{"id":"bgb-3111","rwe":[{"pmid":"41901313","year":"2026","title":"Is Brukinsa (Zanubrutinib) a Safer Bruton's Tyrosine Kinase (BTK) Inhibitor in Relapsed or Refractory Chronic Lymphocytic Leukemia? A Systematic Review and Meta-Analysis.","finding":"","journal":"Pharmaceuticals (Basel, Switzerland)","studyType":"Clinical Study"},{"pmid":"41824782","year":"2026","title":"Phase 1 Study of Zanubrutinib Plus Lenalidomide in Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma.","finding":"","journal":"Blood advances","studyType":"Clinical Study"},{"pmid":"41304918","year":"2025","title":"Therapeutic Impact of Zanubrutinib in Chronic Lymphocytic Leukemia: Evidence from a Systematic Review and Single-Arm Meta-Analysis.","finding":"","journal":"Pharmaceuticals (Basel, Switzerland)","studyType":"Clinical Study"},{"pmid":"40924923","year":"2025","title":"Outcomes after transition from ibrutinib to zanubrutinib in patients with Waldenström macroglobulinemia from the ASPEN study.","finding":"","journal":"Blood advances","studyType":"Clinical Study"},{"pmid":"40900302","year":"2026","title":"Relative Bioavailability, Food Effect, and Bioequivalence Studies to Assess a New Zanubrutinib 160-mg Tablet: Results From 2 Phase 1 Studies in Healthy Volunteers.","finding":"","journal":"Clinical pharmacology in drug development","studyType":"Clinical Study"}],"_fda":{"id":"cb0c9753-cca4-421e-9512-1b710a56b342","set_id":"3e08fe23-d70e-424c-bc51-1222e320f902","openfda":{"nui":["N0000175605","N0000193934"],"unii":["AG9MHG098Z"],"route":["ORAL"],"rxcui":["2262440","2262446","2719220","2719223"],"spl_id":["cb0c9753-cca4-421e-9512-1b710a56b342"],"brand_name":["BRUKINSA"],"spl_set_id":["3e08fe23-d70e-424c-bc51-1222e320f902"],"package_ndc":["72579-011-02","72579-011-01","72579-122-01"],"product_ndc":["72579-011","72579-122"],"generic_name":["ZANUBRUTINIB"],"product_type":["HUMAN PRESCRIPTION DRUG"],"substance_name":["ZANUBRUTINIB"],"pharm_class_epc":["Kinase Inhibitor [EPC]"],"pharm_class_moa":["Bruton's Tyrosine Kinase Inhibitors [MoA]"],"manufacturer_name":["BeOne Medicines USA, Inc."],"application_number":["NDA213217","NDA218785"],"is_original_packager":[true]},"version":"22","pregnancy":["8.1 Pregnancy Risk Summary Based on findings in animals, BRUKINSA can cause fetal harm when administered to pregnant women. There are no available data on BRUKINSA use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. In animal reproduction studies, oral administration of zanubrutinib to pregnant rats during the period of organogenesis was associated with fetal heart malformation at approximately 5-fold human exposures (see Data ) . Women should be advised to avoid pregnancy while taking BRUKINSA. If BRUKINSA is used during pregnancy, or if the patient becomes pregnant while taking BRUKINSA, the patient should be apprised of the potential hazard to the fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Data Animal Data Embryo-fetal development toxicity studies were conducted in both rats and rabbits. Zanubrutinib was administered orally to pregnant rats during the period of organogenesis at doses of 30, 75, and 150 mg/kg/day. Malformations in the heart (2 or 3-chambered hearts) were noted at all dose levels in the absence of maternal toxicity. The dose of 30 mg/kg/day is approximately 5 times the exposure (AUC) in patients receiving the recommended dose of 160 mg twice daily. Administration of zanubrutinib to pregnant rabbits during the period of organogenesis at 30, 70, and 150 mg/kg/day resulted in postimplantation loss at the highest dose. The dose of 150 mg/kg is approximately 32 times the exposure (AUC) in patients at the recommended dose and was associated with maternal toxicity. In a pre and postnatal developmental toxicity study, zanubrutinib was administered orally to rats at doses of 30, 75, and 150 mg/kg/day from implantation through weaning. The offspring from the middle and high dose groups had decreased body weights preweaning, and all dose groups had adverse ocular findings (e.g., cataract, protruding eye). The dose of 30 mg/kg/day is approximately 5 times the AUC in patients receiving the recommended dose."],"description":["11 DESCRIPTION BRUKINSA (zanubrutinib) is a kinase inhibitor. The empirical formula of zanubrutinib is C 27 H 29 N 5 O 3 and the chemical name is ( S )-7-(1-acryloylpiperidin-4-yl)-2-(4-phenoxyphenyl)-4,5,6,7-tetrahydropyrazolo[1,5- a ]pyrimidine-3-carboxamide. Zanubrutinib is a white to off-white powder, with a pH of 7.8 in saturated solution. The aqueous solubility of zanubrutinib is pH dependent, from very slightly soluble to practically insoluble. The molecular weight of zanubrutinib is 471.55 Daltons. Zanubrutinib has the following structure: Each BRUKINSA capsule for oral administration contains 80 mg zanubrutinib and the following inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and sodium lauryl sulfate. The capsule shell contains edible black ink, gelatin, and titanium dioxide. Each BRUKINSA tablet for oral administration contains 160 mg zanubrutinib and the following inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, and sodium lauryl sulfate. The film coating contains FD&C Blue No. 1, FD&C Blue No. 2, hypromellose, titanium dioxide, and triacetin. Chemical Structure"],"how_supplied":["16 HOW SUPPLIED/STORAGE AND HANDLING How Supplied Strength Description Package Size NDC Number 80 mg white to off-white opaque capsule, marked with \"ZANU 80\" in black ink 120-count capsules in a bottle with a child-resistant cap 72579-011-02 160 mg blue, oval, film-coated tablets debossed with \"zanu\" on one side and functional scoring on the other side 60-count tablets in a bottle with a child-resistant cap 72579-122-01 Storage Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) [See USP Controlled Room Temperature]."],"geriatric_use":["8.5 Geriatric Use Of the 1729 patients with MCL, MZL, WM, CLL/SLL, and FL in clinical studies with BRUKINSA, 59% were ≥65 years of age, and 21% were ≥75 years of age. Patients ≥65 years of age had numerically higher rates of Grade 3 or higher adverse reactions and serious adverse reactions (57% and 38%, respectively) than patients <65 years of age (51% and 29%, respectively). No overall differences in effectiveness were observed between younger and older patients."],"pediatric_use":["8.4 Pediatric Use Safety and effectiveness of BRUKINSA in pediatric patients have not been established."],"effective_time":"20260202","clinical_studies":["14 CLINICAL STUDIES 14.1 Mantle Cell Lymphoma The efficacy of BRUKINSA was assessed in BGB-3111-206 [NCT03206970], a Phase 2, open-label, multicenter, single-arm trial of 86 previously treated patients with MCL who had received at least one prior therapy. BRUKINSA was given orally at a dose of 160 mg twice daily until disease progression or unacceptable toxicity. The median age of patients was 60.5 years (range: 34 to 75) and the majority were male (78%). The median time since diagnosis to study entry was 30 months (range: 3 to 102) and the median number of prior therapies was 2 (range: 1 to 4). The most common prior regimens were CHOP-based (91%) followed by rituximab-based (74%). The majority of patients had extranodal involvement (71%) and refractory disease (52%). Blastoid variant of MCL was present in 14% of patients. The MIPI score was low in 58%, intermediate in 29%, and high risk in 13%. The efficacy of BRUKINSA was also assessed in BGB-3111-AU-003 [NCT02343120], a Phase 1/2, open-label, dose-escalation, global, multicenter, single-arm trial of B cell malignancies including 32 previously treated MCL patients treated with BRUKINSA. BRUKINSA was given orally at doses of 160 mg twice daily or 320 mg daily. The median age of patients with previously treated MCL was 70 years (range: 42 to 86) and 38% of patients were ≥75 years old. Most patients were male (69%) and White (78%). The MIPI score was low in 28%, intermediate in 41%, and high risk in 31%. Tumor response was according to the 2014 Lugano Classification for both studies, and the primary efficacy endpoint was overall response rate as assessed by an Independent Review Committee (IRC). Table 19: Efficacy Results per IRC in Patients with MCL Study BGB-3111-206 (N=86) Study BGB-3111-AU-003 (N=32) ORR: overall response rate, CR: complete response, PR: partial response, DOR: duration of response, CI: confidence interval, NE: not estimable. ORR (95% CI) 84% (74, 91) 84% (67, 95) CR 59% 22% FDG-PET scans were not required for response assessment. PR 24% 62% Median DOR in months (95% CI) 19.5 (16.6, NE) 18.5 (12.6, NE) 14.2 Waldenström's Macroglobulinemia The efficacy of BRUKINSA was evaluated in ASPEN [NCT03053440], a randomized, active control, open-label trial, comparing BRUKINSA and ibrutinib in patients with MYD88 L265P mutation ( MYD88 MUT ) WM. Patients in Cohort 1 (n=201) were randomized 1:1 to receive BRUKINSA 160 mg twice daily or ibrutinib 420 mg once daily until disease progression or unacceptable toxicity. Randomization was stratified by number of prior therapies (0 vs 1-3 vs >3) and CXCR4 status (presence or absence of a WHIM-like mutation as measured by Sanger assay). The major efficacy outcome was the response rate defined as PR or better as assessed by IRC based on standard consensus response criteria from the International Workshop on Waldenström's Macroglobulinemia (IWWM)-6 criteria. An additional efficacy outcome measure was duration of response (DOR). The median age was 70 years (range: 38 to 90) and 68% were male. Of those enrolled, 2% were Asian, 91% were White, and 7% were of unknown race. ECOG performance status of 0 or 1 was present in 93% patients at baseline and 7% had a baseline ECOG performance status of 2. A total of 82% had relapsed/refractory disease with 85% having received prior alkylating agents and 91% prior anti-CD20 therapy. The median number of prior therapies in those with relapsed/refractory disease was 1 (range: 1 to 8). A total of 91 (45%) patients had International Prognostic Scoring System (IPSS) high WM. The study did not meet statistical significance for the prespecified efficacy outcome of superior CR+VGPR as assessed by IRC, tested first in patients with R/R disease in ASPEN. Table 20 shows the response rates in ASPEN based on IRC assessment. Table 20: Response Rate and Duration of Response Based on IRC Assessment in ASPEN Standard IWWM-6 IWWM-6 criteria (Owen et al, 2013) require complete resolution of extramedullary disease (EMD) if present at baseline for VGPR to be assessed. Modified IWWM-6 Modified IWWM-6 criteria (Treon, 2015) require a reduction in EMD if present at baseline for VGPR to be assessed. Response Category BRUKINSA (N=102) Ibrutinib (N=99) BRUKINSA (N=102) Ibrutinib (N=99) Response rate (CR+VGPR+PR), n (%) 79 (77.5) 77 (77.8) 79 (77.5) 77 (77.8) 95% CI (%) 2-sided Clopper-Pearson 95% confidence interval. (68.1, 85.1) (68.3, 85.5) (68.1, 85.1) (68.3, 85.5) Complete Response (CR) 0 (0) 0 (0) 0 (0) 0 (0) Very Good Partial Response (VGPR) 16 (15.7) 7 (7.1) 29 (28.4) 19 (19.2) Partial Response (PR) 63 (61.8) 70 (70.7) 50 (49) 58 (58.6) Duration of response (DOR), Event-free at 12 months (95% CI) Estimated by Kaplan-Meier method with 95% CIs estimated using the method of Brookmeyer and Crowley. 94.4% (85.8, 97.9) 87.9% (77, 93.8) 94.4% (85.8, 97.9) 87.9% (77, 93.8) ASPEN Cohort 2 Cohort 2 enrolled patients with MYD88 wildtype ( MYD88 WT ) or MYD88 mutation unknown WM (N=26 and 2, respectively) and received BRUKINSA 160 mg twice daily. The median age was 72 years (range: 39 to 87) with 43% >75 years, 50% were male, 96% were White, and 4% were not reported (unknown race). Eighty-six percent of patients had a baseline ECOG performance status 0 or 1 and 14% had a baseline performance status of 2. Twenty-three of the 28 patients in Cohort 2 had relapsed or refractory disease. In Cohort 2, response (CR+VGPR+PR) as assessed by IRC using IWWM-6 or modified IWWM-6 was seen in 50% (13 out of 26 response evaluable patients; 95% CI: 29.9, 70.1). 14.3 Marginal Zone Lymphoma The efficacy of BRUKINSA was assessed in Study BGB-3111-214 [NCT03846427], an open-label, multicenter, single-arm trial that evaluated 66 patients with MZL who received at least one prior anti–CD20-based therapy. BRUKINSA was given orally at a dosage of 160 mg twice daily until disease progression or unacceptable toxicity. The median age was 70 years (range: 37 to 85); 55% were male; 38% had extranodal MZL, 38% nodal, 18% splenic, and 6% had unknown subtype. The median number of prior systemic therapies was 2 (range: 1 to 6), with 27% having 3 or more lines of systemic therapy; 88% had prior rituximab-based chemotherapy; 32% had refractory disease at study entry. The efficacy of BRUKINSA was also assessed in BGB-3111-AU-003 [NCT02343120], an open-label, multicenter, single-arm trial that included 20 patients with previously treated MZL (45% having extranodal MZL, 25% nodal, 30% splenic). BRUKINSA was given orally at dosages of 160 mg twice daily or 320 mg once daily. The median age was 70 years (range: 52 to 85); 50% were male. The median number of prior systemic therapies was 2 (range: 1 to 5), with 20% having 3 or more lines of systemic therapy; 95% had prior rituximab-based chemotherapy. Efficacy was based on overall response rate (ORR) and duration of response as assessed by an Independent Review Committee (IRC) using 2014 Lugano criteria (Table 21). Table 21: Efficacy Results per IRC in Patients with MZL Parameter Study BGB-3111-214 (N=66) Study BGB-3111-AU-003 (N=20) ORR: overall response rate, CR: complete response, PR: partial response, DOR: duration of response, CI: confidence interval, NE: not estimable. Overall response rate (CT-based) Per 2014 CT-based Lugano criteria. FDG-PET scans were not considered for this response assessment. ORR, n 37 (56%) 16 (80%) (95% CI, %) (43, 68) (56, 94) CR, n 13 (20%) 4 (20%) PR, n 24 (36%) 12 (60%) Time to response Median (range), months 2.9 (1.8, 11.1) 2.9 (2.6, 23.1) Duration of response Based on Kaplan-Meier estimation. Estimated median follow-up for DOR was 8.3 months for Study BGB-3111-214 and 31.4 months for Study BGB-3111-AU-003. Median DOR (95% CI), months NE (NE, NE) NE (8.4, NE) Rate at 12 months (95% CI) 85% (67, 93) 72% (40, 88) In study BGB-3111-214, ORR prioritizing PET-CT when available (55 patients, with the remainder assessed by CT scan) was 67% (95% CI: 54, 78) with a CR rate of 26%. 14.4 Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma The efficacy of BRUKINSA in patients with CLL/SLL was evaluated in two randomized controlled trials. SEQUOIA The efficacy of BRUKINSA in patients with previously untreated CLL/SLL was evaluated in a multicenter, open-label trial (SEQUOIA; NCT03336333). The trial required patients to be unsuitable for FCR therapy defined as either age ≥65 years or age 18 to <65 with a total Cumulative Illness Rating Scale (CIRS) >6, creatinine clearance 30 to 69 mL/min, or history of serious or recurrent infection. Patients without 17p deletion (17p del) were randomized to receive either BRUKINSA 160 mg twice daily until disease progression or unacceptable toxicity (n=241) or bendamustine plus rituximab (BR) for 6 cycles (n=238). Bendamustine was dosed at 90 mg/m 2 /day intravenously on the first 2 days of each cycle, and rituximab was dosed at 375 mg/m 2 on day 1 of Cycle 1 and 500 mg/m 2 on day 1 of Cycles 2 to 6 with a 28-day cycle length. Randomization was stratified by age, Binet stage, immunoglobulin variable region heavy chain (IGHV) mutational status, and geographic region. Additionally, the same BRUKINSA regimen was evaluated in 110 patients with previously untreated 17p del CLL/SLL in a non-randomized cohort. Efficacy is summarized according to cohort. Randomized Cohort: Previously Untreated CLL/SLL without 17p Deletion In the randomized cohort of patients with previously untreated CLL/SLL without 17p deletion, the median age was 70 years; 62% were male, 89% were White, 3% were Asian, and 1% were Black. Fifty-three percent of patients had an unmutated IGHV gene and 29% had Binet Stage C disease. Baseline characteristics were generally similar between treatment arms. Efficacy in this cohort was based on progression-free survival as assessed by an IRC. Efficacy results are presented in Table 22 and Figure 1. Table 22: Efficacy Results per IRC in Patients with Previously Untreated CLL/SLL without 17p Deletion in SEQUOIA (Randomized Cohort) Parameter Efficacy was assessed using the 2008 International Workshop for Chronic Lymphocytic Leukemia (iwCLL) guidelines and 2014 Lugano criteria for SLL. CLL/SLL without del(17p) BRUKINSA (N=241) Bendamustine + Rituximab (N=238) CI=Confidence interval, CR=complete response, CRi=complete response with incomplete hematopoietic recovery, HR=hazard ratio, NE=not estimable, nPR=nodular partial response, ORR=overall response rate, PFS=progression-free survival, PR=partial response. Progression-free survival Number of Events, n 36 (15%) 71 (30%) Disease Progression 27 (11%) 59 (25%) Death 9 (3.7%) 12 (5%) Median PFS (95% CI), months Based on Kaplan-Meier estimation. Estimated median follow-up for PFS was 25 months. NE (NE, NE) 33.7 (28.1, NE) HR (95% CI) Based on a stratified Cox-regression model with bendamustine + rituximab as the reference group. 