When You Should Take Notice of Those Unexplained Joint Problems and See Your Doctor

(BPT) - Joint issues, which can be experienced in the form of pain, stiffness, swelling, clicking, numbness and more, can be very debilitating and have a significant impact on daily life. As joint pain and other issues can be caused by several conditions, some people may live with their symptoms for years and see multiple doctors trying to find the root cause. But did you know that unresolved joint problems could be caused by a rare condition called tenosynovial giant cell tumor or TGCT?

TGCT, also known as pigmented villondular synovitis (PVNS) or giant cell tumor of the tendon sheath (GCT-TS), is a rare type of tumor that is typically non-malignant and occurs in or around a joint, reducing range of motion and damaging neighboring tissues. It can affect people at any age but is most often seen in those between the ages of 30 and 50 years.^[1]

TGCT symptoms such as pain, swelling and stiffness of the involved joint can come on slowly.^1,[2] Unfortunately, because of the rarity of TGCT, a definitive diagnosis may take several years and visits to a variety of healthcare providers.

There are two forms of TGCT – localized and diffuse. Localized TGCT is most often found in smaller joints, such as those around the hands and feet, and makes up the majority of cases. This form can usually be treated effectively with surgery.

Diffuse TGCT most commonly occurs in large joints, such as the knee, ankle and hip and may be more difficult to remove with surgery. In the U.S., the annual incidence of new diffuse cases was estimated to be about 1,300 in 2019.^[3],[4]

“For many years, people who couldn’t be treated successfully with surgery had to cope with living with TGCT because there were no approved systemic treatments and only a few experts truly understood the ramifications of the disease,” said Howard Rutman, MD, Vice President, Medical Affairs, Daiichi Sankyo, Inc. “Following the approval of Turalio, a prescription medicine used to treat certain patients with TGCT, it is critical that we continue to increase awareness and have patients see the appropriate specialists so we can help those patients.”

In August 2019, TURALIO^® (pexidartinib) became the first and only treatment approved by the U.S. Food and Drug Administration for adult patients with symptomatic TGCT associated with severe morbidity or functional limitations and not amenable to improvement with surgery.

Turalio can cause serious side effects, including serious liver problems, which may be severe and can lead to death. The most common side effects of Turalio include: changes in blood liver tests; hair color changes; tiredness; increased cholesterol level in the blood; decreased white blood cells and red blood cells; swelling in and around your eyes; rash; and loss of taste or changes in the way things taste. Turalio can cause harm to an unborn baby when administered to a pregnant woman.

Because of the risk of serious liver problems, Turalio is available only through a restricted program called the Turalio REMS program.

If you experience signs of TGCT, contact your doctor, who may be able to refer you to a specialized center where physicians are more familiar with the disease. All members of a multidisciplinary healthcare team at a specialized center are highly trained to recognize the signs and symptoms of rare diseases like TGCT.

Important Safety Information

What is the most important information I should know about TURALIO^® (pexidartinib)?
TURALIO can cause serious side effects, including serious liver problems, which may be severe and can lead to death.

Your healthcare provider will do blood tests to check for liver problems:

• before starting treatment with TURALIO
• every week for the first 8 weeks during treatment
• every 2 weeks for the next month
• then every 3 months after that

If you develop liver problems during treatment with TURALIO, your healthcare provider may do blood tests more often to monitor you. It is important to stay under the care of your healthcare provider during treatment with TURALIO.

Stop taking TURALIO and call your healthcare provider right away if you develop yellowing of your skin and whites of your eyes or dark urine.

Tell your healthcare provider right away if you have any of these symptoms of liver problems while taking TURALIO: lack or loss of appetite, right upper stomach-area (abdomen) pain or tenderness, feeling overly tired, nausea, vomiting, fever, rash, or itching.

TURALIO Risk Evaluation and Mitigation Strategy (REMS): Because of the risk of serious liver problems, TURALIO is available only through a restricted program called the TURALIO REMS Program. Your healthcare provider must be enrolled in the program in order for you to be prescribed TURALIO. There is a registry that collects information about the effects of taking TURALIO over time. You must complete and sign an enrollment form for the TURALIO REMS Program and the registry. Ask your healthcare provider for more information.

