessitating intervention; live vaccination should be avoided for 5 weeks after treatment completion.
Etrasimod is a sphingosine 1-phosphate (S1P) receptor modulator that binds to S1P1,4,5 receptors and minimally to SIP3 but has no activity at S1P2, which results in partial, reversible blockade of lymphocyte egress from lymphoid organs and a decreased number of lymphocytes in the peripheral blood. The exact mechanism of etrasimod in ulcerative colitis is unknown but may involve a reduction in lymphocyte migration to the intestines.
Distribution: Vd: 66 L.
Protein binding: 97.9%.
Metabolism: Metabolized by oxidation and dehydrogenation mediated primarily by CYP2C8, CYP2C9, and CYP3A4, with a minor contribution from CYP2C19 and CYP2J2. Etrasimod also undergoes conjugation primarily mediated by uridine 5'-diphospho-glucuronosyltransferases, with a minor contribution by sulfotransferases. Unchanged etrasimod is the main circulating component in plasma.
Half-life elimination: ~30 hours.
Time to peak: ~4 hours.
Excretion: Feces: 82% (~11% as unchanged drug); urine: 5%.
Hepatic function: Etrasimod AUC increased by 13% in subjects with Child-Turcotte-Pugh A, 29% in Child-Turcotte-Pugh B, and 57% in Child-Turcotte-Pugh C, compared to subjects with normal liver function. No change in unbound etrasimod was observed.
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