NAVIGATION YOUR PATIENTS CAN DEPEND ON
A dedicated team of Care Partners will collaborate with your patients to help them seamlessly incorporate IMCIVREE into their lives.
- Help patients understand their insurance benefits
- Ensure patients' IMCIVREE and supplies are there when they need them
With patient consent on the Start Form, we can also:
- Explore financial support options, such as co-pay assistance and a patient assistance program, for patients with a qualifying diagnosis
- Arrange supplemental injection training with a nurse to help your patient properly inject IMCIVREE (after you review the instructions with your patient)
- Offer IMCIVREE education and support
Tell your patients they can give us a call
Monday—Friday, 8 AM to 8 PM ET
We’re ready to help
Interested in starting a patient on IMCIVREE?
Download and complete the Start Form
FINANCIAL SUPPORT MAY BE AVAILABLE FOR QUALIFIED PATIENTS FOR WHOM IMCIVREE IS INDICATED
Co-pay assistance program
- May help cover out-of-pocket costs associated with IMCIVREE, up to $8550 per year
- To be eligible, patients must have a commercial insurance policy and a prescription for IMCIVREE
Patient assistance program
Can help individuals who are:
- who have temporarily lost insurance coverage, or
- whose insurance doesn’t cover IMCIVREE
WE ARE COMMITTED TO PROVIDING SUPPORT TO YOU AND YOUR PATIENTS
Resources are available on the IMCIVREE patient website, www.IMCIVREE.com
GETTING YOUR PATIENT STARTED ON IMCIVREE
IMCIVREE is indicated for chronic weight management in patients aged 6+ with obesity due to POMC, PCSK1, and LEPR deficiency confirmed by genetic testing. These diseases are biallelic, signifying that variants are present in both copies of the gene, and therefore include both homozygous and compound heterozygous forms. Financial support may be available to eligible patients for whom IMCIVREE treatment is indicated.
- IMCIVREE is only available through our specialty pharmacy
- To prescribe IMCIVREE, submit a completed Start Form, including a copy of the patient’s genetic test results
- Download the IMCIVREE Start Form at www.IMCIVREE.com/start
For questions on IMCIVREE or how to start a patient, call
at 1-844-YOUR-GPS (844-968-7477)
Monday—Friday, 8 AM to 8 PM ET
LEPR, leptin receptor; PCSK1, proprotein convertase subtilisin/kexin type 1; POMC, pro-opiomelanocortin.
Rhythm Pharmaceuticals offers no-cost genetic testing for rare genetic diseases of obesity to eligible patients
Rhythm covers the cost of the test, with the patient responsible for any office visit, sample collection, or related costs. Additional information is available at www.UncommonObesity.com/test or by calling PreventionGenetics at 1-844-513-3994, Monday—Friday from 9 AM to 8 PM ET.
FREQUENTLY ASKED QUESTIONS ABOUT IMCIVREE
What is IMCIVREE indicated for?
IMCIVREE is indicated for chronic weight management in adult and pediatric patients 6 years of age and older with obesity due to proopiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor (LEPR) deficiency. The condition must be confirmed by genetic testing demonstrating variants in POMC, PCSK1, or LEPR genes that are interpreted as pathogenic, likely pathogenic, or of uncertain significance (VUS).1
IMCIVREE is not indicated for the treatment of patients with the following conditions as IMCIVREE would not be expected to be effective1:
- Obesity due to suspected POMC, PCSK1, or LEPR deficiency with POMC, PCSK1, or LEPR variants classified as benign or likely benign
- Other types of obesity not related to POMC, PCSK1, or LEPR deficiency, including obesity associated with other genetic syndromes and general (polygenic) obesity
Are there any contraindications to IMCIVREE?
No. There are no contraindications to IMCIVREE.1
Do I have to submit the results of genetic testing with the Start Form?
Yes, you must send your patient’s genetic test results with the IMCIVREE Start Form. Rhythm Pharmaceuticals offers no-cost genetic testing for rare genetic diseases of obesity to eligible patients. Rhythm Pharmaceuticals covers the cost of the test, with the patient responsible for any office visit, sample collection, or related elements. Additional information is available at www.UncommonObesity.com/test or by calling PreventionGenetics at 1-844-513-3994, Monday—Friday, 9 AM to 8 PM ET.
How is IMCIVREE administered?
IMCIVREE is administered by subcutaneous injection, once per day, at the beginning of each day without regard to meals.1 The process for subcutaneous injection is described in the Instructions for Use, which contains complete administration instructions with illustrations.
What part of the body should patients inject IMCIVREE into?
IMCIVREE should be injected subcutaneously in the abdomen, thigh, or arm, rotating to a different site each day. (Refer to Step 5 of the Instructions for Use.) Do not administer IMCIVREE intravenously or intramuscularly.1
What type of syringe should the patient use to administer IMCIVREE?