0.42 (0.28, 0.63) P-value Based on a stratified log-rank test, with a 2-sided significance level of 0.0372. <0.0001 Overall response rate Defined as CR, CRi, PR, and nPR. No patients had CRi as best response. ORR, n (%) 225 (93) 203 (85) 95% CI, % (89, 96) (80, 90) CR, n (%) 16 (7) 36 (15) nPR, n (%) 3 (1.2) 14 (6) PR, n (%) 206 (85) 153 (64) Figure 1: Kaplan-Meier Plot of IRC-Assessed Progression-Free Survival in Patients with Previously Untreated CLL/SLL without 17p Deletion in SEQUOIA At the time of analysis, overall survival data were immature. With an estimated median follow-up of 25.7 months, median overall survival was not reached in either arm, with fewer than 7% of patients experiencing an event. Figure 1 Single-Arm Cohort: Previously Untreated CLL/SLL with 17p Deletion In this cohort, 110 patients with previously untreated CLL/SLL and centrally confirmed 17p deletion received BRUKINSA 160 mg twice daily until disease progression or unacceptable toxicity. The median age was 70, 71% were male, 95% were White, and 1% were Asian. Sixty percent of patients had an unmutated IGHV gene and 35% had Binet Stage C disease. Efficacy was based on overall response rate and duration of response as assessed by an IRC. Efficacy results are presented in Table 23. Table 23: Efficacy Results per IRC in Patients with Previously Untreated CLL/SLL and 17p Deletion in SEQUOIA Parameter Efficacy was assessed using the 2008 iwCLL guidelines and Lugano criteria for SLL. del(17p) CLL/SLL N=110 DOR=duration of response. A + sign indicates a censored observation. Overall response rate Defined as CR, CRi, PR, and nPR. No patients had CRi as best response. ORR, n (%) 97 (88) (95% CI, %) (81, 94) CR, n (%) 7 (6) nPR, n (%) 2 (1.8) PR, n (%) 88 (80) Time to response Median (range), months 2.9 (1.9 to 13.9) Duration of response Median DOR (95% CI), Kaplan-Meier estimate. Estimated median follow-up for DOR was 25.1 months. months NE (NE, NE) Range, months (5.6 to 35.9+) Rate at 12 months, % (95% CI) 96 (89, 98) Rate at 18 months, % (95% CI) 95 (88, 98) ALPINE The efficacy of BRUKINSA in patients with relapsed or refractory CLL/SLL was evaluated in ALPINE, a randomized, multicenter, open-label, actively controlled trial (NCT03734016). The trial enrolled 652 patients with relapsed or refractory CLL/SLL after at least 1 systemic therapy. The patients were randomized in a 1:1 ratio to receive either BRUKINSA 160 mg orally twice daily (n=327) or ibrutinib 420 mg orally once daily (n=325), each administered until disease progression or unacceptable toxicity. Randomization was stratified by age, geographic region, refractoriness to last therapy, and 17p deletion/ TP53 mutation status. Baseline characteristics were similar between treatment arms. Overall, the median age was 67 years, 68% were male, 81% were White, 14% were Asian, and 1% were Black. Forty-three percent had advanced stage disease, 73% had an unmutated IGHV gene, and 23% had 17p deletion or TP53 mutation. Patients had a median of one prior line of therapy (range: 1-8), 18% of patients had ≥3 prior lines of therapy, 78% had prior chemoimmunotherapy, and 2.3% had prior BCL2 inhibitor. Efficacy was based on overall response rate and duration of response as determined by an IRC. For progression-free survival per IRC, the final analysis occurred with a median follow-up of 31 months. Efficacy results are shown in Table 24 and Figure 2. Table 24: Efficacy Results per IRC in Patients with Relapsed or Refractory CLL/SLL in ALPINE Parameter Efficacy was based on 2008 iwCLL guidelines for CLL and the Lugano criteria for SLL. BRUKINSA (N=327) Ibrutinib (N=325) CI=Confidence interval, CR=complete response, CRi=complete response with incomplete hematopoietic recovery, DOR=duration of response, HR=hazard ratio, NE=not estimable, nPR=nodular partial response, ORR=overall response rate, PR=partial response. A + sign indicates a censored observation. Overall response rate Defined as CR + CRi + nPR + PR. No patients had CRi as best response. ORR, n (%) 263 (80) 237 (73) (95% CI, %) (76, 85) (68, 78) CR, n (%) 13 (4) 8 (2.5) nPR, n (%) 1 (0.3) 0 (0) PR, n (%) 249 (76) 229 (70) Response Rate Ratio (95% CI) Estimate stratified by randomization stratification factors. 1.10 (1.01, 1.20) 2-sided p-value 2-sided significance level of 0.0469 was allocated for ORR superiority testing. 0.0264 Duration of response Median DOR (95% CI) Based on Kaplan-Meier estimate. Estimated median follow-up for DOR was 14.1 months. NE (NE, NE) NE (NE, NE) Range, months (1.4 to 30.4+) (1.9+ to 30.8+) Rate at 12 months, % (95% CI) 92 (87, 95) 86 (80, 91) Progression-free survival Events, n (%) 88 (27) 120 (37) Median PFS (95% CI), months Based on Kaplan-Meier estimation. Estimated median follow-up for PFS was 30.7 months. NE (34.3, NE) 35 (33.2, 44.3) HR (95% CI) Based on a stratified Cox-regression model with ibrutinib as the reference group. 0.65 (0.49, 0.86) 2-sided p-value Based on a stratified log-rank test. 0.0024 The median time to response was 5.5 months for BRUKINSA and 5.6 months for ibrutinib. Figure 2: Kaplan-Meier Plot of Progression-Free Survival by IRC in ALPINE At the time of final analysis, the median overall survival was not reached in either arm. There were a total of 108 deaths: 48 (14.7%) in the zanubrutinib arm and 60 (18.5%) in the ibrutinib arm. Figure 2 14.5 Follicular Lymphoma The efficacy of BRUKINSA, in combination with obinutuzumab, was evaluated in Study BGB-3111-212 (ROSEWOOD; NCT03332017), an open-label, multicenter, randomized trial that enrolled 217 adult patients with relapsed or refractory FL after at least 2 prior systemic treatments. The study required prior receipt of an anti-CD20 antibody and an alkylator-based combination therapy, and excluded patients with FL Grade 3b, transformed lymphoma, and prior exposure to a BTK inhibitor. Patients were randomized in a 2:1 ratio to receive either BRUKINSA 160 mg orally twice daily until disease progression or unacceptable toxicity plus obinutuzumab, or obinutuzumab alone. Obinutuzumab was administered 1,000 mg intravenously on days 1, 8, and 15 of Cycle 1, 1,000 mg on Day 1 of Cycles 2 to 6; and then 1,000 mg every 8 weeks for up to 20 doses. At the discretion of the investigator, obinutuzumab could be administered as 100 mg on Day 1 and 900 mg on Day 2 of Cycle 1. Randomization was stratified by the number of prior lines of therapy (2 to 3 vs ˃3), rituximab-refractory status (yes vs no), and geographic region. Of the 217 patients randomized (145 to BRUKINSA plus obinutuzumab, 72 to obinutuzumab monotherapy), the median age was 64 years (range: 31 to 88), 50% were male, 64% were White, and 22% were Asian. In total, 83% had stage 3 or 4 disease and 57% met Groupe d'Etude des Lymphomes Folliculaires (GELF) criteria at enrollment. Patients had a median of 3 prior lines of therapy (range: 2-11), with 27% of patients having more than 3 prior lines of therapy. In the BRUKINSA in combination with obinutuzumab arm, 5% had received lenalidomide plus rituximab, 21% had received stem cell transplantation, 53% had refractory disease to rituximab, and 37% had progression of disease within 24 months of the first systemic therapy. Efficacy was based on overall response rate and duration of response, as determined by an IRC. Efficacy results are shown in Table 25. The median time to response in the BRUKINSA combination arm was 2.8 months (range 2 to 23 months). Table 25: Efficacy Results per IRC in Patients with Relapsed or Refractory Follicular Lymphoma Parameter BRUKINSA + Obinutuzumab (N=145) Obinutuzumab (N=72) CI=Confidence interval, CR=complete response, DOR=duration of response, NE=not estimable, ORR=overall response rate, PR=partial response. Overall response rate ORR, n (%) 100 (69) 33 (46) (95% CI) Estimated using the Clopper-Pearson method. (61, 76) (34, 58) CR 57 (39) 14 (19) PR 43 (30) 19 (26) Risk difference, % (95% CI) Estimated by stratified Cochran-Mantel-Haenszel method. 22.7 (9, 36.5) 2-sided p-value , Significance level, 0.05. 0.0012 Duration of response Median DOR (95% CI), Estimated by Kaplan-Meier method. Estimated median follow-up for DOR was 19 months overall. months NE (25.3, NE) 14 (9.2, 25.1) The estimated DOR rate at 18 months was 69% (95% CI: 58, 78) in the BRUKINSA combination arm and 42% (95% CI: 23, 60) in the obinutuzumab monotherapy arm."],"pharmacodynamics":["12.2 Pharmacodynamics BTK Occupancy in PBMCs and Lymph Nodes The median steady-state BTK occupancy in peripheral blood mononuclear cells was maintained at 100% over 24 hours at a total daily dose of 320 mg in patients with B-cell malignancies. The median steady-state BTK occupancy in lymph nodes was 94% to 100% following the approved recommended dosage. Cardiac Electrophysiology At the approved recommended doses (160 mg twice daily or 320 mg once daily), there were no clinically relevant effects on the QTc interval. The effect of BRUKINSA on the QTc interval above the therapeutic exposure has not been evaluated. In Vitro Platelet Aggregation In blood samples from healthy donors, patients on anticoagulant or antiplatelet therapy, and those with severe renal dysfunction, zanubrutinib demonstrated inhibition of platelet aggregation mediated by collagen, CRP-XL, or rhodocytin. Zanubrutinib did not show meaningful inhibition of platelet aggregation for ADP and PAR4-AP."],"pharmacokinetics":["12.3 Pharmacokinetics Zanubrutinib maximum plasma concentration (C max ) and area under the plasma drug concentration over time curve (AUC) increase proportionally over a dosage range from 40 mg to 320 mg (0.13 to 1 time the recommended total daily dose). Limited systemic accumulation of zanubrutinib was observed following repeated administration. The geometric mean (%CV) zanubrutinib steady-state daily AUC is 2,099 (42%) ng∙h/mL following 160 mg twice daily and 1,917 (59%) ng∙h/mL following 320 mg once daily. The geometric mean (%CV) zanubrutinib steady-state C max is 295 (55%) ng/mL following 160 mg twice daily and 537 (55%) ng/mL following 320 mg once daily. Absorption The median t max of zanubrutinib is 2 hours. Effect of Food BRUKINSA Capsules: Zanubrutinib AUC decreased 7% and C max increased 3% following administration of BRUKINSA capsules with a high-fat meal (1,000 calories, 50% fat) in healthy subjects. BRUKINSA Tablets: Zanubrutinib AUC increased up to 17% and C max up to 79% following administration of BRUKINSA tablets with a high-fat meal (1,000 calories, 50% fat) in healthy subjects. Distribution The geometric mean (%CV) apparent volume of distribution (Vz/F) of zanubrutinib is 537 (73%) L. The plasma protein binding of zanubrutinib is approximately 94% and the blood-to-plasma ratio is 0.7 to 0.8. Elimination The mean half-life (t ½ ) of zanubrutinib is approximately 2 to 4 hours following a single oral zanubrutinib dose of 160 mg or 320 mg. The geometric mean (%CV) apparent oral clearance (CL/F) of zanubrutinib is 128 (58%) L/h. Metabolism Zanubrutinib is primarily metabolized by cytochrome P450(CYP)3A. Excretion Following a single radiolabeled zanubrutinib dose of 320 mg to healthy subjects, approximately 87% of the dose was recovered in feces (38% unchanged) and 8% in urine (less than 1% unchanged). Specific Populations No clinically significant differences in the pharmacokinetics of zanubrutinib were observed based on age (19 to 90 years), sex, race (Asian, White, and Other), body weight (36 to 144 kg), or mild, moderate or severe renal impairment (CLcr ≥15 mL/min as estimated by Cockcroft-Gault). The effect of dialysis on zanubrutinib pharmacokinetics is unknown. Hepatic Impairment The total AUC of zanubrutinib increased by 11% in subjects with mild hepatic impairment (Child-Pugh class A), by 21% in subjects with moderate hepatic impairment (Child-Pugh class B), and by 60% in subjects with severe hepatic impairment (Child-Pugh class C) relative to subjects with normal liver function. The unbound AUC of zanubrutinib increased by 23% in subjects with mild hepatic impairment (Child-Pugh class A), by 43% in subjects with moderate hepatic impairment (Child-Pugh class B) and by 194% in subjects with severe hepatic impairment (Child-Pugh class C) relative to subjects with normal liver function. Drug Interaction Studies Clinical Studies and Model-Informed Approaches CYP3A Inhibitors : Coadministration of multiple doses of CYP3A inhibitors increases zanubrutinib C max and AUC (Table 18). Table 18: Observed or Predicted Increase in Zanubrutinib Exposure After Coadministration of CYP3A Inhibitors Coadministered CYP3A Inhibitor Increase in Zanubrutinib C max Increase in Zanubrutinib AUC Observed Itraconazole (200 mg once daily) The assessment was conducted in healthy subjects with a single dose of zanubrutinib 20 mg. 157% 278% Fluconazole (400 mg once daily) The assessment was conducted in patients with B-cell lymphoma administered multiple doses of zanubrutinib at the respective recommended zanubrutinib dosages in Table 1. 81% 88% Diltiazem (180 mg once daily) 62% 62% Voriconazole (200 mg twice daily) 229% 230% Clarithromycin (250 mg twice daily) 101% 92% Predicted Posaconazole suspension (100 mg once daily) The predicted values were based on simulations with patients administered multiple doses of zanubrutinib at the respective recommended dosages in Table 1. 169% 180% Posaconazole suspension (100 mg twice daily) 207% 279% Posaconazole delayed-release tablets (300 mg once daily) 232% 407% Posaconazole intravenously (300 mg once daily) 205% 333% Itraconazole (200 mg once daily) 273% 320% CYP3A Inducers : Coadministration of multiple doses of rifampin (strong CYP3A inducer) decreased the zanubrutinib C max by 92% and AUC by 93%. Coadministration of multiple doses of rifabutin (moderate CYP3A inducer) decreased the zanubrutinib C max by 48% and AUC by 44%. Coadministration of multiple doses of efavirenz (moderate CYP3A inducer) is predicted to decrease zanubrutinib C max by 58% and AUC by 60%. CYP3A Substrates : Coadministration of multiple doses of zanubrutinib decreased midazolam (CYP3A substrate) C max by 30% and AUC by 47%. CYP2C19 Substrates : Coadministration of multiple doses of zanubrutinib decreased omeprazole (CYP2C19 substrate) C max by 20% and AUC by 36%. Other CYP Substrates : No clinically significant differences were observed with warfarin (CYP2C9 substrate) pharmacokinetics when coadministered with zanubrutinib. Transporter Systems : Coadministration of multiple doses of zanubrutinib increased digoxin (P-gp substrate) C max by 34% and AUC by 11%. No clinically significant differences in the pharmacokinetics of rosuvastatin (BCRP substrate) were observed when coadministered with zanubrutinib. Gastric Acid Reducing Agents : No clinically significant differences in zanubrutinib pharmacokinetics were observed when coadministered with gastric acid reducing agents (proton pump inhibitors, H2-receptor antagonists). In Vitro Studies CYP Enzymes : Zanubrutinib is an inducer of CYP2B6 and CYP2C8. Transporter Systems : Zanubrutinib is likely to be a substrate of P-gp. Zanubrutinib is not a substrate or inhibitor of OAT1, OAT3, OCT2, OATP1B1, or OATP1B3."],"adverse_reactions":["6 ADVERSE REACTIONS The following clinically significant adverse reactions are discussed in more detail in other sections of the labeling: Hemorrhage [see Warnings and Precautions (5.1) ] Infections [see Warnings and Precautions (5.2) ] Cytopenias [see Warnings and Precautions (5.3) ] Second Primary Malignancies [see Warnings and Precautions (5.4) ] Cardiac Arrhythmias [see Warnings and Precautions (5.5) ] Hepatotoxicity, including DILI [see Warnings and Precautions (5.6) ] The most common adverse reactions (≥30%), including laboratory abnormalities, are neutrophil count decreased, platelet count decreased, upper respiratory tract infection, hemorrhage, and musculoskeletal pain. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact BeOne Medicines at 1-877-828-5596 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The data in the WARNINGS AND PRECAUTIONS reflect exposure to BRUKINSA in nine monotherapy and 2 combination clinical trials, administered at 160 mg twice daily in 1608 patients and at 320 mg once daily in 121 patients. Among these 1729 patients, the median duration of exposure was 27.6 months, 78% of patients were exposed for at least 12 months, and 60% of patients were exposed for at least 24 months. In this pooled safety population, the most common adverse reactions (≥30%), including laboratory abnormalities, were neutrophil count decreased (51%), platelet count decreased (41%), upper respiratory tract infection (38%), hemorrhage (32%), and musculoskeletal pain (31%). Mantle Cell Lymphoma (MCL) The safety of BRUKINSA was evaluated in 118 patients with MCL who received at least one prior therapy in two single-arm clinical trials, BGB-3111-206 [NCT03206970] and BGB-3111-AU-003 [NCT02343120] [see Clinical Studies (14.1) ] . The median age of patients who received BRUKINSA in studies BGB-3111-206 and BGB-3111-AU-003 was 62 years (range: 34 to 86), 75% were male, 75% were Asian, 21% were White, and 94% had an ECOG performance status of 0 to 1. Patients had a median of 2 prior lines of therapy (range: 1 to 4). The BGB-3111-206 trial required a platelet count ≥75 × 10 9 /L and an absolute neutrophil count ≥1 × 10 9 /L independent of growth factor support, hepatic enzymes ≤2.5 × upper limit of normal, total bilirubin ≤1.5 × ULN. The BGB-3111-AU-003 trial required a platelet count ≥50 × 10 9 /L and an absolute neutrophil count ≥1 × 10 9 /L independent of growth factor support, hepatic enzymes ≤3 × upper limit of normal, total bilirubin ≤1.5 × ULN. Both trials required a creatinine clearance (CLcr) ≥30 mL/min. Both trials excluded patients with prior allogeneic hematopoietic stem cell transplant, exposure to a BTK inhibitor, known infection with HIV, and serologic evidence of active hepatitis B or hepatitis C infection, and patients requiring strong CYP3A inhibitors or strong CYP3A inducers. Patients received BRUKINSA 160 mg twice daily or 320 mg once daily. Among patients receiving BRUKINSA, 79% were exposed for 6 months or longer, and 68% were exposed for greater than one year. Fatal adverse reactions within 30 days of the last dose of BRUKINSA occurred in 8 (7%) of 118 patients with MCL. Fatal cases included pneumonia in 2 patients and cerebral hemorrhage in one patient. Serious adverse reactions were reported in 36 patients (31%). The most frequent serious adverse reactions that occurred were pneumonia (11%) and hemorrhage (5%). Of the 118 patients with MCL treated with BRUKINSA, 8 (7%) patients discontinued treatment due to adverse reactions in the trials. The most frequent adverse reaction leading to treatment discontinuation was pneumonia (3.4%). One (0.8%) patient experienced an adverse reaction leading to dose reduction (hepatitis B). Table 3 summarizes the adverse reactions in BGB-3111-206 and BGB-3111-AU-003. Table 3: Adverse Reactions (≥10%) in Patients Receiving BRUKINSA in BGB-3111-206 and BGB-3111-AU-003 Trials Body System Adverse Reaction Percent of Patients (N=118) All Grades % Grade 3 or Higher % Infections and infestations Upper respiratory tract infection Upper respiratory tract infection includes upper respiratory tract infection, upper respiratory tract infection viral. 