Azacitidine

How it works

As a pyrimidine nucleoside analogue it is incorporated into nucleic acids and inhibits DNA methyltransferase, causing DNA hypomethylation and direct cytotoxicity to abnormal haematopoietic cells.

Prescribing in practice

• It causes pronounced and often profound myelosuppression, so neutropenia, thrombocytopenia and anaemia must be anticipated with febrile-neutropenia precautions and dose delays.
• Injection-site reactions are common with the subcutaneous route and benefit from site rotation.
• Nausea, vomiting and antiemetic cover are usually needed, and renal and hepatic function should be checked.

Monitoring

Monitor the full blood count before each cycle and as needed, alongside renal function, liver function and electrolytes including bicarbonate.

Counselling the patient

• Report fever, sore throat or any sign of infection or unusual bleeding urgently.
• Expect possible site soreness with subcutaneous injection and attend for blood tests as scheduled.

Evidence & guidelines

Use is supported by randomised trials showing improved survival versus conventional care in higher-risk myelodysplastic syndromes and by NICE guidance.