Instruct patients to use a 1-mL syringe with a 28- or 29-gauge needle appropriate for subcutaneous injection.1
My patient missed a dose. Does he/she need to retitrate their dose?
If a dose is missed, the once-daily regimen should be resumed as prescribed with the next scheduled dose.1
My patient discontinued treatment for an extended period of time. Do I need to retitrate the dose?
Dose titration is recommended to initially assess tolerability to the medication and to determine the therapeutic dose. In clinical studies, patients were placed on placebo for a 4-week period, then re-initiated therapy at the therapeutic dose for the remainder of the study.1
My patient accidentally administered an overdose of IMCIVREE. What adverse events should we be most concerned about?
In the event of an overdose, initiate appropriate supportive treatment according to the patient’s clinical signs and symptoms.1
How is IMCIVREE supplied?
IMCIVREE is supplied in a 1-mL, multiple-dose vial, containing 10 mg of medication. The solution should appear clear to slightly opalescent, colorless to slightly yellow.1
How should IMCIVREE be stored?
- Refrigerator: 2°C to 8°C (36°F to 46°F) until expiration date1
- Room temperature: 2°C to 25°C (36°F to 77°F)* for up to 30 days or until the expiration date (whichever is earlier)1
Open (in‐use) Vials: up to 30 days or until the expiration date (whichever is earlier)
- Refrigerator: 2°C to 8°C (36°F to 46°F)1
- Room temperature: 2°C to 25°C (36°F ‐ 77°F)*1
Always store in original carton to protect from light.1
Do not freeze.1
*Brief excursions up to 30°C (86°F) are permitted. Above 30°C (86°F), discard vials and do not use.1
Can IMCIVREE cause prolonged erections?
Spontaneous penile erections in males (23%) occurred in clinical trials with IMCIVREE. Patients who have an erection lasting longer than 4 hours should be instructed to seek emergency medical attention.1
What sexual disturbances were reported in females in the clinical trials?
In a 12-week, placebo-controlled clinical study in an unapproved population, 4 female patients (7%) treated with IMCIVREE experienced sexual adverse reactions compared to 0 patients in the placebo group; 3 experienced a disturbance in sexual arousal and 1 experienced hypersensitivity of the labia.1
Does IMCIVREE cause or worsen depression?
Patients with a history of severe depression were excluded from the clinical trials. However, some drugs that target the central nervous system, such as IMCIVREE, may cause depression or suicidal ideation. Depression occurred in 26% of patients, and suicidal ideation occurred in 11% of patients included in the IMCIVREE clinical studies.
Monitor patients for new onset or worsening of depression. Consider discontinuing IMCIVREE if patients experience suicidal thoughts or behaviors.1
Can IMCIVREE be used with antidepressants?
No clinical studies evaluating the drug-drug interaction potential of IMCIVREE have been conducted.1
What is hyperpigmentation? Is it just skin darkening?
Hyperpigmentation can involve the darkening of skin and pre-existing nevi in the absence of ultraviolet (UV) exposure.1
Is skin darkening reversible?
Skin darkening was observed in the majority (78%) of subjects treated with IMCIVREE. This effect is reversible upon discontinuation of the drug.1
Why does my patient need a skin examination before starting IMCIVREE?
- IMCIVREE is an MC4 receptor agonist with some activity at the melanocortin 1 (MC1) receptors; activation of MC1 leads to accumulation of melanin and increased skin pigmentation1
- Hyperpigmentation occurred in 21 patients (78%) treated with IMCIVREE and was reversible upon discontinuation of the drug1
- Perform a full body skin examination prior to initiation and periodically during treatment with IMCIVREE to monitor pre-existing and new skin pigmentary lesions1
Can IMCIVREE cause skin cancer?
There is no evidence that this change in pigmentation is detrimental to the patient, and no cases of melanoma have been reported.1,3
What were the most common adverse events observed in the clinical trials?
The most common adverse reactions affecting ≥23% of patients were injection site reactions, skin hyperpigmentation, nausea, headache, diarrhea, abdominal pain, back pain, fatigue, vomiting, depression, upper respiratory tract infection, and spontaneous penile erection.1
Injection site reactions, nausea, and vomiting tend to occur within the first month after starting treatment, and then diminish over time.4
Changes in skin pigmentation/hair color are primarily reported within the first month of treatment, then become more gradual or stabilize afterward.4
Were any serious treatment-related adverse events observed in clinical studies?
No serious treatment-related adverse reactions were observed in the clinical trial. However, because there is benzyl alcohol preservative in IMCIVREE, there is a risk of serious adverse reactions in neonates and low birth weight infants. IMCIVREE is not approved for use in neonates or infants. Serious and fatal adverse reactions including “gasping syndrome” can occur in neonates and low birth weight infants treated with benzyl alcohol–preserved drugs.1
What should a patient do if they think they are or may become pregnant?