39 0 Pneumonia Pneumonia includes pneumonia, pneumonia fungal, pneumonia cryptococcal, pneumonia streptococcal, atypical pneumonia, lung infection, lower respiratory tract infection, lower respiratory tract infection bacterial, lower respiratory tract infection viral. 15 10 Includes fatal adverse reaction. Urinary tract infection 11 0.8 Skin and subcutaneous tissue disorders Rash Rash includes all related terms containing rash. 36 0 Bruising Bruising includes all related terms containing bruise, bruising, contusion, ecchymosis. 14 0 Gastrointestinal disorders Diarrhea 23 0.8 Constipation 13 0 Vascular disorders Hypertension 12 3.4 Hemorrhage Hemorrhage includes all related terms containing hemorrhage, hematoma. 11 3.4 Musculoskeletal and connective tissue disorders Musculoskeletal pain Musculoskeletal pain includes musculoskeletal pain, musculoskeletal discomfort, myalgia, back pain, arthralgia, arthritis. 14 3.4 Respiratory, thoracic, and mediastinal disorders Cough 12 0 Other clinically significant adverse reactions that occurred in <10% of patients with mantle cell lymphoma include major hemorrhage (defined as ≥ Grade 3 hemorrhage or CNS hemorrhage of any grade) (5%) and headache (4.2%). Table 4: Selected Laboratory Abnormalities Based on laboratory measurements. (>20%) in Patients with MCL in Studies BGB-3111-206 and BGB-3111-AU-003 Laboratory Parameter Percent of Patients (N=118) All Grades (%) Grade 3 or 4 (%) Hematologic abnormalities Neutrophils decreased 45 20 Lymphocytosis Asymptomatic lymphocytosis is a known effect of BTK inhibition. 41 16 Platelets decreased 40 7 Hemoglobin decreased 27 6 Chemistry abnormalities Blood uric acid increased 29 2.6 ALT increased 28 0.9 Bilirubin increased 24 0.9 Waldenström's Macroglobulinemia (WM) The safety of BRUKINSA was investigated in two cohorts of Study BGB-3111-302 (ASPEN). Cohort 1 included 199 patients with MYD88 mutation ( MYD88 MUT ) WM, randomized to and treated with either BRUKINSA (101 patients) or ibrutinib (98 patients). The trial also included a non-randomized arm, Cohort 2, with 26 wild type MYD88 ( MYD88 WT ) WM patients and 2 patients with unknown MYD88 status [see Clinical Studies (14.2) ] . Among patients who received BRUKINSA, 93% were exposed for 6 months or longer, and 89% were exposed for greater than 1 year. In Cohort 1 of the ASPEN study safety population (N=101), the median age of patients who received BRUKINSA was 70 years (45-87 years old); 67% were male, 86% were White, 4% were Asian, and 10% were not reported (unknown race). In Cohort 2 of the ASPEN study safety population (N=28), the median age of patients who received BRUKINSA was 72 (39-87 years old); 50% were male, 96% were White, and 4% were not reported (unknown race). In Cohort 1, serious adverse reactions occurred in 44% of patients who received BRUKINSA. Serious adverse reactions in >2% of patients included influenza (3%), pneumonia (4%), neutropenia and neutrophil count decreased (3%), hemorrhage (4%), pyrexia (3%), and febrile neutropenia (3%). In Cohort 2, serious adverse reactions occurred in 39% of patients. Serious adverse reactions in >2 patients included pneumonia (14%). Permanent discontinuation of BRUKINSA due to an adverse reaction occurred in 2% of patients in Cohort 1 and included hemorrhage (1 patient), neutropenia and neutrophil count decreased (1 patient); in Cohort 2, permanent discontinuation of BRUKINSA due to an adverse reaction occurred in 7% of patients and included subdural hemorrhage (1 patient) and diarrhea (1 patient). Dosage interruptions of BRUKINSA due to an adverse reaction occurred in 32% of patients in Cohort 1 and in 29% in Cohort 2. Adverse reactions which required dosage interruption in >2% of patients included neutropenia, vomiting, hemorrhage, thrombocytopenia, and pneumonia in Cohort 1. Adverse reactions leading to dosage interruption in >2 patients in Cohort 2 included pneumonia and pyrexia. Dose reductions of BRUKINSA due to an adverse reaction occurred in 11% of patients in Cohort 1 and in 7% in Cohort 2. Adverse reactions which required dose reductions in >2% of patients included neutropenia in Cohort 1. Adverse reaction leading to dose reduction occurred in 2 patients in Cohort 2 (each with one event: diarrhea and pneumonia). Table 5 summarizes the adverse reactions in Cohort 1 in ASPEN. Table 5: Adverse Reactions (≥10%) Occurring in Patients with WM Who Received BRUKINSA in Cohort 1 Body System Adverse Reaction BRUKINSA (N=101) Ibrutinib (N=98) All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) Infections and infestations Upper respiratory tract infection Upper respiratory tract infection includes upper respiratory tract infection, laryngitis, nasopharyngitis, sinusitis, rhinitis, viral upper respiratory tract infection, pharyngitis, rhinovirus infection, upper respiratory tract congestion. 44 0 40 2 Pneumonia Pneumonia includes lower respiratory tract infection, lung infiltration, pneumonia, pneumonia aspiration, pneumonia viral. 12 4 26 10 Urinary tract infection 11 0 13 2 Gastrointestinal disorders Diarrhea 22 3 34 2 Nausea 18 0 13 1 Constipation 16 0 7 0 Vomiting 12 0 14 1 General disorders Fatigue Fatigue includes asthenia, fatigue, lethargy. 31 1 25 1 Pyrexia 16 4 13 2 Edema peripheral 12 0 20 0 Skin and subcutaneous tissue disorders Bruising Bruising includes all related terms containing bruise, contusion, or ecchymosis. 20 0 34 0 Rash Rash includes all related terms rash, maculo-papular rash, erythema, rash erythematous, drug eruption, dermatitis allergic, dermatitis atopic, rash pruritic, dermatitis, photodermatoses, dermatitis acneiform, stasis dermatitis, vasculitic rash, eyelid rash, urticaria, skin toxicity. 29 0 32 0 Pruritus 11 1 6 0 Musculoskeletal and connective tissue disorders Musculoskeletal pain Musculoskeletal pain includes back pain, arthralgia, pain in extremity, musculoskeletal pain, myalgia, bone pain, spinal pain, musculoskeletal chest pain, neck pain, arthritis, musculoskeletal discomfort. 45 9 39 1 Muscle spasms 10 0 28 1 Nervous system disorders Headache 18 1 14 1 Dizziness 13 1 12 0 Respiratory, thoracic, and mediastinal disorders Cough 16 0 18 0 Dyspnea 14 0 7 0 Vascular disorders Hemorrhage Hemorrhage includes epistaxis, hematuria, conjunctival hemorrhage, hematoma, rectal hemorrhage, periorbital hemorrhage, mouth hemorrhage, post procedural hemorrhage, hemoptysis, skin hemorrhage, hemorrhoidal hemorrhage, ear hemorrhage, eye hemorrhage, hemorrhagic diathesis, periorbital hematoma, subdural hemorrhage, wound hemorrhage, gastric hemorrhage, lower gastrointestinal hemorrhage, spontaneous hematoma, traumatic hematoma, traumatic intracranial hemorrhage, tumor hemorrhage, retinal hemorrhage, hematochezia, diarrhea hemorrhagic, hemorrhage, melena, post-procedural hematoma, subdural hematoma, anal hemorrhage, hemorrhagic disorder, pericardial hemorrhage, postmenopausal hemorrhage, stoma site hemorrhage, subarachnoid hemorrhage. 42 4 43 9 Hypertension 14 9 19 14 Clinically relevant adverse reactions in <10% of patients who received BRUKINSA included localized infection, atrial fibrillation or atrial flutter, and hematuria. Table 6 summarizes the laboratory abnormalities in ASPEN. Table 6: Select Laboratory Abnormalities Based on laboratory measurements. (≥20%) that Worsened from Baseline in Patients with WM Who Received BRUKINSA in Cohort 1 Laboratory Abnormality BRUKINSA The denominator used to calculate the rate varied from 86 to 101 based on the number of patients with a baseline value and at least one post-treatment value. Ibrutinib All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) Hematologic abnormalities Neutrophils decreased 50 24 34 9 Platelets decreased 35 8 39 5 Hemoglobin decreased 20 7 20 7 Chemistry abnormalities Glucose increased 45 2.3 33 2.3 Creatinine increased 31 1 21 1 Calcium decreased 27 2 26 0 Potassium increased 24 2 12 0 Phosphate decreased 20 3.1 18 0 Urate increased 16 3.2 34 6 Bilirubin increased 12 1 33 1 Marginal Zone Lymphoma The safety of BRUKINSA was evaluated in 88 patients with previously treated MZL in two single-arm clinical studies, BGB-3111-214 and BGB-3111-AU-003 [see Clinical Studies (14.3) ] . The trials required an absolute neutrophil count ≥1 × 10 9 /L, platelet count ≥50 or ≥75 × 10 9 /L and adequate hepatic function and excluded patients requiring a strong CYP3A inhibitor or inducer. Patients received BRUKINSA 160 mg twice daily (97%) or 320 mg once daily (3%). The median age in both studies combined was 70 years (range: 37 to 95), 52% were male, 64% were White, and 19% were Asian. Most patients (92%) had an ECOG performance status of 0 to 1. Eighty percent received BRUKINSA for 6 months or longer, and 67% received treatment for more than one year. Two fatal adverse reactions (2.3%) occurred within 30 days of the last dose of BRUKINSA, including myocardial infarction and a Covid-19–related death. Serious adverse reactions occurred in 40% of patients. The most frequent serious adverse reactions were pyrexia (8%) and pneumonia (7%). Adverse reactions lead to treatment discontinuation in 6% of patients, dose reduction in 2.3%, and dose interruption in 34%. The leading cause of dose modification was respiratory tract infections (13%). Table 7 summarizes selected adverse reactions in BGB-3111-214 and BGB-3111-AU-003. Table 7: Adverse Reactions Occurring in ≥10% Patients with MZL Who Received BRUKINSA Body System Adverse Reaction BRUKINSA (N=88) All Grades (%) Grade 3 or 4 (%) Infections and infestations Upper respiratory tract infection Upper respiratory tract infection includes upper respiratory tract infection, nasopharyngitis, sinusitis, tonsillitis, rhinitis, viral upper respiratory tract infection. 26 3.4 Urinary tract infection Urinary tract infection includes urinary tract infection, cystitis, Escherichia urinary tract infection, pyelonephritis, cystitis. 11 2.3 Pneumonia Pneumonia includes COVID-19 pneumonia, pneumonia, bronchopulmonary aspergillosis, lower respiratory tract infection, organizing pneumonia. , Includes 2 fatalities from COVID-19 pneumonia. 10 6 Gastrointestinal disorders Diarrhea Diarrhea includes diarrhea and diarrhea hemorrhagic. 25 3.4 Abdominal pain Abdominal pain includes abdominal pain, abdominal pain upper, abdominal discomfort. 14 2.3 Nausea 13 0 Skin and subcutaneous tissue disorders Bruising Bruising includes contusion, ecchymosis, increased tendency to bruise, post procedural contusion. 24 0 Rash Rash includes rash, rash maculo-papular, rash pruritic, dermatitis, dermatitis allergic, dermatitis atopic, dermatitis contact, drug reaction with eosinophilia and systemic symptoms, erythema, photosensitivity reaction, rash erythematous, rash papular, seborrheic dermatitis. 21 0 Musculoskeletal and connective tissue disorders Musculoskeletal pain Musculoskeletal pain includes back pain, arthralgia, musculoskeletal pain, myalgia, pain in extremity, musculoskeletal chest pain, bone pain, musculoskeletal discomfort, neck pain. 27 1.1 Vascular disorders Hemorrhage Hemorrhage includes epistaxis, hematuria, hemorrhoidal hemorrhage, hematoma, hemoptysis, conjunctival hemorrhage, diarrhea hemorrhagic, hemorrhage urinary tract, mouth hemorrhage, pulmonary hematoma, subcutaneous hematoma, gingival bleeding, melena, upper gastrointestinal hemorrhage. 23 1.1 General disorders Fatigue Fatigue includes fatigue, lethargy, asthenia. 21 2.3 Respiratory, thoracic, and mediastinal disorders Cough Cough includes cough and productive cough. 10 0 Clinically relevant adverse reactions in <10% of patients who received BRUKINSA included peripheral neuropathy, second primary malignancies, dizziness, edema, headache, petechiae, purpura, and atrial fibrillation or flutter. Table 8 summarizes select laboratory abnormalities. Table 8: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with MZL Laboratory Abnormality The denominator used to calculate the rate varied from 87 to 88 based on the number of patients with a baseline value and at least one post-treatment value. BRUKINSA All Grades (%) Grade 3 or 4 (%) Hematologic abnormalities Neutrophils decreased 43 15 Platelets decreased 33 10 Lymphocytes decreased 32 8 Hemoglobin decreased 26 6 Chemistry abnormalities Glucose increased 54 4.6 Creatinine increased 34 1.1 Phosphate decreased 27 2.3 Calcium decreased 23 0 ALT increased 22 1.1 Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma The safety data described below reflect exposure to BRUKINSA (160 mg twice daily) in 675 patients with CLL from two randomized controlled clinical trials [see Clinical Studies (14.4) ] . The trials required patients to be unsuitable for fludarabine, cyclophosphamide, and rituximab (FCR) therapy defined as age ≥65 years, or age 18 to <65 years with either a total Cumulative Illness Rating Scale (CIRS) >6, CLcr 30 to 69 mL/min, or history of serious or frequent infections. The trial excluded patients with AST or ALT ≥2 times the upper limit of normal (ULN) or bilirubin ≥3 times (ULN) and patients requiring a strong CYP3A inhibitor or inducer. SEQUOIA The safety of BRUKINSA monotherapy in patients with previously untreated CLL/SLL was evaluated in a randomized, multicenter, open-label, actively controlled trial [see Clinical Studies (14.4) ] . Patients without deletion of chromosome 17p13.1 (17p deletion) (Cohort 1) received either BRUKINSA 160 mg twice daily until disease progression or unacceptable toxicity (n=240) or bendamustine plus rituximab (BR) for 6 cycles (n=227). Bendamustine was dosed at 90 mg/m 2 /day intravenously on the first 2 days of each cycle, and rituximab was dosed at 375 mg/m 2 on day 1 of Cycle 1 and 500 mg/m 2 on day 1 of Cycles 2 to 6. Additionally, the same BRUKINSA regimen was evaluated in 111 patients with previously untreated CLL/SLL with 17p deletion in a non-randomized single arm (Cohort 2). Randomized Cohort: Previously Untreated CLL/SLL without 17p Deletion In patients with previously untreated CLL/SLL without 17p deletion, the median age was 70, 62% were male, 89% were White, 2% were Asian, and 2% were Black. Most patients (93%) had an ECOG performance status of 0 to 1. The median duration of exposure to BRUKINSA was 26 months, with 71% exposed for more than 2 years. Serious adverse reactions occurred in 36% of patients who received BRUKINSA. Serious adverse reactions that occurred in ≥5% of patients were COVID-19, pneumonia, and second primary malignancy (5% each). Fatal adverse reactions occurred in 11 (4.6%) patients with the leading cause of death being COVID-19 (2.1%). Adverse reactions led to permanent discontinuation of BRUKINSA in 8% of patients, dose reduction in 8%, and dose interruption in 46%. The most common adverse reactions leading to permanent discontinuation were second primary malignancy and COVID-19. The leading causes of dose modification (≥5% of all patients) were respiratory infections (COVID-19, pneumonia) and hemorrhage. Table 9 summarizes select adverse reactions in this randomized cohort. Table 9: Adverse Reactions in ≥10% Patients with Previously Untreated CLL/SLL without 17p Deletion in SEQUOIA CLL/SLL without 17p deletion BRUKINSA (N=240) BR (N=227) System Organ Class Preferred Term All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) Musculoskeletal and connective tissue disorders Musculoskeletal pain Musculoskeletal pain: musculoskeletal pain, arthralgia, back pain, pain in extremity, myalgia, neck pain, spinal pain, musculoskeletal discomfort, bone pain. 33 1.7 17 0.4 Infections and infestations Upper respiratory tract infection Upper respiratory tract infection: upper respiratory tract infection, nasopharyngitis, sinusitis, rhinitis, pharyngitis, upper respiratory tract congestion, laryngitis, tonsillitis and upper respiratory tract inflammation, and related terms. 28 1.3 15 0.9 Pneumonia Pneumonia: pneumonia, COVID-19 pneumonia, lower respiratory tract infection, lung infiltration, and related terms including specific types of infection. 13 Includes 3 fatal outcomes. 5 8 Includes 2 fatal outcomes. 4 Vascular disorders Hemorrhage Hemorrhage: all terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding. 27 4 4 0.4 Hypertension Includes multiple similar adverse reaction terms. 14 7 5 2.6 Skin and subcutaneous tissue disorders Rash Rash: Rash, dermatitis, drug eruption, and related terms. 24 1.3 30 5 Bruising Bruising: all terms containing bruise, bruising, contusion, or ecchymosis. 24 0 2.6 0 Respiratory, thoracic, and mediastinal disorders Cough 15 0 10 0 Gastrointestinal disorders Diarrhea 14 0.8 12 0.9 Constipation 10 0.4 18 0 Nausea 10 0 33 1.3 General disorders Fatigue Fatigue: fatigue, asthenia, and lethargy. 14 1.3 21 1.8 Neoplasms Second primary malignancy Second primary malignancy: includes non-melanoma skin cancer, malignant solid tumors (including lung, renal, genitourinary, breast, ovarian, and rectal), and chronic myeloid leukemia. 13 6 1.3 0.4 Nervous system disorders Headache 12 0 8 0 Dizziness Dizziness: dizziness and vertigo. 11 0.8 5 0 Other clinically significant adverse reactions occurring in <10% of BRUKINSA recipients in this cohort included COVID-19 (9%), edema (8%), abdominal pain (8%), urinary tract infection (7%), and atrial fibrillation or flutter (3.3%). Table 10 summarizes select laboratory abnormalities in this cohort. Table 10: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with Previously Untreated CLL/SLL without 17p Deletion in SEQUOIA Laboratory Abnormality The denominator used to calculate the rate was 239 in the BRUKINSA arm and 227 in the BR arm, based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria. BRUKINSA BR All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) Hematologic abnormalities Neutrophils decreased 37 15 80 53 Hemoglobin decreased 29 2.5 66 8 Platelets decreased 27 1.7 61 11 Leukocytes increased 21 Lymphocytes increased in 15%. 21 0.4 0.4 Chemistry abnormalities Glucose increased Nonfasting conditions. 