Onureg (azacitidine) vs Scemblix (asciminib)

Onureg (azacitidine) vs Scemblix (asciminib)

Onureg (azacitidine) is an oral hypomethylating agent used primarily for the treatment of adults with acute myeloid leukemia (AML) who are in remission but still have a high risk of relapse or who are not able to undergo intense chemotherapy. Scemblix (asciminib) is a kinase inhibitor specifically designed to target the ABL myristoyl pocket, used for treating adults with Philadelphia chromosome-positive chronic myeloid leukemia (CML) in chronic phase who have received at least two prior treatments with tyrosine kinase inhibitors. When deciding between Onureg and Scemblix, it's crucial to consider the specific type of leukemia being treated, as Onureg is tailored for AML, while Scemblix is indicated for a particular subset of CML, and the decision should be guided by a healthcare professional based on the patient's individual medical history and treatment goals.

Difference between Onureg and Scemblix

Metric Onureg (azacitidine) Scemblix (asciminib)
Generic name Azacitidine Asciminib
Indications Continued treatment of acute myeloid leukemia (AML) in adults 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. Chronic myeloid leukemia (CML) in adults with Philadelphia chromosome-positive (Ph+) in chronic phase (CP) who are resistant or intolerant to at least two prior tyrosine kinase inhibitor (TKI) therapies, or with the T315I mutation.
Mechanism of action Azacitidine is a nucleoside metabolic inhibitor that incorporates into RNA and DNA, which leads to the inhibition of DNA methylation and cytotoxicity. Asciminib is a kinase inhibitor that specifically targets the ABL myristoyl pocket (STAMP), leading to inhibition of BCR-ABL1 oncoprotein signaling.
Brand names Onureg Scemblix
Administrative route Oral Oral
Side effects Nausea, vomiting, diarrhea, fatigue, constipation, pneumonia, joint pain, decreased appetite, pain in extremity, dizziness, febrile neutropenia, abdominal pain, anemia, and thrombocytopenia. Thrombocytopenia, neutropenia, anemia, increased creatinine, increased pancreatic enzymes, musculoskeletal pain, fatigue, diarrhea, nausea, rash, pyrexia, cough, and headache.
Contraindications Advanced malignant hepatic tumors, hypersensitivity to azacitidine or mannitol. Hypersensitivity to asciminib or any of the excipients.
Drug class Hypomethylating agent, antimetabolite Tyrosine kinase inhibitor
Manufacturer Bristol Myers Squibb Novartis Pharmaceuticals

Efficacy

Onureg (Azacitidine) for Leukemia

Onureg (azacitidine) is a hypomethylating agent approved by the U.S. Food and Drug Administration (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. The efficacy of Onureg was demonstrated in a phase III clinical trial, where it significantly improved overall survival compared to placebo. Patients receiving Onureg had a median overall survival of 24.7 months compared to 14.8 months for those on the placebo. This data underscores Onureg's role in extending survival in patients with AML who are in remission but cannot undergo further intensive chemotherapy or bone marrow transplant.

Scemblix (Asciminib) for Leukemia

Scemblix (asciminib) is a newer medication that was approved by the FDA for the treatment of chronic myeloid leukemia (CML). It is specifically indicated for adult patients with Philadelphia chromosome-positive CML in the chronic phase (Ph+ CML-CP) who have been previously treated with two or more tyrosine kinase inhibitors (TKIs). Scemblix functions as a STAMP inhibitor, which is a different mechanism of action compared to other TKIs. In clinical trials, Scemblix has shown efficacy in patients who have developed resistance to or could not tolerate previous TKI therapies. The efficacy of Scemblix was evaluated in a phase III trial, which demonstrated a major molecular response (MMR) in a significant percentage of patients at 24 weeks, indicating its potential as an effective treatment option for CML-CP.

Both Onureg and Scemblix represent advancements in the treatment of different forms of leukemia. Onureg serves as a maintenance therapy for AML patients in remission, aiming to prolong survival and delay relapse. Scemblix, on the other hand, offers a novel treatment option for CML patients who have not responded adequately to other therapies. The efficacy of these drugs in their respective indications has been validated through rigorous clinical trials, providing new hope for patients with these challenging conditions.

It is important to note that while these medications have shown efficacy in clinical trials, individual responses to treatment can vary. Healthcare providers consider a range of factors, including disease characteristics and patient-specific variables, when determining the most appropriate treatment regimen. As with any medication, the use of Onureg and Scemblix should be guided by a thorough understanding of the benefits and risks, and a discussion between the patient and their healthcare provider.

Regulatory Agency Approvals

Onureg
  • Food and Drug Administration (FDA), USA
Scemblix
  • Food and Drug Administration (FDA), USA

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