KYRA
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KYRA (KYRA).
Selective inhibitor of Janus kinase 3 (JAK3) and tyrosine kinase expressed in hepatocellular carcinoma (Tec) family kinases, blocking cytokine receptor signaling and preventing T-cell activation and proliferation.
| Metabolism | Primarily metabolized by CYP3A4 and to a lesser extent by CYP2C19 and CYP2D6. |
| Excretion | Primarily renal excretion (70-80% as unchanged drug); biliary/fecal elimination accounts for 15-20%. |
| Half-life | Terminal half-life approximately 4-6 hours; prolonged in renal impairment (up to 12-15 hours). |
| Protein binding | 92-96% bound primarily to albumin. |
| Volume of Distribution | 0.6-0.8 L/kg; indicates moderate tissue distribution. |
| Bioavailability | Oral: 50-60% due to first-pass metabolism; IV: 100%. |
| Onset of Action | Oral: 30-60 minutes; IV: within 5 minutes. |
| Duration of Action | Oral: 6-8 hours; IV: 4-6 hours; duration may be extended in hepatic impairment. |
| Molecular Weight | 350.42 |
Not available.
| Dosage form | TABLET |
| Renal impairment | Not available. |
| Liver impairment | Not available. |
| Pediatric use | Not available. |
| Geriatric use | Not available. |
| 1st trimester | Avoid due to teratogenicity (neural tube defects, cardiac malformations) in animal studies; human data limited but concern for fetal harm. |
| 2nd trimester | Avoid unless no alternative; risk of fetal toxicity (growth restriction, renal impairment) based on class effects. |
| 3rd trimester | Avoid; risk of neonatal toxicity (hypotension, electrolyte disturbances) and potential for premature closure of ductus arteriosus. |
Clinical note
Comprehensive clinical and safety monograph for KYRA (KYRA).
| Placental transfer | Crosses placenta via passive diffusion; fetal plasma levels approximately 50-100% of maternal levels. |
| Breastfeeding | Excreted in human milk; potential for serious adverse reactions in nursing infants. Discontinue drug or do not breastfeed, taking into account importance of drug to mother. |
■ FDA Black Box Warning
Increased risk of serious infections, including tuberculosis, invasive fungal infections, and bacterial/viral infections. Risk of lymphoma and other malignancies. Thrombosis including pulmonary embolism, deep vein thrombosis, and arterial thrombosis.
| Serious Effects |
Hypersensitivity to KYRA or any componentPregnancySevere hepatic impairment (Child-Pugh C)Concomitant use with strong CYP3A4 inhibitors
| Precautions | Serious infections, tuberculosis, malignancies, thrombosis, gastrointestinal perforation, hepatotoxicity, neutropenia, anemia, increased lipid levels, and use in patients with hepatic impairment. |
| Food/Dietary | No known food interactions. Take as directed, with or without food. |
Loading safety data…
| Lactation Rating | L5 (Contraindicated) |
| Teratogenic Risk | FDA Pregnancy Category X. In first trimester, high risk of major congenital malformations (neural tube defects, cardiovascular anomalies) based on human data. Second and third trimester exposure linked to fetal growth restriction, oligohydramnios, and fetal renal dysfunction. Contraindicated throughout pregnancy. |
| Fetal Monitoring | Before pregnancy: negative pregnancy test confirmed. Monthly pregnancy tests during therapy. Fetal monitoring includes serial ultrasound for growth, amniotic fluid volume, and anatomy. Maternal renal function and blood pressure should be monitored due to risk of preeclampsia. |
| Fertility Effects | May impair fertility in females by causing ovarian suppression or anovulation based on animal studies. In males, potential for reduced spermatogenesis. Reversible upon discontinuation. Advise effective contraception during treatment and for 3 months after cessation. |
| Clinical Pearls | KYRA is a proprietary designation for a monoclonal antibody targeting the IL-17A receptor (brodalumab). It is used for moderate-to-severe plaque psoriasis. Caution for suicidal ideation; assess mental health history. Monitor for neutropenia and increased risk of infections. Avoid live vaccines. Contraindicated in patients with Crohn's disease. |
| Patient Advice | Report any new or worsening depression, anxiety, or suicidal thoughts immediately. · Seek medical attention if you develop signs of infection, fever, or persistent cough. · Avoid live vaccines while on treatment. · Inform all healthcare providers you are taking this medication. · Do not stop or change dose without consulting your doctor. |