55 7 67 10 Creatinine increased 22 0.8 18 0.4 Magnesium increased 22 0 14 0.4 Alanine aminotransferase increased 21 2.1 23 2.2 Single-Arm Cohort: Previously Untreated CLL/SLL and 17p Deletion In 111 patients with previously untreated, 17p del CLL/SLL, the median age was 70, 71% were male, 95% were White, and 1% were Asian. Most patients (87%) had an ECOG performance status of 0 to 1. The median duration of exposure to BRUKINSA was 30 months. Fatal adverse reactions occurred in 3 (2.7%) patients, including pneumonia, renal insufficiency, and aortic dissection (1 patient each). Serious adverse reactions occurred in 41% of patients treated with BRUKINSA. Serious adverse reactions reported in ≥5% of patients were pneumonia (8%) and second primary malignancy (7%). Adverse reactions led to treatment discontinuation in 5% of patients, dose reduction in 5%, and dose interruption in 51%. The leading causes of dose modification (≥5% of all patients) were pneumonia, neutropenia, second primary malignancy, and diarrhea. Table 11 summarizes select adverse reactions in this cohort. Table 11: Adverse Reactions in ≥10% of Patients with Previously Untreated CLL/SLL and 17p Deletion in SEQUOIA CLL/SLL with 17p Deletion BRUKINSA (N=111) System Organ Class Preferred Term All Grades (%) Grade 3 or 4 (%) Infections and infestations Upper respiratory tract infection Upper respiratory tract infection: upper respiratory tract infection, nasopharyngitis, sinusitis, rhinitis, pharyngitis, upper respiratory tract congestion, upper respiratory tract inflammation, viral upper respiratory tract infection, and related terms. 38 0 Pneumonia Pneumonia: pneumonia, COVID-19 pneumonia, lower respiratory tract infection, and related terms including specific types of infection. 20 Includes 1 fatal outcome. 8 Musculoskeletal and connective tissue disorders Musculoskeletal pain Musculoskeletal pain: musculoskeletal pain, arthralgia, back pain, pain in extremity, myalgia, neck pain, bone pain. 38 2.7 Skin and subcutaneous tissue disorders Rash Rash: Rash, dermatitis, toxic skin eruption, and related terms. 28 0 Bruising Bruising: all terms containing bruise, bruising, contusion, or ecchymosis. 26 0.9 Vascular disorders Hemorrhage Hemorrhage: all terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding. 28 4.5 Hypertension 11 5.4 Neoplasms Second primary malignancy Second primary malignancy: includes non-melanoma skin cancer, malignant solid tumors (including bladder, lung, renal, breast, prostate, ovarian, pelvis, and ureter), and malignant melanoma. 22 Includes non-melanoma skin cancer in 13%. 6 Gastrointestinal disorders Diarrhea 18 0.9 Nausea 16 0 Constipation 15 0 Abdominal pain 12 1.8 Respiratory, thoracic, and mediastinal disorders Cough Includes multiple similar adverse reaction terms. 18 0 Dyspnea 13 0 General disorders and administration site conditions Fatigue Fatigue: fatigue, asthenia, and lethargy. 14 0.9 Nervous system disorders Headache 11 1.8 Clinically significant adverse reactions occurring in <10% of BRUKINSA recipients in this cohort included urinary tract infection (8%), edema (7%), atrial fibrillation or flutter (4.5%), and COVID-19 (3.6%). Table 12 summarizes select laboratory abnormalities in this cohort. Table 12: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with Previously Untreated CLL/SLL and 17p Deletion in SEQUOIA Laboratory Abnormality The denominator used to calculate the rate varied from 110 to 111 based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria. BRUKINSA All Grades (%) Grade 3 or 4 (%) Hematologic abnormalities Neutrophils decreased 42 19 Grade 4, 9%. Hemoglobin decreased 26 3.6 Platelets decreased 23 0.9 Chemistry abnormalities Glucose increased Nonfasting conditions. 52 6 Magnesium increased 31 0 Creatinine increased 27 0.9 ALPINE The safety of BRUKINSA monotherapy was evaluated in patients with previously treated CLL/SLL in a randomized, multicenter, open-label, actively controlled trial [see Clinical Studies (14.4) ] . In ALPINE, 324 patients received BRUKINSA monotherapy, 160 mg orally twice daily and 324 patients received ibrutinib monotherapy, 420 mg orally daily until disease progression or unacceptable toxicity. In ALPINE, the median duration of exposure was 24 months for BRUKINSA. Adverse reactions leading to death in the BRUKINSA arm occurred in 24 (7%) patients. Adverse reactions leading to death that occurred in >1% of patients were pneumonia (2.8%) and COVID-19 infection (1.9%). One hundred and four patients in the BRUKINSA arm (32%) reported ≥1 serious adverse reaction. Serious adverse reactions occurring in ≥5% of patients were pneumonia (10%), COVID-19 (7%), and second primary malignancies (5%). Adverse reactions led to treatment discontinuation in 13% of patients, dose reduction in 11%, and dose interruption in 42%. The leading cause of treatment discontinuation was pneumonia. The leading causes of dose modification (≥5% of all patients) were respiratory infections (COVID-19, pneumonia) and neutropenia. Table 13 summarizes select adverse reactions in ALPINE. Table 13: Adverse Reactions in ≥10% of Patients with Relapsed or Refractory CLL/SLL Who Received BRUKINSA in ALPINE System Organ Class Preferred Term BRUKINSA (N=324) Ibrutinib (N=324) All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) Infections and infestations Upper respiratory tract infection Upper respiratory tract infection: upper respiratory tract infection, sinusitis, pharyngitis, rhinitis, nasopharyngitis, laryngitis, tonsillitis, and related terms. 27 1.2 22 1.2 Pneumonia Pneumonia: Pneumonia, COVID-19 pneumonia, lower respiratory tract infection, lung infiltration, and related terms including specific types of infection. 18 Includes fatal outcomes: pneumonia (9 patients), COVID-19 (8 patients), and hemorrhage (1 patient). 9 19 Includes fatal outcomes: pneumonia (10 patients), COVID-19 (9 patients), and hemorrhage (2 patients). 11 COVID-19 COVID-19: COVID-19, COVID-19 pneumonia, postacute COVID-19 syndrome, SARS-CoV-2 test positive. 14 7 10 4.6 Musculoskeletal and connective tissue disorders Musculoskeletal pain Musculoskeletal pain: musculoskeletal pain, arthralgia, back pain, pain in extremity, myalgia, neck pain, spinal pain, bone pain, and musculoskeletal discomfort. 26 0.6 28 0.6 Vascular disorders Hemorrhage Hemorrhage: all terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding. 24 2.5 26 3.7 Hypertension Includes multiple similar adverse reaction terms. 19 13 20 13 Skin and subcutaneous tissue disorders Rash Rash: Rash, Dermatitis, and related terms. 20 1.2 21 0.9 Bruising Bruising: all terms containing bruise, bruising, contusion, or ecchymosis. 16 0 14 0 Gastrointestinal disorders Diarrhea 14 1.5 22 0.9 General disorders Fatigue Fatigue: asthenia, fatigue, lethargy. 13 0.9 14 0.9 Respiratory, thoracic, and mediastinal disorders Cough 11 0.3 11 0 Nervous system disorders Dizziness 10 0 7 0 Clinically relevant adverse reactions in <10% of patients who received BRUKINSA included urinary tract infection (9%), supraventricular arrhythmias (9%) including atrial fibrillation or flutter (4.6%), abdominal pain (8%), headache (8%), pruritus (6.2%), constipation (5.9%), and edema (4.6%). Table 14 summarizes select laboratory abnormalities in ALPINE. Table 14: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients Who Received BRUKINSA in ALPINE Laboratory Abnormality The denominator used to calculate the rate was 321 in the BRUKINSA arm, and varied from 320 to 321 in the ibrutinib arm, based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria. BRUKINSA Ibrutinib All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) Hematologic abnormalities Neutrophils decreased 43 15 33 16 Hemoglobin decreased 28 4 32 3.7 Lymphocytes increased 24 19 26 19 Platelets decreased 22 4 24 3.4 Chemistry abnormalities Glucose increased 52 5 29 2.8 Creatinine increased 26 0 23 0 Phosphate decreased 21 2.5 13 2.2 Calcium decreased 21 0.6 29 0 Follicular Lymphoma The safety of BRUKINSA in combination with obinutuzumab was evaluated in 143 adult patients with relapsed or refractory follicular lymphoma (FL) in study BGB-3111-212 (ROSEWOOD), a randomized, multicenter, open-label trial [see Clinical Studies (14.5) ] . The trial required an absolute neutrophil count ≥1 × 10 9 /L, platelet count ≥50 × 10 9 /L, and CLcr ≥30 mL/min and excluded patients requiring a strong CYP3A inhibitor or inducer. Patients were randomized to receive either BRUKINSA 160 mg twice daily until disease progression or unacceptable toxicity plus obinutuzumab (n=143) or obinutuzumab monotherapy (n=71). Obinutuzumab was dosed at 1,000 mg intravenously on Days 1, 8, and 15 of Cycle 1; on Day 1 of Cycles 2 to 6; and then every 8 weeks for up to 20 doses. At the discretion of the investigator, obinutuzumab was administered intravenously on Day 1 (100 mg) and on Day 2 (900 mg) of Cycle 1 instead of 1,000 mg on Day 1 of Cycle 1. In patients who received BRUKINSA in combination with obinutuzumab, the median age was 63, 49% were female, 63% were White, and 21% were Asian. Most patients (97%) had an ECOG performance status of 0 to 1. The median duration of BRUKINSA treatment was 12 months, with 24% of patients treated for at least 2 years. Serious adverse reactions occurred in 35% of patients who received BRUKINSA in combination with obinutuzumab. Serious adverse reactions in ≥5% of patients included pneumonia (11%) and COVID-19 (10%). Fatal adverse reactions occurred in 4.2% of patients, with the leading cause of death being COVID-19 (2.1%). Adverse reactions led to permanent discontinuation of BRUKINSA in 17% of patients, dose reduction in 9%, and dose interruption in 40%. Adverse reactions leading to permanent discontinuation in ≥2% of patients were pneumonia, COVID-19, and second primary malignancy. The leading causes of BRUKINSA dosage modification (42% of all patients) were pneumonia, COVID-19, thrombocytopenia, and neutropenia. Table 15 summarizes adverse reactions in BGB-3111-212. Table 15: Adverse Reactions in ≥10% of Patients with Relapsed or Refractory FL Who Received BRUKINSA in Study BGB-3111-212 System Organ Class Preferred Term BGB-3111-212 BRUKINSA + Obinutuzumab (N=143) Obinutuzumab (N=71) All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) General disorders and administration site conditions Fatigue Includes multiple related terms. , Fatigue: Fatigue, asthenia, and lethargy. 27 1.4 25 1.4 Pyrexia 13 0 20 0 Musculoskeletal and connective tissue disorders Musculoskeletal pain , Musculoskeletal pain: Back pain, musculoskeletal pain, musculoskeletal discomfort, noncardiac chest pain, neck pain, pain in extremity, myalgia, spinal pain, bone pain, arthralgia, and related terms. 22 3.5 23 1.4 Vascular disorders Hemorrhage , Hemorrhage: All terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding. 20 1.4 10 1.4 Gastrointestinal disorders Diarrhea 18 2.8 17 1.4 Constipation 13 0 9 0 Abdominal pain 11 2.1 11 0 Infections and infestations Upper respiratory tract infection , Upper respiratory tract infection: Upper respiratory tract infection, sinusitis, pharyngitis, laryngitis, rhinitis, nasopharyngitis, laryngopharyngitis, tonsillitis bacterial, and related terms. 17 2.8 10 0 Pneumonia , Pneumonia: Pneumonia, COVID-19 pneumonia, lung infiltration, lung consolidation, and related terms including specific types of infection. , Includes fatal outcomes: COVID-19 (3 patients), pneumonia (2 patients), dyspnea (1 patient). 15 13 11 7 COVID-19 , 13 9 11 4.2 Herpes virus infection Herpes virus infection: Herpes viral infection, herpes zoster, herpes simplex, herpes simplex reactivation, varicella, and Epstein-Barr viremia. 11 2.1 1.4 0 Urinary tract infection Urinary tract infection: Urinary tract infection, cystitis, pyelonephritis, and related terms. 10 1.4 7 0 Respiratory, thoracic, and mediastinal disorders Cough 14 0 14 0 Dyspnea , 11 2.1 13 0 Skin and subcutaneous tissue disorders Rash , Rash: Rash, erythema, dermatitis, drug eruption, skin reaction, and related terms. 11 0 14 0 Clinically relevant adverse reactions in <10% of patients who received BRUKINSA in combination with obinutuzumab included bruising, edema, pruritus, petechiae, vomiting, headache, arthralgia, hypertension, sepsis, cardiac arrhythmias, renal insufficiency, febrile neutropenia, transaminase elevation, and pneumonitis. Table 16: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients Who Received BRUKINSA in Study BGB-3111-212 Laboratory Abnormality The denominator used to calculate the rate was 122 in the BRUKINSA + obinutuzumab arm, and varied from 56 to 58 in the obinutuzumab arm, based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria. BGB-3111-212 BRUKINSA + Obinutuzumab Obinutuzumab All Grades (%) Grade 3 or 4 (%) All Grades (%) Grade 3 or 4 (%) Hematologic abnormalities Platelets decreased 65 11 43 11 Neutrophils decreased 47 17 42 14 Hemoglobin decreased 31 0.8 23 0 Lymphocytes decreased 30 11 51 25 Chemistry Glucose increased Nonfasting conditions. 53 8 41 9 Alanine aminotransferase increased 23 0 28 0 Phosphate decreased 21 0.8 14 0 6.2 Postmarketing Experience The following adverse reactions have been identified during postapproval use of BRUKINSA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Hepatobiliary disorder: drug-induced liver injury"],"contraindications":["4 CONTRAINDICATIONS None. None. ( 4 )"],"drug_interactions":["7 DRUG INTERACTIONS CYP3A Inhibitors: Modify BRUKINSA dose with moderate or strong CYP3A inhibitors as described. ( 2.3 , 7.1 ) CYP3A Inducers: Avoid coadministration with strong or moderate CYP3A inducers. Dose adjustment may be recommended with moderate CYP3A inducers. ( 2.3 , 7.1 ) 7.1 Effect of Other Drugs on BRUKINSA Table 17: Drug Interactions that Affect Zanubrutinib Moderate and Strong CYP3A Inhibitors Clinical Impact Coadministration with a moderate or strong CYP3A inhibitor increases zanubrutinib C max and AUC [see Clinical Pharmacology (12.3) ] which may increase the risk of BRUKINSA toxicities. Prevention or management Reduce BRUKINSA dosage when coadministered with moderate or strong CYP3A inhibitors [see Dosage and Administration (2.3) ] . Moderate and Strong CYP3A Inducers Clinical Impact Coadministration with a moderate or strong CYP3A inducer decreases zanubrutinib C max and AUC [see Clinical Pharmacology (12.3) ] which may reduce BRUKINSA efficacy. Prevention or management Avoid coadministration of BRUKINSA with strong CYP3A inducers [see Dosage and Administration (2.3) ] . Avoid coadministration of BRUKINSA with moderate CYP3A inducers [see Dosage and Administration (2.3) ] . If these inducers cannot be avoided, increase BRUKINSA dosage to 320 mg twice daily [see Dosage and Administration (2.3) ] ."],"how_supplied_table":["
StrengthDescriptionPackage SizeNDC Number
80 mgwhite to off-white opaque capsule, marked with "ZANU 80" in black ink120-count capsules in a bottle with a child-resistant cap72579-011-02
160 mgblue, oval, film-coated tablets debossed with "zanu" on one side and functional scoring on the other side60-count tablets in a bottle with a child-resistant cap72579-122-01
"],"mechanism_of_action":["12.1 Mechanism of Action Zanubrutinib is a small-molecule inhibitor of Bruton's tyrosine kinase (BTK). Zanubrutinib forms a covalent bond with a cysteine residue in the BTK active site, leading to inhibition of BTK activity. BTK is a signaling molecule of the B-cell antigen receptor (BCR) and cytokine receptor pathways. In B-cells, BTK signaling results in activation of pathways necessary for B-cell proliferation, trafficking, chemotaxis, and adhesion. In nonclinical studies, zanubrutinib inhibited malignant B-cell proliferation and reduced tumor growth."],"recent_major_changes":["Dosage and Administration, Recommended Dosage ( 2.1 ) 6/2025 Dosage and Administration, Dosage Modification for Use in Hepatic Impairment ( 2.2 ) 6/2025"],"storage_and_handling":["Storage Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) [See USP Controlled Room Temperature]."],"clinical_pharmacology":["12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Zanubrutinib is a small-molecule inhibitor of Bruton's tyrosine kinase (BTK). Zanubrutinib forms a covalent bond with a cysteine residue in the BTK active site, leading to inhibition of BTK activity. BTK is a signaling molecule of the B-cell antigen receptor (BCR) and cytokine receptor pathways. In B-cells, BTK signaling results in activation of pathways necessary for B-cell proliferation, trafficking, chemotaxis, and adhesion. In nonclinical studies, zanubrutinib inhibited malignant B-cell proliferation and reduced tumor growth. 