The Educational Health Care Professional’s Kit shall contain the following elements: • Brief background on lenalidomide and its licensed indication • Posology • The need to avoid foetal exposure due to teratogenicity of lenalidomide in animals and the expected teratogenic effect of lenalidomide in humans including a summary of the interim results of study CC-5013-TOX-004 • Obligations of the health care professional in relation to the prescribing of Revlimid o Need to provide comprehensive advice and counselling to patients o That patients should be capable of complying with the requirements for the safe use of Revlimid o Need to provide patients with appropriate patient educational brochure and patient card • Safety advice relevant to all patients o Description and management of neutropenia and thrombocytopenia including incidence rates from clinical trials o Description and management of thromboembolic risk including incidence rates from clinical trials o Use in patients with hepatic and/or renal impairment o Disposal of unwanted medicine o Local country specific arrangements for a prescription for Revlimid to be dispensed o Description of risk of hypothyroidism o Explanation of unknown risk of neuropathy with long term use • Description of the PPP and categorisation of patients based on sex and childbearing potential o Algorithm for implementation of PPP o Definition of women of childbearing potential (WCBP) and actions the physician should take if unsure • Safety advice for women of childbearing potential o The need to avoid foetal exposure o Description of the PPP o Need for adequate contraception (even if woman has amenorrhoea) and definition of adequate contraception o Pregnancy test regime Advice on suitable tests Before commencing treatment During treatment based on method of contraception After finishing treatment o Need to stop Revlimid immediately upon suspicion of pregnancy o Need to tell treating doctor immediately upon suspicion of pregnancy • Safety advice for men o The need to avoid foetal exposure o The need to use condoms if sexual partner is a WCBP (even if man has had a vasectomy) During Revlimid treatment For one week following final dose. o That if his partner becomes pregnant whilst he is taking Revlimid or shortly after he has stopped taking Revlimid he should inform his treating doctor immediately • Requirements in the event of pregnancy o Instructions to stop Revlimid immediately upon suspicion of pregnancy o Need to refer to physician specialised or experienced in dealing with teratology and its diagnosis for evaluation and advice o Local contact details for reporting of any suspected pregnancy 64 o Pregnancy reporting form • Check list for physicians ensuring that patients receive the appropriate counselling concerning the treatment, contraceptive methods and pregnancy prevention appropriate for their sex and childbearing status • Adverse event reporting forms
72 • Consejos sobre la seguridad para los varones o La necesidad de evitar la exposición fetal o La necesidad de utilizar preservativos si la pareja sexual es una mujer con capacidad de gestación (incluso aunque el varón se haya sometido a una vasectomía) Durante el tratamiento con Revlimid Durante una semana después de la dosis final. o Si su pareja se queda embarazada mientras él está tomando Revlimid o poco después de que él haya suspendido la toma de Revlimid, debe informar inmediatamente al médico a cargo del tratamiento • Medidas en caso de embarazo o Instrucciones de interrumpir inmediatamente el tratamiento con Revlimid ante la sospecha de embarazo o Necesidad de derivar a la paciente a un médico especialista o con experiencia en teratología y su diagnóstico, para evaluación y asesoramiento. o Información de contacto local para notificar cualquier sospecha de embarazo. o Formulario de notificación de embarazo • Lista de verificación para los médicos para comprobar que los pacientes reciben el asesoramiento apropiado sobre el tratamiento, los métodos anticonceptivos y la prevención del embarazo, adecuado a su sexo y capacidad de gestación • Formularios de notificación de reacciones adversas