Discontinue IMCIVREE when pregnancy is recognized unless the benefits of therapy outweigh the potential risks to the fetus.1
Can patients take IMCIVREE while breastfeeding? Does IMCIVREE enter the breast milk?
There is no information on the presence of IMCIVREE or its metabolites in human milk, the effects on the breastfed infant, or the effects on milk production. Treatment with IMCIVREE is not recommended while breastfeeding.1
IMCIVREE from multiple-dose vials contains the preservative benzyl alcohol. Because benzyl alcohol is rapidly metabolized by a lactating woman, benzyl alcohol exposure in the breastfed infant is unlikely. However, adverse reactions have occurred in premature neonates and low birth weight infants who received intravenously administered benzyl alcohol-containing drugs.1
What is the mechanism of action?
Setmelanotide is an melanocortin-4 (MC4) receptor agonist with 20-fold less activity at the MC3 and MC1 receptors. MC4 receptors in the brain are involved in regulation of hunger, satiety, and energy expenditure. In patients with obesity due to POMC, PCSK1, and LEPR deficiency associated with insufficient activation of the MC4 receptor, setmelanotide may re-establish MC4 receptor pathway activity to reduce hunger and promote weight loss through decreased caloric intake and increased energy expenditure. Nonclinical evidence shows that MC4 receptors are important for setmelanotide-regulated appetite and weight loss.1
How does IMCIVREE work?
IMCIVREE is thought to work by selectively activating melanocortin-4 receptor (MC4R) neurons to restore proper regulation of hunger, energy expenditure, and consequently body weight.1
Have the pivotal studies on IMCIVREE been published?
Yes. The results of these studies have been published in The Lancet Diabetes & Endocrinology. To see the publication, click here.
How were the safety and effectiveness of IMCIVREE evaluated?
The safety and efficacy of IMCIVREE for the treatment of POMC, PCSK1, or LEPR deficiency obesity were established in 2 identically designed, 1-year, open-label studies, each with an 8-week, double-blind withdrawal period.1
To see the full results of the IMCIVREE clinical trials, click here.
Were the patients who did not achieve at least a 5 kg weight loss (or at least 5% weight loss if baseline body weight was <100 kg) at the end of the open-label treatment period included in any analyses? If so, which ones?
Yes. These patients were included in the primary endpoint analysis and safety analyses.1,3
Do patients regain weight after stopping IMCIVREE?
Yes. When treatment with IMCIVREE was withdrawn in patients who had lost weight during the 10-week open-label period, these patients gained an average of 5.5 kg in Study 1 and 5.0 kg in Study 2 over 4 weeks. Reinitiation of treatment with IMCIVREE resulted in subsequent weight loss.1
To see the full results of the IMCIVREE clinical trials, click here.
The package insert mentions skin darkening as a potential reversible side effect. I have read that IMCIVREE may darken hair as well. Is this also a reversible side effect?
Changes in hair color following discontinuation of IMCIVREE have not been studied.
Is there a pharmacologic therapy recommended to manage nausea or vomiting if it were to occur? Are there any therapies for nausea or vomiting that should be avoided?
Treating physicians should manage and mitigate based on their own clinical judgment. No clinical studies evaluating the drug-drug interaction potential of IMCIVREE have been conducted.
How do I prescribe IMCIVREE for my patient(s)?
To prescribe IMCIVREE, a completed Start Form, including a copy of the patient’s genetic test results, will need to be faxed to 1-877-805-0130.
A Start Form also enrolls your patient in the IMCIVREE GPS program, which will provide your patient with a number of resources including help understanding their insurance, financial assistance, and educational services. Additionally, IMCIVREE GPS will coordinate the delivery of IMCIVREE, and provide support in learning how to inject IMCIVREE.
How do I obtain the genetic testing required to start my patient on IMCIVREE?
If you have not yet confirmed that your patient has POMC, PCSK1, or LEPR deficiency, you can order an obesity panel at www.UncommonObesity.com or you can call PreventionGenetics at 1-844-513-3994, Monday—Friday from 9 AM—8 PM ET for more information.
What is the cost of the genetic testing?
Rhythm Pharmaceuticals' Uncovering Rare Obesity® Program offers free genetic testing to eligible patients. Rhythm Pharmaceuticals covers the cost of test only. This excludes office visits, sample collection, and any other related costs to the patient.
References: 1. IMCIVREE [prescribing information]. Boston, MA. Rhythm Pharmaceuticals, Inc. 2. IMCIVREE [patient information]. Boston, MA. Rhythm Pharmaceuticals, Inc. 3. Clément K et al. Lancet Diabetes Endocrinol. 2020 Dec;8(12):960-970. doi: 10.1016/S2213-8587(20)30364-8. Epub 2020 Oct 30. PMID: 33137293. 4. Data on file. Rhythm Pharmaceuticals, Inc. Boston, MA.