12.2 Pharmacodynamics BTK Occupancy in PBMCs and Lymph Nodes The median steady-state BTK occupancy in peripheral blood mononuclear cells was maintained at 100% over 24 hours at a total daily dose of 320 mg in patients with B-cell malignancies. The median steady-state BTK occupancy in lymph nodes was 94% to 100% following the approved recommended dosage. Cardiac Electrophysiology At the approved recommended doses (160 mg twice daily or 320 mg once daily), there were no clinically relevant effects on the QTc interval. The effect of BRUKINSA on the QTc interval above the therapeutic exposure has not been evaluated. In Vitro Platelet Aggregation In blood samples from healthy donors, patients on anticoagulant or antiplatelet therapy, and those with severe renal dysfunction, zanubrutinib demonstrated inhibition of platelet aggregation mediated by collagen, CRP-XL, or rhodocytin. Zanubrutinib did not show meaningful inhibition of platelet aggregation for ADP and PAR4-AP. 12.3 Pharmacokinetics Zanubrutinib maximum plasma concentration (C max ) and area under the plasma drug concentration over time curve (AUC) increase proportionally over a dosage range from 40 mg to 320 mg (0.13 to 1 time the recommended total daily dose). Limited systemic accumulation of zanubrutinib was observed following repeated administration. The geometric mean (%CV) zanubrutinib steady-state daily AUC is 2,099 (42%) ng∙h/mL following 160 mg twice daily and 1,917 (59%) ng∙h/mL following 320 mg once daily. The geometric mean (%CV) zanubrutinib steady-state C max is 295 (55%) ng/mL following 160 mg twice daily and 537 (55%) ng/mL following 320 mg once daily. Absorption The median t max of zanubrutinib is 2 hours. Effect of Food BRUKINSA Capsules: Zanubrutinib AUC decreased 7% and C max increased 3% following administration of BRUKINSA capsules with a high-fat meal (1,000 calories, 50% fat) in healthy subjects. BRUKINSA Tablets: Zanubrutinib AUC increased up to 17% and C max up to 79% following administration of BRUKINSA tablets with a high-fat meal (1,000 calories, 50% fat) in healthy subjects. Distribution The geometric mean (%CV) apparent volume of distribution (Vz/F) of zanubrutinib is 537 (73%) L. The plasma protein binding of zanubrutinib is approximately 94% and the blood-to-plasma ratio is 0.7 to 0.8. Elimination The mean half-life (t ½ ) of zanubrutinib is approximately 2 to 4 hours following a single oral zanubrutinib dose of 160 mg or 320 mg. The geometric mean (%CV) apparent oral clearance (CL/F) of zanubrutinib is 128 (58%) L/h. Metabolism Zanubrutinib is primarily metabolized by cytochrome P450(CYP)3A. Excretion Following a single radiolabeled zanubrutinib dose of 320 mg to healthy subjects, approximately 87% of the dose was recovered in feces (38% unchanged) and 8% in urine (less than 1% unchanged). Specific Populations No clinically significant differences in the pharmacokinetics of zanubrutinib were observed based on age (19 to 90 years), sex, race (Asian, White, and Other), body weight (36 to 144 kg), or mild, moderate or severe renal impairment (CLcr ≥15 mL/min as estimated by Cockcroft-Gault). The effect of dialysis on zanubrutinib pharmacokinetics is unknown. Hepatic Impairment The total AUC of zanubrutinib increased by 11% in subjects with mild hepatic impairment (Child-Pugh class A), by 21% in subjects with moderate hepatic impairment (Child-Pugh class B), and by 60% in subjects with severe hepatic impairment (Child-Pugh class C) relative to subjects with normal liver function. The unbound AUC of zanubrutinib increased by 23% in subjects with mild hepatic impairment (Child-Pugh class A), by 43% in subjects with moderate hepatic impairment (Child-Pugh class B) and by 194% in subjects with severe hepatic impairment (Child-Pugh class C) relative to subjects with normal liver function. Drug Interaction Studies Clinical Studies and Model-Informed Approaches CYP3A Inhibitors : Coadministration of multiple doses of CYP3A inhibitors increases zanubrutinib C max and AUC (Table 18). Table 18: Observed or Predicted Increase in Zanubrutinib Exposure After Coadministration of CYP3A Inhibitors Coadministered CYP3A Inhibitor Increase in Zanubrutinib C max Increase in Zanubrutinib AUC Observed Itraconazole (200 mg once daily) The assessment was conducted in healthy subjects with a single dose of zanubrutinib 20 mg. 157% 278% Fluconazole (400 mg once daily) The assessment was conducted in patients with B-cell lymphoma administered multiple doses of zanubrutinib at the respective recommended zanubrutinib dosages in Table 1. 81% 88% Diltiazem (180 mg once daily) 62% 62% Voriconazole (200 mg twice daily) 229% 230% Clarithromycin (250 mg twice daily) 101% 92% Predicted Posaconazole suspension (100 mg once daily) The predicted values were based on simulations with patients administered multiple doses of zanubrutinib at the respective recommended dosages in Table 1. 169% 180% Posaconazole suspension (100 mg twice daily) 207% 279% Posaconazole delayed-release tablets (300 mg once daily) 232% 407% Posaconazole intravenously (300 mg once daily) 205% 333% Itraconazole (200 mg once daily) 273% 320% CYP3A Inducers : Coadministration of multiple doses of rifampin (strong CYP3A inducer) decreased the zanubrutinib C max by 92% and AUC by 93%. Coadministration of multiple doses of rifabutin (moderate CYP3A inducer) decreased the zanubrutinib C max by 48% and AUC by 44%. Coadministration of multiple doses of efavirenz (moderate CYP3A inducer) is predicted to decrease zanubrutinib C max by 58% and AUC by 60%. CYP3A Substrates : Coadministration of multiple doses of zanubrutinib decreased midazolam (CYP3A substrate) C max by 30% and AUC by 47%. CYP2C19 Substrates : Coadministration of multiple doses of zanubrutinib decreased omeprazole (CYP2C19 substrate) C max by 20% and AUC by 36%. Other CYP Substrates : No clinically significant differences were observed with warfarin (CYP2C9 substrate) pharmacokinetics when coadministered with zanubrutinib. Transporter Systems : Coadministration of multiple doses of zanubrutinib increased digoxin (P-gp substrate) C max by 34% and AUC by 11%. No clinically significant differences in the pharmacokinetics of rosuvastatin (BCRP substrate) were observed when coadministered with zanubrutinib. Gastric Acid Reducing Agents : No clinically significant differences in zanubrutinib pharmacokinetics were observed when coadministered with gastric acid reducing agents (proton pump inhibitors, H2-receptor antagonists). In Vitro Studies CYP Enzymes : Zanubrutinib is an inducer of CYP2B6 and CYP2C8. Transporter Systems : Zanubrutinib is likely to be a substrate of P-gp. Zanubrutinib is not a substrate or inhibitor of OAT1, OAT3, OCT2, OATP1B1, or OATP1B3."],"indications_and_usage":["1 INDICATIONS AND USAGE BRUKINSA is a kinase inhibitor indicated for the treatment of adult patients with: Mantle cell lymphoma (MCL) who have received at least one prior therapy. ( 1.1 ) This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. Waldenström's macroglobulinemia (WM). ( 1.2 ) Relapsed or refractory marginal zone lymphoma (MZL) who have received at least one anti–CD20-based regimen. ( 1.3 ) This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). ( 1.4 ) Relapsed or refractory follicular lymphoma (FL), in combination with obinutuzumab, after two or more lines of systemic therapy. ( 1.5 ) This indication is approved under accelerated approval based on response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. 1.1 Mantle Cell Lymphoma BRUKINSA is indicated for the treatment of adult patients with mantle cell lymphoma (MCL) who have received at least one prior therapy. This indication is approved under accelerated approval based on overall response rate [see Clinical Studies (14.1) ] . Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. 1.2 Waldenström's Macroglobulinemia BRUKINSA is indicated for the treatment of adult patients with Waldenström's macroglobulinemia (WM) [see Clinical Studies (14.2) ] . 1.3 Marginal Zone Lymphoma BRUKINSA is indicated for the treatment of adult patients with relapsed or refractory marginal zone lymphoma (MZL) who have received at least one anti–CD20-based regimen. This indication is approved under accelerated approval based on overall response rate [see Clinical Studies (14.3) ] . Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. 1.4 Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma BRUKINSA is indicated for the treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) [see Clinical Studies (14.4) ] . 1.5 Follicular Lymphoma BRUKINSA is indicated for the treatment of adult patients with relapsed or refractory follicular lymphoma (FL), in combination with obinutuzumab, after two or more lines of systemic therapy. This indication is approved under accelerated approval based on response rate and durability of response [see Clinical Studies (14.5) ] . Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial."],"warnings_and_cautions":["5 WARNINGS AND PRECAUTIONS Hemorrhage : Monitor for bleeding and manage appropriately. ( 5.1 ) Infections : Monitor patients for signs and symptoms of infection, including opportunistic infections, and treat as needed. ( 5.2 ) Cytopenias : Monitor complete blood counts during treatment. ( 5.3 ) Second Primary Malignancies : Other malignancies have developed including skin cancers and non-skin carcinomas. Monitor and advise patients to use sun protection. ( 5.4 ) Cardiac Arrhythmias : Monitor for signs and symptoms of arrhythmias and manage appropriately. ( 5.5 ) Hepatotoxicity, Including Drug-Induced Liver Injury : Monitor hepatic function throughout treatment. ( 5.6 ) Embryo-Fetal Toxicity : Can cause fetal harm. Advise women of the potential risk to a fetus and to use effective contraception. ( 5.7 ) 5.1 Hemorrhage Fatal and serious hemorrhage has occurred in patients with hematological malignancies treated with BRUKINSA. Grade 3 or higher hemorrhage including intracranial and gastrointestinal hemorrhage, hematuria, and hemothorax was reported in 3.8% of patients treated with BRUKINSA in clinical trials, with fatalities occurring in 0.2% of patients. Bleeding of any grade, excluding purpura and petechiae, occurred in 32% of patients. Bleeding has occurred in patients with and without concomitant antiplatelet or anticoagulation therapy. Coadministration of BRUKINSA with antiplatelet or anticoagulant medications may further increase the risk of hemorrhage. Monitor for signs and symptoms of bleeding. Discontinue BRUKINSA if intracranial hemorrhage of any grade occurs. Consider the benefit-risk of withholding BRUKINSA for 3-7 days before and after surgery depending upon the type of surgery and the risk of bleeding. 5.2 Infections Fatal and serious infections (including bacterial, viral, or fungal infections) and opportunistic infections have occurred in patients with hematological malignancies treated with BRUKINSA. Grade 3 or higher infections occurred in 26% of patients, most commonly pneumonia (7.9%), with fatal infections occurring in 3.2% of patients. Infections due to hepatitis B virus (HBV) reactivation have occurred. Consider prophylaxis for herpes simplex virus, pneumocystis jirovecii pneumonia, and other infections according to standard of care in patients who are at increased risk for infections. Monitor and evaluate patients for fever or other signs and symptoms of infection and treat appropriately. 5.3 Cytopenias Grade 3 or 4 cytopenias, including neutropenia (21%), thrombocytopenia (8%), and anemia (8%) based on laboratory measurements, developed in patients treated with BRUKINSA [see Adverse Reactions (6.1) ]. Grade 4 neutropenia occurred in 10% of patients, and Grade 4 thrombocytopenia occurred in 2.5% of patients. Monitor complete blood counts regularly during treatment and interrupt treatment, reduce the dose, or discontinue treatment as warranted [see Dosage and Administration (2.4) ] . Treat using growth factor or transfusions, as needed. 5.4 Second Primary Malignancies Second primary malignancies, including non-skin carcinoma, have occurred in 14% of patients treated with BRUKINSA. The most frequent second primary malignancy was non-melanoma skin cancers (8%), followed by other solid tumors in 7% of the patients (including melanoma in 1% of patients) and hematologic malignancies (0.7%). Advise patients to use sun protection and monitor patients for the development of second primary malignancies. 5.5 Cardiac Arrhythmias Serious cardiac arrhythmias have occurred in patients treated with BRUKINSA. Atrial fibrillation and atrial flutter were reported in 4.4% of patients treated with BRUKINSA, including Grade 3 or higher cases in 1.9% of patients. Patients with cardiac risk factors, hypertension, and acute infections may be at increased risk. Grade 3 or higher ventricular arrhythmias were reported in 0.3% of patients. Monitor for signs and symptoms of cardiac arrhythmias (e.g., palpitations, dizziness, syncope, dyspnea, chest discomfort), manage appropriately [see Dosage and Administration (2.4) ] , and consider the risks and benefits of continued BRUKINSA treatment. 5.6 Hepatotoxicity, Including Drug-Induced Liver Injury Hepatotoxicity, including severe, life-threatening, and potentially fatal cases of drug-induced liver injury (DILI), has occurred in patients treated with Bruton tyrosine kinase inhibitors, including BRUKINSA. Evaluate bilirubin and transaminases at baseline and throughout treatment with BRUKINSA. For patients who develop abnormal liver tests after BRUKINSA, monitor more frequently for liver test abnormalities and clinical signs and symptoms of hepatic toxicity. If DILI is suspected, withhold BRUKINSA. Upon confirmation of DILI, discontinue BRUKINSA. 5.7 Embryo-Fetal Toxicity Based on findings in animals, BRUKINSA can cause fetal harm when administered to a pregnant woman. Administration of zanubrutinib to pregnant rats during the period of organogenesis caused embryo-fetal toxicity, including malformations at exposures that were 5 times higher than those reported in patients at the recommended dose of 160 mg twice daily. Advise women to avoid becoming pregnant while taking BRUKINSA and for 1 week after the last dose. Advise men to avoid fathering a child during treatment and for 1 week after the last dose. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus [see Use in Specific Populations (8.1) ] ."],"clinical_studies_table":["
Table 19: Efficacy Results per IRC in Patients with MCL
Study BGB-3111-206 (N=86)Study BGB-3111-AU-003 (N=32)
ORR: overall response rate, CR: complete response, PR: partial response, DOR: duration of response, CI: confidence interval, NE: not estimable.
ORR (95% CI)84% (74, 91)84% (67, 95)
CR 59%22%FDG-PET scans were not required for response assessment.
PR 24%62%
Median DOR in months (95% CI)19.5 (16.6, NE)18.5 (12.6, NE)
","
Table 20: Response Rate and Duration of Response Based on IRC Assessment in ASPEN
Standard IWWM-6IWWM-6 criteria (Owen et al, 2013) require complete resolution of extramedullary disease (EMD) if present at baseline for VGPR to be assessed.Modified IWWM-6Modified IWWM-6 criteria (Treon, 2015) require a reduction in EMD if present at baseline for VGPR to be assessed.
Response CategoryBRUKINSA (N=102)Ibrutinib (N=99)BRUKINSA (N=102)Ibrutinib (N=99)
Response rate (CR+VGPR+PR), n (%)79 (77.5)77 (77.8)79 (77.5)77 (77.8)
95% CI (%)2-sided Clopper-Pearson 95% confidence interval.(68.1, 85.1)(68.3, 85.5)(68.1, 85.1)(68.3, 85.5)
Complete Response (CR)0 (0)0 (0)0 (0)0 (0)
Very Good Partial Response (VGPR)16 (15.7)7 (7.1)29 (28.4)19 (19.2)
Partial Response (PR)63 (61.8)70 (70.7)50 (49)58 (58.6)
Duration of response (DOR), Event-free at 12 months (95% CI)Estimated by Kaplan-Meier method with 95% CIs estimated using the method of Brookmeyer and Crowley.94.4% (85.8, 97.9)87.9% (77, 93.8)94.4% (85.8, 97.9)87.9% (77, 93.8)
","
Table 21: Efficacy Results per IRC in Patients with MZL
ParameterStudy BGB-3111-214 (N=66)Study BGB-3111-AU-003 (N=20)
ORR: overall response rate, CR: complete response, PR: partial response, DOR: duration of response, CI: confidence interval, NE: not estimable.
Overall response rate (CT-based)Per 2014 CT-based Lugano criteria. FDG-PET scans were not considered for this response assessment.
ORR, n37 (56%)16 (80%)
(95% CI, %)(43, 68)(56, 94)
CR, n13 (20%)4 (20%)
PR, n24 (36%)12 (60%)
Time to response
Median (range), months2.9 (1.8, 11.1)2.9 (2.6, 23.1)
Duration of responseBased on Kaplan-Meier estimation. Estimated median follow-up for DOR was 8.3 months for Study BGB-3111-214 and 31.4 months for Study BGB-3111-AU-003.
Median DOR (95% CI), monthsNE (NE, NE)NE (8.4, NE)
Rate at 12 months (95% CI)85% (67, 93)72% (40, 88)
","
Table 22: Efficacy Results per IRC in Patients with Previously Untreated CLL/SLL without 17p Deletion in SEQUOIA (Randomized Cohort)
ParameterEfficacy was assessed using the 2008 International Workshop for Chronic Lymphocytic Leukemia (iwCLL) guidelines and 2014 Lugano criteria for SLL.CLL/SLL without del(17p)
BRUKINSA (N=241)Bendamustine + Rituximab (N=238)
CI=Confidence interval, CR=complete response, CRi=complete response with incomplete hematopoietic recovery, HR=hazard ratio, NE=not estimable, nPR=nodular partial response, ORR=overall response rate, PFS=progression-free survival, PR=partial response.
Progression-free survival
Number of Events, n36 (15%)71 (30%)
Disease Progression27 (11%)59 (25%)
Death9 (3.7%)12 (5%)
Median PFS (95% CI), monthsBased on Kaplan-Meier estimation. Estimated median follow-up for PFS was 25 months.NE (NE, NE)33.7 (28.1, NE)
HR (95% CI)Based on a stratified Cox-regression model with bendamustine + rituximab as the reference group.0.42 (0.28, 0.63)
P-valueBased on a stratified log-rank test, with a 2-sided significance level of 0.0372.<0.0001
Overall response rateDefined as CR, CRi, PR, and nPR. No patients had CRi as best response.
ORR, n (%)225 (93)203 (85)
95% CI, %(89, 96)(80, 90)
CR, n (%)16 (7)36 (15)
nPR, n (%)3 (1.2)14 (6)
PR, n (%)206 (85)153 (64)
","
Table 23: Efficacy Results per IRC in Patients with Previously Untreated CLL/SLL and 17p Deletion in SEQUOIA
ParameterEfficacy was assessed using the 2008 iwCLL guidelines and Lugano criteria for SLL.del(17p) CLL/SLL N=110
DOR=duration of response. A + sign indicates a censored observation.
Overall response rateDefined as CR, CRi, PR, and nPR. No patients had CRi as best response.
ORR, n (%)97 (88)
(95% CI, %)(81, 94)
CR, n (%)7 (6)
nPR, n (%)2 (1.8)
PR, n (%)88 (80)
Time to response
Median (range), months2.9 (1.9 to 13.9)
Duration of response
Median DOR (95% CI),Kaplan-Meier estimate. Estimated median follow-up for DOR was 25.1 months. monthsNE (NE, NE)
Range, months(5.6 to 35.9+)
Rate at 12 months, % (95% CI)96 (89, 98)
Rate at 18 months, % (95% CI)95 (88, 98)
","
Table 24: Efficacy Results per IRC in Patients with Relapsed or Refractory CLL/SLL in ALPINE
ParameterEfficacy was based on 2008 iwCLL guidelines for CLL and the Lugano criteria for SLL.BRUKINSA (N=327)Ibrutinib (N=325)
CI=Confidence interval, CR=complete response, CRi=complete response with incomplete hematopoietic recovery, DOR=duration of response, HR=hazard ratio, NE=not estimable, nPR=nodular partial response, ORR=overall response rate, PR=partial response. A + sign indicates a censored observation.
Overall response rateDefined as CR + CRi + nPR + PR. No patients had CRi as best response.
ORR, n (%)263 (80)237 (73)
(95% CI, %)(76, 85)(68, 78)
CR, n (%)13 (4)8 (2.5)
nPR, n (%)1 (0.3)0 (0)
PR, n (%)249 (76)229 (70)
Response Rate Ratio (95% CI)Estimate stratified by randomization stratification factors.1.10 (1.01, 1.20)
2-sided p-value2-sided significance level of 0.0469 was allocated for ORR superiority testing.0.0264
Duration of response
Median DOR (95% CI)Based on Kaplan-Meier estimate. Estimated median follow-up for DOR was 14.1 months.NE (NE, NE)NE (NE, NE)
Range, months(1.4 to 30.4+)(1.9+ to 30.8+)
Rate at 12 months, % (95% CI)92 (87, 95)86 (80, 91)
Progression-free survival
Events, n (%)88 (27)120 (37)
Median PFS (95% CI), monthsBased on Kaplan-Meier estimation. Estimated median follow-up for PFS was 30.7 months.NE (34.3, NE)35 (33.2, 44.3)
HR (95% CI)Based on a stratified Cox-regression model with ibrutinib as the reference group.0.65 (0.49, 0.86)
2-sided p-valueBased on a stratified log-rank test.0.0024
","
Table 25: Efficacy Results per IRC in Patients with Relapsed or Refractory Follicular Lymphoma
ParameterBRUKINSA + Obinutuzumab (N=145) Obinutuzumab (N=72)
CI=Confidence interval, CR=complete response, DOR=duration of response, NE=not estimable, ORR=overall response rate, PR=partial response.
