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. |
Not available.
| Dosage form | TABLET |
| Renal impairment | Not available. |
| Liver impairment | Not available. |
| Pediatric use | Not available. |
| Geriatric use | Not available. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for KYRA (KYRA).
| Breastfeeding | Excreted into human breast milk; M/P ratio not reported. Potential for serious adverse reactions in nursing infants (e.g., nephrotoxicity). Breastfeeding is contraindicated during therapy and for at least 1 month after last dose. |
| 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. |
■ 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 |
Known hypersensitivity to the drug, active serious infections, severe hepatic impairment (Child-Pugh C).
| 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. |
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| 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. |