What is TURALIO?
TURALIO is a prescription medicine used to treat certain adults who have tenosynovial giant cell tumor (TGCT) that is not likely to improve with surgery. TGCT is also known as giant cell tumor of the tendon sheath (GCT-TS) or pigmented villonodular synovitis (PVNS).

It is not known if TURALIO is safe and effective in children.

Before you take TURALIO, tell your healthcare provider about all of your medical conditions, including if you:

• have or had liver problems.
• are breastfeeding or plan to breastfeed. Do not breastfeed during treatment with TURALIO and for at least 1 week after the final dose.
• are pregnant or plan to become pregnant. TURALIO may harm your unborn baby.

If you are a female who is able to become pregnant:

• Your healthcare provider will do a pregnancy test before you start treatment with TURALIO.
• Females who are able to become pregnant should use an effective nonhormonal method of birth control (contraception) during treatment with TURALIO and for 1 month after your final dose of TURALIO.
• Birth control pills (oral contraceptives) and other hormonal forms of birth control may not be effective if used during treatment with TURALIO. Talk with your healthcare provider about birth control methods you can use during this time.
• Tell your healthcare provider right away if you become pregnant or think you are pregnant during treatment with TURALIO.

If you are a male with a female partner who is able to become pregnant:

• Use effective birth control (contraception) during treatment and for 1 week after your final dose of TURALIO.
• Tell your healthcare provider right away if your female partner becomes pregnant or thinks she is pregnant during your treatment with TURALIO.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Certain medicines may affect the way TURALIO works and TURALIO may affect how other medicines work. Taking TURALIO with certain medicines can increase the amount of TURALIO in your blood. This may make it more likely for you to have side effects and may cause more severe side effects.

• Avoid taking the following medicines during treatment with TURALIO because they can affect how TURALIO works: proton pump inhibitor medicines (PPIs); St. John’s wort.

How should I take TURALIO?

• Your healthcare provider will explain to you how you will receive your TURALIO.
• Take TURALIO exactly as your healthcare provider tells you to.
• TURALIO is usually taken 2 times a day. Your healthcare provider will tell you how much TURALIO to take and when to take it.
• TURALIO must be taken on an empty stomach, at least 1 hour before or 2 hours after a meal or snack.
• Swallow TURALIO capsules whole.
• Do not open, break, or chew TURALIO capsules.
• If you need to take an acid-reducing medicine, follow your healthcare provider’s instructions for which medicine to take and when to take it. See “What should I avoid while taking TURALIO?”
  • Antacid medicines: Take TURALIO either 2 hours before or 2 hours after taking an antacid medicine.
  • H₂ receptor blocker medicines. Take TURALIO at least 2 hours before or 10 hours after taking an H₂ receptor blocker medicine.

• If you vomit after taking a dose, or if you miss a dose of TURALIO, take your next dose at your regular time.

What should I avoid while taking TURALIO?

• Avoid grapefruit or drinking grapefruit juice during treatment with TURALIO. Grapefruit or grapefruit juice can cause you to have too much TURALIO in your blood and may lead to increased side effects and more severe side effects.

What are the possible side effects of TURALIO?
TURALIO can cause serious side effects. See "What is the most important information I should know about TURALIO?"

The most common side effects of TURALIO include: changes in blood liver tests; hair color changes; tiredness; increased cholesterol level in the blood; decreased white blood cells and red blood cells; swelling in and around your eyes; rash; and loss of taste or changes in the way things taste.

• TURALIO may affect fertility in females and males, which may affect your ability to have children. Talk to your healthcare provider if you have concerns about fertility.

These are not all of the possible side effects of TURALIO. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

General information about the safe and effective use of TURALIO
Do not give TURALIO to other people, even if they have the same symptoms that you have. It may harm them. You can ask your healthcare provider for more information.

Please see accompanying full Prescribing Information, including Medication Guide.

TURALIO^® is a registered trademark of Daiichi Sankyo Company, Limited.

© 2020 Daiichi Sankyo, Inc.

PP-US-TU-0482

07/20