Overall response rate
ORR, n (%)100 (69)33 (46)
(95% CI)Estimated using the Clopper-Pearson method.(61, 76)(34, 58)
CR57 (39)14 (19)
PR43 (30)19 (26)
Risk difference, % (95% CI)Estimated by stratified Cochran-Mantel-Haenszel method.22.7 (9, 36.5)
2-sided p-value,Significance level, 0.05.0.0012
Duration of response
Median DOR (95% CI),Estimated by Kaplan-Meier method. Estimated median follow-up for DOR was 19 months overall. monthsNE (25.3, NE)14 (9.2, 25.1)
"],"nonclinical_toxicology":["13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies have not been conducted with zanubrutinib. Zanubrutinib was not mutagenic in a bacterial mutagenicity (Ames) assay, was not clastogenic in a chromosome aberration assay in mammalian (CHO) cells, nor was it clastogenic in an in vivo bone marrow micronucleus assay in rats. A combined male and female fertility and early embryonic development study was conducted in rats at oral zanubrutinib doses of 30 to 300 mg/kg/day. Male rats were dosed 4 weeks prior to mating and through mating and female rats were dosed 2 weeks prior to mating and to gestation day 7. No effect on male or female fertility was noted at lower doses, but at the highest dose tested, morphological abnormalities in sperm and increased postimplantation loss were noted. The high dose of 300 mg/kg/day is approximately 10 times the human recommended dose, based on body surface area."],"pharmacokinetics_table":["
Table 18: Observed or Predicted Increase in Zanubrutinib Exposure After Coadministration of CYP3A Inhibitors
Coadministered CYP3A InhibitorIncrease in Zanubrutinib CmaxIncrease in Zanubrutinib AUC
Observed
Itraconazole (200 mg once daily)The assessment was conducted in healthy subjects with a single dose of zanubrutinib 20 mg.157%278%
Fluconazole (400 mg once daily)The assessment was conducted in patients with B-cell lymphoma administered multiple doses of zanubrutinib at the respective recommended zanubrutinib dosages in Table 1.81%88%
Diltiazem (180 mg once daily)62%62%
Voriconazole (200 mg twice daily)229%230%
Clarithromycin (250 mg twice daily)101%92%
Predicted
Posaconazole suspension (100 mg once daily)The predicted values were based on simulations with patients administered multiple doses of zanubrutinib at the respective recommended dosages in Table 1.169%180%
Posaconazole suspension (100 mg twice daily)207%279%
Posaconazole delayed-release tablets (300 mg once daily)232%407%
Posaconazole intravenously (300 mg once daily)205%333%
Itraconazole (200 mg once daily)273%320%
"],"adverse_reactions_table":["
Table 3: Adverse Reactions (≥10%) in Patients Receiving BRUKINSA in BGB-3111-206 and BGB-3111-AU-003 Trials
Body SystemAdverse ReactionPercent of Patients (N=118)
All Grades %Grade 3 or Higher %
Infections and infestationsUpper respiratory tract infectionUpper respiratory tract infection includes upper respiratory tract infection, upper respiratory tract infection viral.390
PneumoniaPneumonia includes pneumonia, pneumonia fungal, pneumonia cryptococcal, pneumonia streptococcal, atypical pneumonia, lung infection, lower respiratory tract infection, lower respiratory tract infection bacterial, lower respiratory tract infection viral.1510Includes fatal adverse reaction.
Urinary tract infection110.8
Skin and subcutaneous tissue disordersRashRash includes all related terms containing rash.360
BruisingBruising includes all related terms containing bruise, bruising, contusion, ecchymosis.140
Gastrointestinal disordersDiarrhea230.8
Constipation130
Vascular disordersHypertension123.4
HemorrhageHemorrhage includes all related terms containing hemorrhage, hematoma.113.4
Musculoskeletal and connective tissue disordersMusculoskeletal painMusculoskeletal pain includes musculoskeletal pain, musculoskeletal discomfort, myalgia, back pain, arthralgia, arthritis.143.4
Respiratory, thoracic, and mediastinal disordersCough120
","
Table 4: Selected Laboratory AbnormalitiesBased on laboratory measurements. (>20%) in Patients with MCL in Studies BGB-3111-206 and BGB-3111-AU-003
Laboratory ParameterPercent of Patients (N=118)
All Grades (%)Grade 3 or 4 (%)
Hematologic abnormalities
Neutrophils decreased4520
LymphocytosisAsymptomatic lymphocytosis is a known effect of BTK inhibition.4116
Platelets decreased407
Hemoglobin decreased276
Chemistry abnormalities
Blood uric acid increased292.6
ALT increased280.9
Bilirubin increased240.9
","
Table 5: Adverse Reactions (≥10%) Occurring in Patients with WM Who Received BRUKINSA in Cohort 1
Body SystemAdverse ReactionBRUKINSA (N=101)Ibrutinib (N=98)
All Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
Infections and infestationsUpper respiratory tract infectionUpper respiratory tract infection includes upper respiratory tract infection, laryngitis, nasopharyngitis, sinusitis, rhinitis, viral upper respiratory tract infection, pharyngitis, rhinovirus infection, upper respiratory tract congestion.440402
PneumoniaPneumonia includes lower respiratory tract infection, lung infiltration, pneumonia, pneumonia aspiration, pneumonia viral.1242610
Urinary tract infection110132
Gastrointestinal disordersDiarrhea223342
Nausea180131
Constipation16070
Vomiting120141
General disordersFatigueFatigue includes asthenia, fatigue, lethargy.311251
Pyrexia164132
Edema peripheral120200
Skin and subcutaneous tissue disordersBruisingBruising includes all related terms containing bruise, contusion, or ecchymosis.200340
RashRash includes all related terms rash, maculo-papular rash, erythema, rash erythematous, drug eruption, dermatitis allergic, dermatitis atopic, rash pruritic, dermatitis, photodermatoses, dermatitis acneiform, stasis dermatitis, vasculitic rash, eyelid rash, urticaria, skin toxicity.290320
Pruritus11160
Musculoskeletal and connective tissue disordersMusculoskeletal painMusculoskeletal pain includes back pain, arthralgia, pain in extremity, musculoskeletal pain, myalgia, bone pain, spinal pain, musculoskeletal chest pain, neck pain, arthritis, musculoskeletal discomfort.459391
Muscle spasms100281
Nervous system disordersHeadache181141
Dizziness131120
Respiratory, thoracic, and mediastinal disordersCough160180
Dyspnea14070
Vascular disordersHemorrhageHemorrhage includes epistaxis, hematuria, conjunctival hemorrhage, hematoma, rectal hemorrhage, periorbital hemorrhage, mouth hemorrhage, post procedural hemorrhage, hemoptysis, skin hemorrhage, hemorrhoidal hemorrhage, ear hemorrhage, eye hemorrhage, hemorrhagic diathesis, periorbital hematoma, subdural hemorrhage, wound hemorrhage, gastric hemorrhage, lower gastrointestinal hemorrhage, spontaneous hematoma, traumatic hematoma, traumatic intracranial hemorrhage, tumor hemorrhage, retinal hemorrhage, hematochezia, diarrhea hemorrhagic, hemorrhage, melena, post-procedural hematoma, subdural hematoma, anal hemorrhage, hemorrhagic disorder, pericardial hemorrhage, postmenopausal hemorrhage, stoma site hemorrhage, subarachnoid hemorrhage.424439
Hypertension1491914
","
Table 6: Select Laboratory AbnormalitiesBased on laboratory measurements. (≥20%) that Worsened from Baseline in Patients with WM Who Received BRUKINSA in Cohort 1
Laboratory AbnormalityBRUKINSAThe denominator used to calculate the rate varied from 86 to 101 based on the number of patients with a baseline value and at least one post-treatment value.Ibrutinib
All Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
Hematologic abnormalities
Neutrophils decreased5024349
Platelets decreased358395
Hemoglobin decreased207207
Chemistry abnormalities
Glucose increased452.3332.3
Creatinine increased311211
Calcium decreased272260
Potassium increased242120
Phosphate decreased203.1180
Urate increased163.2346
Bilirubin increased121331
","
Table 7: Adverse Reactions Occurring in ≥10% Patients with MZL Who Received BRUKINSA
Body SystemAdverse ReactionBRUKINSA (N=88)
All Grades (%)Grade 3 or 4 (%)
Infections and infestationsUpper respiratory tract infectionUpper respiratory tract infection includes upper respiratory tract infection, nasopharyngitis, sinusitis, tonsillitis, rhinitis, viral upper respiratory tract infection.263.4
Urinary tract infectionUrinary tract infection includes urinary tract infection, cystitis, Escherichia urinary tract infection, pyelonephritis, cystitis.112.3
PneumoniaPneumonia includes COVID-19 pneumonia, pneumonia, bronchopulmonary aspergillosis, lower respiratory tract infection, organizing pneumonia.,Includes 2 fatalities from COVID-19 pneumonia.106
Gastrointestinal disordersDiarrheaDiarrhea includes diarrhea and diarrhea hemorrhagic.253.4
Abdominal painAbdominal pain includes abdominal pain, abdominal pain upper, abdominal discomfort.142.3
Nausea130
Skin and subcutaneous tissue disordersBruisingBruising includes contusion, ecchymosis, increased tendency to bruise, post procedural contusion.240
RashRash includes rash, rash maculo-papular, rash pruritic, dermatitis, dermatitis allergic, dermatitis atopic, dermatitis contact, drug reaction with eosinophilia and systemic symptoms, erythema, photosensitivity reaction, rash erythematous, rash papular, seborrheic dermatitis.210
Musculoskeletal and connective tissue disordersMusculoskeletal painMusculoskeletal pain includes back pain, arthralgia, musculoskeletal pain, myalgia, pain in extremity, musculoskeletal chest pain, bone pain, musculoskeletal discomfort, neck pain.271.1
Vascular disordersHemorrhageHemorrhage includes epistaxis, hematuria, hemorrhoidal hemorrhage, hematoma, hemoptysis, conjunctival hemorrhage, diarrhea hemorrhagic, hemorrhage urinary tract, mouth hemorrhage, pulmonary hematoma, subcutaneous hematoma, gingival bleeding, melena, upper gastrointestinal hemorrhage.231.1
General disordersFatigueFatigue includes fatigue, lethargy, asthenia.212.3
Respiratory, thoracic, and mediastinal disordersCoughCough includes cough and productive cough.100
","
Table 8: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with MZL
Laboratory AbnormalityThe denominator used to calculate the rate varied from 87 to 88 based on the number of patients with a baseline value and at least one post-treatment value.BRUKINSA
All Grades (%)Grade 3 or 4 (%)
Hematologic abnormalities
Neutrophils decreased4315
Platelets decreased3310
Lymphocytes decreased328
Hemoglobin decreased266
Chemistry abnormalities
Glucose increased544.6
Creatinine increased341.1
Phosphate decreased272.3
Calcium decreased230
ALT increased221.1
","
Table 9: Adverse Reactions in ≥10% Patients with Previously Untreated CLL/SLL without 17p Deletion in SEQUOIA
CLL/SLL without 17p deletion
BRUKINSA (N=240)BR (N=227)
System Organ Class Preferred TermAll Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
Musculoskeletal and connective tissue disorders
Musculoskeletal painMusculoskeletal pain: musculoskeletal pain, arthralgia, back pain, pain in extremity, myalgia, neck pain, spinal pain, musculoskeletal discomfort, bone pain.331.7170.4
Infections and infestations
Upper respiratory tract infectionUpper respiratory tract infection: upper respiratory tract infection, nasopharyngitis, sinusitis, rhinitis, pharyngitis, upper respiratory tract congestion, laryngitis, tonsillitis and upper respiratory tract inflammation, and related terms.281.3150.9
PneumoniaPneumonia: pneumonia, COVID-19 pneumonia, lower respiratory tract infection, lung infiltration, and related terms including specific types of infection.13Includes 3 fatal outcomes.58Includes 2 fatal outcomes.4
Vascular disorders
HemorrhageHemorrhage: all terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding.27440.4
HypertensionIncludes multiple similar adverse reaction terms.14752.6
Skin and subcutaneous tissue disorders
RashRash: Rash, dermatitis, drug eruption, and related terms.241.3305
Bruising Bruising: all terms containing bruise, bruising, contusion, or ecchymosis.2402.60
Respiratory, thoracic, and mediastinal disorders
Cough150100
Gastrointestinal disorders
Diarrhea140.8120.9
Constipation100.4180
Nausea100331.3
General disorders
FatigueFatigue: fatigue, asthenia, and lethargy.141.3211.8
Neoplasms
Second primary malignancySecond primary malignancy: includes non-melanoma skin cancer, malignant solid tumors (including lung, renal, genitourinary, breast, ovarian, and rectal), and chronic myeloid leukemia.1361.30.4
Nervous system disorders
Headache12080
Dizziness Dizziness: dizziness and vertigo.110.850
","
Table 10: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with Previously Untreated CLL/SLL without 17p Deletion in SEQUOIA
Laboratory AbnormalityThe denominator used to calculate the rate was 239 in the BRUKINSA arm and 227 in the BR arm, based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria.BRUKINSABR
All Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
Hematologic abnormalities
Neutrophils decreased37158053
Hemoglobin decreased292.5668
Platelets decreased271.76111
Leukocytes increased21Lymphocytes increased in 15%.210.40.4
Chemistry abnormalities
Glucose increasedNonfasting conditions.5576710
Creatinine increased220.8180.4
Magnesium increased220140.4
Alanine aminotransferase increased212.1232.2
","
Table 11: Adverse Reactions in ≥10% of Patients with Previously Untreated CLL/SLL and 17p Deletion in SEQUOIA
CLL/SLL with 17p Deletion
BRUKINSA (N=111)
System Organ Class Preferred TermAll Grades (%)Grade 3 or 4 (%)
Infections and infestations
Upper respiratory tract infectionUpper respiratory tract infection: upper respiratory tract infection, nasopharyngitis, sinusitis, rhinitis, pharyngitis, upper respiratory tract congestion, upper respiratory tract inflammation, viral upper respiratory tract infection, and related terms.380
PneumoniaPneumonia: pneumonia, COVID-19 pneumonia, lower respiratory tract infection, and related terms including specific types of infection.20Includes 1 fatal outcome.8
Musculoskeletal and connective tissue disorders
Musculoskeletal painMusculoskeletal pain: musculoskeletal pain, arthralgia, back pain, pain in extremity, myalgia, neck pain, bone pain.382.7
Skin and subcutaneous tissue disorders
RashRash: Rash, dermatitis, toxic skin eruption, and related terms. 280
BruisingBruising: all terms containing bruise, bruising, contusion, or ecchymosis.260.9
Vascular disorders
HemorrhageHemorrhage: all terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding. 284.5
Hypertension115.4
Neoplasms
Second primary malignancySecond primary malignancy: includes non-melanoma skin cancer, malignant solid tumors (including bladder, lung, renal, breast, prostate, ovarian, pelvis, and ureter), and malignant melanoma.22Includes non-melanoma skin cancer in 13%.6
Gastrointestinal disorders
Diarrhea180.9
Nausea160
Constipation150
Abdominal pain121.8
Respiratory, thoracic, and mediastinal disorders
CoughIncludes multiple similar adverse reaction terms.180
Dyspnea130
General disorders and administration site conditions
FatigueFatigue: fatigue, asthenia, and lethargy.140.9
Nervous system disorders
Headache111.8
","
Table 12: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients with Previously Untreated CLL/SLL and 17p Deletion in SEQUOIA
Laboratory AbnormalityThe denominator used to calculate the rate varied from 110 to 111 based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria.BRUKINSA
All Grades (%)Grade 3 or 4 (%)
Hematologic abnormalities
Neutrophils decreased4219Grade 4, 9%.
Hemoglobin decreased263.6
Platelets decreased230.9
Chemistry abnormalities
Glucose increasedNonfasting conditions.526
Magnesium increased310
Creatinine increased270.9
","
Table 13: Adverse Reactions in ≥10% of Patients with Relapsed or Refractory CLL/SLL Who Received BRUKINSA in ALPINE
System Organ Class Preferred TermBRUKINSA (N=324)Ibrutinib (N=324)
All Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
Infections and infestations
Upper respiratory tract infectionUpper respiratory tract infection: upper respiratory tract infection, sinusitis, pharyngitis, rhinitis, nasopharyngitis, laryngitis, tonsillitis, and related terms.271.2221.2
PneumoniaPneumonia: Pneumonia, COVID-19 pneumonia, lower respiratory tract infection, lung infiltration, and related terms including specific types of infection.18Includes fatal outcomes: pneumonia (9 patients), COVID-19 (8 patients), and hemorrhage (1 patient).919Includes fatal outcomes: pneumonia (10 patients), COVID-19 (9 patients), and hemorrhage (2 patients).11
COVID-19COVID-19: COVID-19, COVID-19 pneumonia, postacute COVID-19 syndrome, SARS-CoV-2 test positive.147104.6
Musculoskeletal and connective tissue disorders
Musculoskeletal painMusculoskeletal pain: musculoskeletal pain, arthralgia, back pain, pain in extremity, myalgia, neck pain, spinal pain, bone pain, and musculoskeletal discomfort.260.6280.6
Vascular disorders
HemorrhageHemorrhage: all terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding.242.5263.7
HypertensionIncludes multiple similar adverse reaction terms.19132013
Skin and subcutaneous tissue disorders
RashRash: Rash, Dermatitis, and related terms. 201.2210.9
BruisingBruising: all terms containing bruise, bruising, contusion, or ecchymosis.160140
Gastrointestinal disorders
Diarrhea141.5220.9
General disorders
FatigueFatigue: asthenia, fatigue, lethargy.130.9140.9
Respiratory, thoracic, and mediastinal disorders
Cough110.3110
Nervous system disorders
Dizziness10070
","
Table 14: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients Who Received BRUKINSA in ALPINE
Laboratory AbnormalityThe denominator used to calculate the rate was 321 in the BRUKINSA arm, and varied from 320 to 321 in the ibrutinib arm, based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria.BRUKINSAIbrutinib
All Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
Hematologic abnormalities
Neutrophils decreased43153316
Hemoglobin decreased284323.7
Lymphocytes increased24192619
Platelets decreased224243.4
Chemistry abnormalities
Glucose increased525292.8
Creatinine increased260230
Phosphate decreased212.5132.2
Calcium decreased210.6290
","
Table 15: Adverse Reactions in ≥10% of Patients with Relapsed or Refractory FL Who Received BRUKINSA in Study BGB-3111-212
System Organ Class Preferred TermBGB-3111-212
BRUKINSA + Obinutuzumab (N=143)Obinutuzumab (N=71)
All Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
General disorders and administration site conditions
FatigueIncludes multiple related terms.,Fatigue: Fatigue, asthenia, and lethargy.271.4251.4
Pyrexia130200
Musculoskeletal and connective tissue disorders
Musculoskeletal pain,Musculoskeletal pain: Back pain, musculoskeletal pain, musculoskeletal discomfort, noncardiac chest pain, neck pain, pain in extremity, myalgia, spinal pain, bone pain, arthralgia, and related terms. 223.5231.4
Vascular disorders
Hemorrhage,Hemorrhage: All terms containing hematoma, hemorrhage, hemorrhagic, and related terms indicative of bleeding.201.4101.4
Gastrointestinal disorders
Diarrhea182.8171.4
Constipation13090
Abdominal pain112.1110
Infections and infestations
Upper respiratory tract infection,Upper respiratory tract infection: Upper respiratory tract infection, sinusitis, pharyngitis, laryngitis, rhinitis, nasopharyngitis, laryngopharyngitis, tonsillitis bacterial, and related terms.172.8100
Pneumonia,Pneumonia: Pneumonia, COVID-19 pneumonia, lung infiltration, lung consolidation, and related terms including specific types of infection.,Includes fatal outcomes: COVID-19 (3 patients), pneumonia (2 patients), dyspnea (1 patient).1513117
COVID-19,139114.2
Herpes virus infectionHerpes virus infection: Herpes viral infection, herpes zoster, herpes simplex, herpes simplex reactivation, varicella, and Epstein-Barr viremia.112.11.40
Urinary tract infectionUrinary tract infection: Urinary tract infection, cystitis, pyelonephritis, and related terms.101.470
Respiratory, thoracic, and mediastinal disorders
Cough140140
Dyspnea,112.1130
Skin and subcutaneous tissue disorders
Rash,Rash: Rash, erythema, dermatitis, drug eruption, skin reaction, and related terms.110140
","
Table 16: Select Laboratory Abnormalities (≥20%) that Worsened from Baseline in Patients Who Received BRUKINSA in Study BGB-3111-212
Laboratory AbnormalityThe denominator used to calculate the rate was 122 in the BRUKINSA + obinutuzumab arm, and varied from 56 to 58 in the obinutuzumab arm, based on the number of patients with a baseline value and at least one post-treatment value. Grading is based on NCI CTCAE criteria.BGB-3111-212
BRUKINSA + ObinutuzumabObinutuzumab
All Grades (%)Grade 3 or 4 (%)All Grades (%)Grade 3 or 4 (%)
Hematologic abnormalities
Platelets decreased65114311
Neutrophils decreased47174214
Hemoglobin decreased310.8230
Lymphocytes decreased30115125
Chemistry
Glucose increasedNonfasting conditions.538419
Alanine aminotransferase increased230280
Phosphate decreased210.8140
"],"drug_interactions_table":["
Table 17: Drug Interactions that Affect Zanubrutinib
Moderate and Strong CYP3A Inhibitors
Clinical ImpactCoadministration with a moderate or strong CYP3A inhibitor increases zanubrutinib Cmax and AUC [see Clinical Pharmacology (12.3)] which may increase the risk of BRUKINSA toxicities.
Prevention or managementReduce BRUKINSA dosage when coadministered with moderate or strong CYP3A inhibitors [see Dosage and Administration (2.3)].
Moderate and Strong CYP3A Inducers
Clinical ImpactCoadministration with a moderate or strong CYP3A inducer decreases zanubrutinib Cmax and AUC [see Clinical Pharmacology (12.3)] which may reduce BRUKINSA efficacy.
Prevention or managementAvoid coadministration of BRUKINSA with strong CYP3A inducers [see Dosage and Administration (2.3)].Avoid coadministration of BRUKINSA with moderate CYP3A inducers [see Dosage and Administration (2.3)]. If these inducers cannot be avoided, increase BRUKINSA dosage to 320 mg twice daily [see Dosage and Administration (2.3)].
"],"information_for_patients":["17 PATIENT COUNSELING INFORMATION Advise patients to read the FDA-approved patient labeling (Patient Information). Hemorrhage Inform patients to report signs or symptoms of severe bleeding. Inform patients that BRUKINSA may need to be interrupted for major surgeries or procedures [see Warnings and Precautions (5.1) ] . Infections Inform patients to report signs or symptoms suggestive of infection [see Warnings and Precautions (5.2) ] . Cytopenias Inform patients that they will need periodic blood tests to check blood counts during treatment with BRUKINSA [see Warnings and Precautions (5.3) ] . Second Primary Malignancies Inform patients that other malignancies have been reported in patients who have been treated with BRUKINSA, including skin cancer and other solid tumors. Advise patients to use sun protection and have monitoring for development of other cancers [see Warnings and Precautions (5.4) ] . Cardiac Arrhythmias Counsel patients to report any signs of palpitations, lightheadedness, dizziness, fainting, shortness of breath, and chest discomfort [see Warnings and Precautions (5.5) ] . Hepatotoxicity, Including Drug-Induced Liver Injury Inform patients that liver problems, including drug-induced liver injury and abnormalities in liver tests, may develop during BRUKINSA treatment. Advise patients to contact their healthcare provider immediately if they experience abdominal discomfort, dark urine, or jaundice [see Warnings and Precautions (5.6) ] . Embryo-Fetal Toxicity Advise pregnant women and females of reproductive potential of the potential hazard to a fetus and to use effective contraception during treatment and for 1 week after the last dose of BRUKINSA [see Warnings and Precautions (5.7) ] . Advise males with female sexual partners of reproductive potential to use effective contraception during BRUKINSA treatment and for 1 week after the last dose of BRUKINSA [see Use in Specific Populations (8.3) ] . Lactation Advise females not to breastfeed during treatment with BRUKINSA and for 2 weeks after the last dose [see Use in Specific Populations (8.2) ] . Administration Instructions BRUKINSA capsules may be taken with or without food. Advise patients that BRUKINSA capsules should be swallowed whole with a glass of water and not to open, break, or chew the capsules [see Dosage and Administration (2.1) ] . BRUKINSA tablets may be taken with or without food. Advise patients that BRUKINSA tablets should be swallowed whole with a glass of water and not to chew or crush the tablets. Tablets can be split in half as prescribed by the healthcare provider [see Dosage and Administration (2.1) ]. Missed Dose Advise patients that if they miss a dose of BRUKINSA, they may still take it as soon as possible on the same day with a return to the normal schedule the following day [see Dosage and Administration (2.1) ] . Drug Interactions Advise patients to inform their healthcare providers of all concomitant medications, including over-the-counter medications, vitamins, and herbal products [see Drug Interactions (7.1) ] ."],"spl_unclassified_section":["BRUKINSA Capsules: Manufactured for: BeOne Medicines USA, Inc. Pennington, NJ 08534 BRUKINSA Tablets: Manufactured for: BeOne Medicines USA, Inc. Pennington, NJ 08534 Manufactured by: Catalent Pharma Solutions, LLC Winchester, KY 40391 BRUKINSA ® is a registered trademark owned by BeOne Medicines I GmbH or its affiliates. © BeOne Medicines I GmbH, 2025. All Rights Reserved."],"dosage_and_administration":["2 DOSAGE AND ADMINISTRATION Recommended dosage: 160 mg orally twice daily or 320 mg orally once daily with or without food; swallow whole with water. Tablets can be split in half as prescribed by the healthcare provider. ( 2.1 ) Reduce BRUKINSA dose in patients with severe hepatic impairment. ( 2.2 , 8.7 ) Advise patients not to open, break, or chew capsules. ( 2.1 ) Advise patients not to chew or crush tablets. ( 2.1 ) Manage toxicity using treatment interruption, dose reduction, or discontinuation. ( 2.4 ) 2.1 Recommended Dosage The recommended dosage of BRUKINSA for monotherapy or in combination with obinutuzumab is 160 mg taken orally twice daily or 320 mg taken orally once daily until disease progression or unacceptable toxicity. Capsule Administration Instructions Administer BRUKINSA capsules with or without food [see Clinical Pharmacology (12.3) ] . Advise patients to swallow capsules whole with water and not to open, break, or chew capsules. Tablet Administration Instructions Administer BRUKINSA tablets with or without food [see Clinical Pharmacology (12.3) ] . Advise patients to swallow tablets whole with water and not to chew or crush the tablets. The tablets can be split in half as prescribed by the healthcare provider. Missed Dose If a dose of BRUKINSA is missed, it should be taken as soon as possible on the same day with a return to the normal schedule the following day. 2.2 Dosage Modification for Use in Hepatic Impairment The recommended dosage of BRUKINSA for patients with severe hepatic impairment (Child-Pugh class C) is 80 mg orally twice daily; no dosage modification is recommended for patients with mild or moderate hepatic impairment (Child-Pugh class A or B) [see Use in Specific Populations (8.7) and Clinical Pharmacology (12.3) ] . 2.3 Dosage Modifications for Drug Interactions Recommended dosage modifications of BRUKINSA for drug interactions are provided in Table 1 [see Drug Interactions (7.1) ] . Table 1: Dosage Modifications for Use with CYP3A Inhibitors or Inducers Coadministered Drug Recommended BRUKINSA Dosage (Starting Dose: 160 mg twice daily or 320 mg once daily) Clarithromycin 250 mg twice daily Since clarithromycin 250 mg twice daily acts as a moderate CYP3A inhibitor, it is recommended that patients be administered clarithromycin 250 mg twice daily with 80 mg BRUKINSA twice daily [see Clinical Pharmacology (12.3) ] . 80 mg twice daily Modify or interrupt zanubrutinib dose as recommended for adverse reactions [see Dosage and Administration (2.4) ] . Clarithromycin 500 mg twice daily 80 mg once daily Posaconazole suspension 100 mg once daily 80 mg twice daily Posaconazole suspension dosage higher than 100 mg once daily Posaconazole delayed-release tablets 300 mg once daily Posaconazole intravenous 300 mg once daily 80 mg once daily Other strong CYP3A inhibitor 80 mg once daily Moderate CYP3A inhibitor 80 mg twice daily Strong CYP3A inducer Avoid concomitant use. Moderate CYP3A inducer Avoid concomitant use. If these inducers cannot be avoided, increase BRUKINSA dose to 320 mg twice daily. After discontinuation of a CYP3A inhibitor or moderate CYP3A inducer, resume previous dose of BRUKINSA [see Dosage and Administration (2.1 , 2.2) and Drug Interactions (7.1) ] . 2.4 Dosage Modifications for Adverse Reactions Recommended dosage modifications of BRUKINSA for Grade 3 or higher adverse reactions are provided in Table 2. Table 2: Recommended Dosage Modifications for Adverse Reaction Adverse Reaction Adverse Reaction Occurrence Dosage Modification (Starting Dose: 160 mg twice daily or 320 mg once daily) Hematological toxicities [see Warnings and Precautions (5.3) ] Grade 3 or Grade 4 febrile neutropenia Platelet count decreased to 25,000-50,000/mm 3 with significant bleeding Neutrophil count decreased to <500/mm 3 (lasting more than 10 consecutive days) Platelet count decreased to <25,000/mm 3 (lasting more than 10 consecutive days) First Interrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 160 mg twice daily or 320 mg once daily. Second Interrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg twice daily or 160 mg once daily. Third Interrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg once daily. Fourth Discontinue BRUKINSA Nonhematological toxicities [see Warnings and Precautions (5.5) and Adverse Reactions (6.1) ] Severe or life-threatening nonhematological toxicities Evaluate the benefit-risk before resuming treatment at the same dosage for Grade 4 nonhematological toxicity. First Interrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 160 mg twice daily or 320 mg once daily. Second Interrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg twice daily or 160 mg once daily. Third Interrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg once daily. Fourth Discontinue BRUKINSA Asymptomatic lymphocytosis in CLL and MCL should not be regarded as an adverse reaction, and these patients should continue taking BRUKINSA. Refer to the obinutuzumab prescribing information for management of obinutuzumab toxicities."],"spl_product_data_elements":["BRUKINSA zanubrutinib ZANUBRUTINIB ZANUBRUTINIB SILICON DIOXIDE CROSCARMELLOSE SODIUM MAGNESIUM STEARATE MICROCRYSTALLINE CELLULOSE SODIUM LAURYL SULFATE GELATIN, UNSPECIFIED TITANIUM DIOXIDE FERROSOFERRIC OXIDE off-white ZANU;80 BRUKINSA zanubrutinib ZANUBRUTINIB ZANUBRUTINIB CROSCARMELLOSE SODIUM LACTOSE MONOHYDRATE MAGNESIUM STEARATE MICROCRYSTALLINE CELLULOSE 102 POVIDONE K30 SODIUM LAURYL SULFATE SILICON DIOXIDE FD&C BLUE NO. 1 FD&C BLUE NO. 2 HYPROMELLOSE, UNSPECIFIED TITANIUM DIOXIDE TRIACETIN zanu"],"dosage_forms_and_strengths":["3 DOSAGE FORMS AND STRENGTHS Capsules: Each 80 mg capsule is a size 0, white to off-white opaque capsule marked with \"ZANU 80\" in black ink. Tablets: 160 mg, blue, oval, film-coated tablets debossed with \"zanu\" on one side and functional scoring on the other side. Capsules: 80 mg. ( 3 ) Tablets: 160 mg with functional scoring. ( 3 )"],"recent_major_changes_table":["
Dosage and Administration, Recommended Dosage (2.1)6/2025
Dosage and Administration, Dosage Modification for Use in Hepatic Impairment (2.2)6/2025
"],"spl_patient_package_insert":["PATIENT INFORMATION BRUKINSA ® (BROO-kin-sah) (zanubrutinib) capsules BRUKINSA ® (BROO-kin-sah) (zanubrutinib) tablets This Patient Information has been approved by the U.S. Food and Drug Administration. Issued: 6/2025 What is BRUKINSA? BRUKINSA is a prescription medicine used to treat adults with: Mantle cell lymphoma (MCL) who have received at least one prior treatment for their cancer. Waldenström's macroglobulinemia (WM). Marginal zone lymphoma (MZL) when the disease has come back or did not respond to treatment and who have received at least one certain type of treatment. Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). Follicular lymphoma (FL), in combination with the medicine obinutuzumab, when the disease has come back or did not respond to treatment and who have received at least two prior treatments. It is not known if BRUKINSA is safe and effective in children. Before taking BRUKINSA, tell your healthcare provider about all of your medical conditions, including if you: have bleeding problems. have had recent surgery or plan to have surgery. Your healthcare provider may stop BRUKINSA for any planned medical, surgical, or dental procedure. have an infection or have been advised that you are at increased risk of infection. have or had heart rhythm problems. have high blood pressure. have liver problems, including a history of hepatitis B virus (HBV) infection. are pregnant or plan to become pregnant. BRUKINSA can harm your unborn baby. Females who are able to become pregnant: You should avoid getting pregnant during treatment and for 1 week after the last dose of BRUKINSA. Your healthcare provider may do a pregnancy test before starting treatment with BRUKINSA. You should use effective birth control (contraception) during treatment and for 1 week after the last dose of BRUKINSA. Tell your healthcare provider right away if you become pregnant or think you are pregnant during treatment with BRUKINSA. Males with female partners who are able to become pregnant: You should avoid getting female partners pregnant during treatment and for 1 week after the last dose of BRUKINSA. You should use effective birth control (contraception) during treatment and for 1 week after the last dose of BRUKINSA. are breastfeeding or plan to breastfeed. It is not known if BRUKINSA passes into your breast milk. Do not breastfeed during treatment with BRUKINSA and for 2 weeks after the last dose of BRUKINSA. Tell your healthcare provider about all the medicines you take , including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take a blood thinner medicine. Taking BRUKINSA with certain other medications may affect how BRUKINSA works and can cause side effects. How should I take BRUKINSA? Take BRUKINSA exactly as your healthcare provider tells you to take it. Do not change your dose or stop taking BRUKINSA unless your healthcare provider tells you to. Your healthcare provider may tell you to decrease your dose, temporarily stop, or completely stop taking BRUKINSA if you develop certain side effects. Take BRUKINSA with or without food. Swallow BRUKINSA capsules whole with a glass of water. Do not open, break, or chew the capsules. Swallow BRUKINSA tablets whole with a glass of water. Do not chew or crush the tablets. BRUKINSA tablets can be split in half as prescribed by your healthcare provider. If you miss a dose of BRUKINSA, take it as soon as you remember on the same day. Return to your normal schedule the next day. What are the possible side effects of BRUKINSA? BRUKINSA may cause serious side effects, including: Bleeding problems (hemorrhage). Bleeding problems are common with BRUKINSA, and can be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you develop any signs or symptoms of bleeding, including: blood in your stools or black stools (looks like tar) pink or brown urine unexpected bleeding, or bleeding that is severe or you cannot control vomit blood or vomit that looks like coffee grounds cough up blood or blood clots increased bruising dizziness weakness confusion change in speech headache that lasts a long time Infections that can be serious and may lead to death. Tell your healthcare provider right away if you develop fever, chills, or flu-like symptoms during your treatment with BRUKINSA. Decrease in blood cell counts (white blood cells, platelets, and red blood cells). Your healthcare provider should do blood tests during treatment with BRUKINSA to check your blood counts. Second primary cancers. New cancers have happened in people during treatment with BRUKINSA, including cancers of the skin or other organs. Your healthcare provider will check you for other cancers during treatment with BRUKINSA. Use sun protection when you are outside in sunlight. Heart rhythm problems. Serious heart problems, including atrial fibrillation, atrial flutter, and ventricular arrhythmias, have happened in people treated with BRUKINSA and may lead to death . Your risk for heart rhythm problems may be increased if you have high blood pressure or have had heart rhythm problems in the past or have a short-term (acute) infection. Tell your healthcare provider if you develop any of the following signs or symptoms: your heartbeat is fast or irregular feel lightheaded or dizzy pass out (faint) shortness of breath chest discomfort Liver problems. Liver problems, which may be severe or life-threatening, or lead to death, can happen in people treated with BRUKINSA. Your healthcare provider will do blood tests to check your liver before and during treatment with BRUKINSA. Tell your healthcare provider or get medical help right away if you develop any signs of liver problems, including stomach pain or discomfort, dark-colored urine, or yellow skin and eyes. The most common side effects of BRUKINSA include: decreased white blood cell count decreased platelet count cold-like symptoms (upper respiratory tract infection) muscle, bone, or joint pain These are not all the possible side effects of BRUKINSA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store BRUKINSA? Store BRUKINSA at room temperature between 68°F and 77°F (20°C and 25°C). BRUKINSA comes in a bottle with a child-resistant cap. Keep BRUKINSA and all medicines out of the reach of children. General information about the safe and effective use of BRUKINSA. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use BRUKINSA for a condition for which it was not prescribed. Do not give BRUKINSA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your healthcare provider or pharmacist for more information about BRUKINSA that is written for healthcare professionals. What are the ingredients in BRUKINSA? Active ingredient: zanubrutinib Capsule inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and sodium lauryl sulfate. The capsule shell contains edible black ink, gelatin, and titanium dioxide. Tablet inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, and sodium lauryl sulfate. The film-coating contains FD&C Blue No. 1, FD&C Blue No. 2, hypromellose, titanium dioxide, and triacetin. BRUKINSA Capsules: Manufactured for: BeOne Medicines USA, Inc., Pennington, NJ 08534 BRUKINSA Tablets: Manufactured for: BeOne Medicines USA, Inc., Pennington, NJ 08534 Manufactured by: Catalent Pharma Solutions, LLC, Winchester, KY 40391 BRUKINSA ® is a registered trademark owned by BeOne Medicines I GmbH or its affiliates. © BeOne Medicines I GmbH, 2025. All Rights Reserved. For more information, go to www.BRUKINSA.com or call 1-833-969-2463."],"clinical_pharmacology_table":["
Table 18: Observed or Predicted Increase in Zanubrutinib Exposure After Coadministration of CYP3A Inhibitors
Coadministered CYP3A InhibitorIncrease in Zanubrutinib CmaxIncrease in Zanubrutinib AUC
Observed
Itraconazole (200 mg once daily)The assessment was conducted in healthy subjects with a single dose of zanubrutinib 20 mg.157%278%
Fluconazole (400 mg once daily)The assessment was conducted in patients with B-cell lymphoma administered multiple doses of zanubrutinib at the respective recommended zanubrutinib dosages in Table 1.81%88%
Diltiazem (180 mg once daily)62%62%
Voriconazole (200 mg twice daily)229%230%
Clarithromycin (250 mg twice daily)101%92%
Predicted
Posaconazole suspension (100 mg once daily)The predicted values were based on simulations with patients administered multiple doses of zanubrutinib at the respective recommended dosages in Table 1.169%180%
Posaconazole suspension (100 mg twice daily)207%279%
Posaconazole delayed-release tablets (300 mg once daily)232%407%
Posaconazole intravenously (300 mg once daily)205%333%
Itraconazole (200 mg once daily)273%320%
"],"use_in_specific_populations":["8 USE IN SPECIFIC POPULATIONS Lactation: Advise not to breastfeed. ( 8.2 ) 8.1 Pregnancy Risk Summary Based on findings in animals, BRUKINSA can cause fetal harm when administered to pregnant women. There are no available data on BRUKINSA use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. In animal reproduction studies, oral administration of zanubrutinib to pregnant rats during the period of organogenesis was associated with fetal heart malformation at approximately 5-fold human exposures (see Data ) . Women should be advised to avoid pregnancy while taking BRUKINSA. If BRUKINSA is used during pregnancy, or if the patient becomes pregnant while taking BRUKINSA, the patient should be apprised of the potential hazard to the fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Data Animal Data Embryo-fetal development toxicity studies were conducted in both rats and rabbits. Zanubrutinib was administered orally to pregnant rats during the period of organogenesis at doses of 30, 75, and 150 mg/kg/day. Malformations in the heart (2 or 3-chambered hearts) were noted at all dose levels in the absence of maternal toxicity. The dose of 30 mg/kg/day is approximately 5 times the exposure (AUC) in patients receiving the recommended dose of 160 mg twice daily. Administration of zanubrutinib to pregnant rabbits during the period of organogenesis at 30, 70, and 150 mg/kg/day resulted in postimplantation loss at the highest dose. The dose of 150 mg/kg is approximately 32 times the exposure (AUC) in patients at the recommended dose and was associated with maternal toxicity. In a pre and postnatal developmental toxicity study, zanubrutinib was administered orally to rats at doses of 30, 75, and 150 mg/kg/day from implantation through weaning. The offspring from the middle and high dose groups had decreased body weights preweaning, and all dose groups had adverse ocular findings (e.g., cataract, protruding eye). The dose of 30 mg/kg/day is approximately 5 times the AUC in patients receiving the recommended dose. 8.2 Lactation Risk Summary There are no data on the presence of zanubrutinib or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production. Because of the potential for serious adverse reactions from BRUKINSA in a breastfed child, advise lactating women not to breastfeed during treatment with BRUKINSA and for two weeks following the last dose. 8.3 Females and Males of Reproductive Potential BRUKINSA can cause embryo-fetal harm when administered to pregnant women [see Use in Specific Populations (8.1) ] . Pregnancy Testing Pregnancy testing is recommended for females of reproductive potential prior to initiating BRUKINSA therapy. Contraception Females Advise female patients of reproductive potential to use effective contraception during treatment with BRUKINSA and for 1 week following the last dose of BRUKINSA. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be informed of the potential hazard to a fetus. Males Advise men to avoid fathering a child while receiving BRUKINSA and for 1 week following the last dose of BRUKINSA. 8.4 Pediatric Use Safety and effectiveness of BRUKINSA in pediatric patients have not been established. 8.5 Geriatric Use Of the 1729 patients with MCL, MZL, WM, CLL/SLL, and FL in clinical studies with BRUKINSA, 59% were ≥65 years of age, and 21% were ≥75 years of age. Patients ≥65 years of age had numerically higher rates of Grade 3 or higher adverse reactions and serious adverse reactions (57% and 38%, respectively) than patients <65 years of age (51% and 29%, respectively). No overall differences in effectiveness were observed between younger and older patients. 8.6 Renal Impairment No dosage modification is recommended in patients with mild, moderate, or severe renal impairment (CLcr ≥15 mL/min, estimated by Cockcroft-Gault). Monitor for BRUKINSA adverse reactions in patients on dialysis [see Clinical Pharmacology (12.3) ] . 8.7 Hepatic Impairment Dosage modification of BRUKINSA is recommended in patients with severe hepatic impairment [see Dosage and Administration (2.2) ] . The safety of BRUKINSA has not been evaluated in patients with severe hepatic impairment. No dosage modification is recommended in patients with mild to moderate hepatic impairment. Monitor for BRUKINSA adverse reactions in patients with hepatic impairment [see Clinical Pharmacology (12.3) ] ."],"dosage_and_administration_table":["
Table 1: Dosage Modifications for Use with CYP3A Inhibitors or Inducers
Coadministered DrugRecommended BRUKINSA Dosage (Starting Dose: 160 mg twice daily or 320 mg once daily)
Clarithromycin 250 mg twice dailySince clarithromycin 250 mg twice daily acts as a moderate CYP3A inhibitor, it is recommended that patients be administered clarithromycin 250 mg twice daily with 80 mg BRUKINSA twice daily [see Clinical Pharmacology (12.3)].80 mg twice dailyModify or interrupt zanubrutinib dose as recommended for adverse reactions [see Dosage and Administration (2.4)].
Clarithromycin 500 mg twice daily80 mg once daily
Posaconazole suspension 100 mg once daily80 mg twice daily
Posaconazole suspension dosage higher than 100 mg once daily Posaconazole delayed-release tablets 300 mg once daily Posaconazole intravenous 300 mg once daily80 mg once daily
Other strong CYP3A inhibitor 80 mg once daily
Moderate CYP3A inhibitor80 mg twice daily
Strong CYP3A inducerAvoid concomitant use.
Moderate CYP3A inducerAvoid concomitant use. If these inducers cannot be avoided, increase BRUKINSA dose to 320 mg twice daily.
","
Table 2: Recommended Dosage Modifications for Adverse Reaction
Adverse ReactionAdverse Reaction OccurrenceDosage Modification (Starting Dose: 160 mg twice daily or 320 mg once daily)
Hematological toxicities [see Warnings and Precautions (5.3)]
Grade 3 or Grade 4 febrile neutropenia Platelet count decreased to 25,000-50,000/mm3 with significant bleeding Neutrophil count decreased to <500/mm3 (lasting more than 10 consecutive days) Platelet count decreased to <25,000/mm3 (lasting more than 10 consecutive days)FirstInterrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 160 mg twice daily or 320 mg once daily.
SecondInterrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg twice daily or 160 mg once daily.
ThirdInterrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg once daily.
FourthDiscontinue BRUKINSA
Nonhematological toxicities [see Warnings and Precautions (5.5) and Adverse Reactions (6.1)]
Severe or life-threatening nonhematological toxicitiesEvaluate the benefit-risk before resuming treatment at the same dosage for Grade 4 nonhematological toxicity.FirstInterrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 160 mg twice daily or 320 mg once daily.
SecondInterrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg twice daily or 160 mg once daily.
ThirdInterrupt BRUKINSA Once toxicity has resolved to Grade 1 or lower or baseline: Resume at 80 mg once daily.
FourthDiscontinue BRUKINSA
"],"spl_patient_package_insert_table":["
PATIENT INFORMATION
BRUKINSA® (BROO-kin-sah) (zanubrutinib) capsulesBRUKINSA® (BROO-kin-sah) (zanubrutinib) tablets
This Patient Information has been approved by the U.S. Food and Drug Administration.Issued: 6/2025
What is BRUKINSA? BRUKINSA is a prescription medicine used to treat adults with:Mantle cell lymphoma (MCL) who have received at least one prior treatment for their cancer.Waldenström's macroglobulinemia (WM).Marginal zone lymphoma (MZL) when the disease has come back or did not respond to treatment and who have received at least one certain type of treatment.Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).Follicular lymphoma (FL), in combination with the medicine obinutuzumab, when the disease has come back or did not respond to treatment and who have received at least two prior treatments.It is not known if BRUKINSA is safe and effective in children.
Before taking BRUKINSA, tell your healthcare provider about all of your medical conditions, including if you:have bleeding problems.have had recent surgery or plan to have surgery. Your healthcare provider may stop BRUKINSA for any planned medical, surgical, or dental procedure.have an infection or have been advised that you are at increased risk of infection.have or had heart rhythm problems.have high blood pressure.have liver problems, including a history of hepatitis B virus (HBV) infection.are pregnant or plan to become pregnant. BRUKINSA can harm your unborn baby. Females who are able to become pregnant:You should avoid getting pregnant during treatment and for 1 week after the last dose of BRUKINSA.Your healthcare provider may do a pregnancy test before starting treatment with BRUKINSA.You should use effective birth control (contraception) during treatment and for 1 week after the last dose of BRUKINSA.Tell your healthcare provider right away if you become pregnant or think you are pregnant during treatment with BRUKINSA.Males with female partners who are able to become pregnant:You should avoid getting female partners pregnant during treatment and for 1 week after the last dose of BRUKINSA.You should use effective birth control (contraception) during treatment and for 1 week after the last dose of BRUKINSA.are breastfeeding or plan to breastfeed. It is not known if BRUKINSA passes into your breast milk. Do not breastfeed during treatment with BRUKINSA and for 2 weeks after the last dose of BRUKINSA.Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take a blood thinner medicine. Taking BRUKINSA with certain other medications may affect how BRUKINSA works and can cause side effects.
How should I take BRUKINSA?Take BRUKINSA exactly as your healthcare provider tells you to take it.Do not change your dose or stop taking BRUKINSA unless your healthcare provider tells you to.Your healthcare provider may tell you to decrease your dose, temporarily stop, or completely stop taking BRUKINSA if you develop certain side effects.Take BRUKINSA with or without food.Swallow BRUKINSA capsules whole with a glass of water. Do not open, break, or chew the capsules.Swallow BRUKINSA tablets whole with a glass of water. Do not chew or crush the tablets.BRUKINSA tablets can be split in half as prescribed by your healthcare provider.If you miss a dose of BRUKINSA, take it as soon as you remember on the same day. Return to your normal schedule the next day.
What are the possible side effects of BRUKINSA? BRUKINSA may cause serious side effects, including:Bleeding problems (hemorrhage). Bleeding problems are common with BRUKINSA, and can be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you develop any signs or symptoms of bleeding, including:
blood in your stools or black stools (looks like tar)pink or brown urineunexpected bleeding, or bleeding that is severe or you cannot controlvomit blood or vomit that looks like coffee groundscough up blood or blood clotsincreased bruisingdizzinessweaknessconfusionchange in speechheadache that lasts a long time
Infections that can be serious and may lead to death. Tell your healthcare provider right away if you develop fever, chills, or flu-like symptoms during your treatment with BRUKINSA.Decrease in blood cell counts (white blood cells, platelets, and red blood cells). Your healthcare provider should do blood tests during treatment with BRUKINSA to check your blood counts.Second primary cancers. New cancers have happened in people during treatment with BRUKINSA, including cancers of the skin or other organs. Your healthcare provider will check you for other cancers during treatment with BRUKINSA. Use sun protection when you are outside in sunlight.Heart rhythm problems. Serious heart problems, including atrial fibrillation, atrial flutter, and ventricular arrhythmias, have happened in people treated with BRUKINSA and may lead to death. Your risk for heart rhythm problems may be increased if you have high blood pressure or have had heart rhythm problems in the past or have a short-term (acute) infection. Tell your healthcare provider if you develop any of the following signs or symptoms:
your heartbeat is fast or irregularfeel lightheaded or dizzypass out (faint)shortness of breathchest discomfort
Liver problems. Liver problems, which may be severe or life-threatening, or lead to death, can happen in people treated with BRUKINSA. Your healthcare provider will do blood tests to check your liver before and during treatment with BRUKINSA. Tell your healthcare provider or get medical help right away if you develop any signs of liver problems, including stomach pain or discomfort, dark-colored urine, or yellow skin and eyes.
The most common side effects of BRUKINSA include:
decreased white blood cell countdecreased platelet countcold-like symptoms (upper respiratory tract infection)muscle, bone, or joint pain
These are not all the possible side effects of BRUKINSA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I store BRUKINSA?Store BRUKINSA at room temperature between 68°F and 77°F (20°C and 25°C).BRUKINSA comes in a bottle with a child-resistant cap.Keep BRUKINSA and all medicines out of the reach of children.
General information about the safe and effective use of BRUKINSA. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use BRUKINSA for a condition for which it was not prescribed. Do not give BRUKINSA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your healthcare provider or pharmacist for more information about BRUKINSA that is written for healthcare professionals.
What are the ingredients in BRUKINSA? Active ingredient: zanubrutinib Capsule inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and sodium lauryl sulfate. The capsule shell contains edible black ink, gelatin, and titanium dioxide. Tablet inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, and sodium lauryl sulfate. The film-coating contains FD&C Blue No. 1, FD&C Blue No. 2, hypromellose, titanium dioxide, and triacetin. BRUKINSA Capsules: Manufactured for: BeOne Medicines USA, Inc., Pennington, NJ 08534 BRUKINSA Tablets: Manufactured for: BeOne Medicines USA, Inc., Pennington, NJ 08534 Manufactured by: Catalent Pharma Solutions, LLC, Winchester, KY 40391 BRUKINSA® is a registered trademark owned by BeOne Medicines I GmbH or its affiliates. © BeOne Medicines I GmbH, 2025. All Rights Reserved. For more information, go to www.BRUKINSA.com or call 1-833-969-2463.
"],"package_label_principal_display_panel":["PRINCIPAL DISPLAY PANEL - 80 mg Capsule Carton NDC 72579-011-02 Rx only Brukinsa ® zanubrutinib capsules 80 mg Swallow capsules whole. Do not open, break or chew the capsules. 120 capsules PRINCIPAL DISPLAY PANEL - 80 mg Capsule Carton","PRINCIPAL DISPLAY PANEL - 160 mg Tablet Carton Rx only Brukinsa ® zanubrutinib tablets 160 mg Swallow tablets whole. Do not crush or chew the tablets. 60 tablets PRINCIPAL DISPLAY PANEL - 160 mg Tablet Carton"],"carcinogenesis_and_mutagenesis_and_impairment_of_fertility":["13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies have not been conducted with zanubrutinib. Zanubrutinib was not mutagenic in a bacterial mutagenicity (Ames) assay, was not clastogenic in a chromosome aberration assay in mammalian (CHO) cells, nor was it clastogenic in an in vivo bone marrow micronucleus assay in rats. A combined male and female fertility and early embryonic development study was conducted in rats at oral zanubrutinib doses of 30 to 300 mg/kg/day. Male rats were dosed 4 weeks prior to mating and through mating and female rats were dosed 2 weeks prior to mating and to gestation day 7. No effect on male or female fertility was noted at lower doses, but at the highest dose tested, morphological abnormalities in sperm and increased postimplantation loss were noted. The high dose of 300 mg/kg/day is approximately 10 times the human recommended dose, based on body surface area."]},"tags":[{"label":"Kinase Inhibitor","category":"class"},{"label":"Small Molecule","category":"modality"},{"label":"Tyrosine-protein kinase BTK","category":"target"},{"label":"BTK","category":"gene"},{"label":"BLK","category":"gene"},{"label":"ERBB4","category":"gene"},{"label":"L01EL03","category":"atc"},{"label":"Oral","category":"route"},{"label":"Capsule","category":"form"},{"label":"Active","category":"status"},{"label":"Chronic lymphoid leukemia, disease","category":"indication"},{"label":"Mantle cell lymphoma","category":"indication"},{"label":"Marginal zone lymphoma","category":"indication"},{"label":"Waldenström macroglobulinemia","category":"indication"},{"label":"Beigene Usa Inc","category":"company"},{"label":"Approved 2010s","category":"decade"},{"label":"Antineoplastic Agents","category":"pharmacology"},{"label":"Enzyme Inhibitors","category":"pharmacology"},{"label":"Hematologic Agents","category":"pharmacology"},{"label":"Protein Kinase Inhibitors","category":"pharmacology"}],"phase":"marketed","safety":{"boxedWarnings":[],"safetySignals":[{"llr":244.73,"date":"","count":72,"signal":"Myelosuppression","source":"DrugCentral FAERS","actionTaken":"Reported 72 times (LLR=245)"},{"llr":196.855,"date":"","count":24,"signal":"Cytokine increased","source":"DrugCentral FAERS","actionTaken":"Reported 24 times (LLR=197)"},{"llr":155.204,"date":"","count":154,"signal":"Off label use","source":"DrugCentral FAERS","actionTaken":"Reported 154 times (LLR=155)"},{"llr":103.778,"date":"","count":36,"signal":"Cytokine release syndrome","source":"DrugCentral FAERS","actionTaken":"Reported 36 times (LLR=104)"},{"llr":86.595,"date":"","count":28,"signal":"Hypophosphataemia","source":"DrugCentral FAERS","actionTaken":"Reported 28 times (LLR=87)"},{"llr":84.458,"date":"","count":34,"signal":"Lymphocyte count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 34 times (LLR=84)"},{"llr":81.424,"date":"","count":53,"signal":"White blood cell count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 53 times (LLR=81)"},{"llr":77.147,"date":"","count":26,"signal":"Hypoalbuminaemia","source":"DrugCentral FAERS","actionTaken":"Reported 26 times (LLR=77)"},{"llr":70.539,"date":"","count":49,"signal":"Platelet count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 49 times (LLR=71)"},{"llr":67.608,"date":"","count":36,"signal":"Neutrophil count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 36 times (LLR=68)"},{"llr":66.966,"date":"","count":16,"signal":"Blood immunoglobulin G decreased","source":"DrugCentral FAERS","actionTaken":"Reported 16 times (LLR=67)"},{"llr":60.254,"date":"","count":15,"signal":"N-terminal prohormone brain natriuretic peptide increased","source":"DrugCentral FAERS","actionTaken":"Reported 15 times (LLR=60)"},{"llr":58.954,"date":"","count":45,"signal":"Disease progression","source":"DrugCentral FAERS","actionTaken":"Reported 45 times (LLR=59)"},{"llr":56.232,"date":"","count":37,"signal":"Hypokalaemia","source":"DrugCentral FAERS","actionTaken":"Reported 37 times (LLR=56)"},{"llr":45.582,"date":"","count":32,"signal":"C-reactive protein increased","source":"DrugCentral FAERS","actionTaken":"Reported 32 times (LLR=46)"}],"commonSideEffects":[{"effect":"Neutrophil count decreased","drugRate":"54%","severity":"serious","_validated":true},{"effect":"Upper respiratory tract infection","drugRate":"47%","severity":"serious","_validated":true},{"effect":"Platelet count decreased","drugRate":"41%","severity":"serious","_validated":true},{"effect":"Hemorrhage","drugRate":"35%","severity":"serious","_validated":true},{"effect":"Lymphocyte count decreased","drugRate":"31%","severity":"serious","_validated":true},{"effect":"Rash","drugRate":"31%","severity":"serious","_validated":true},{"effect":"Musculoskeletal pain","drugRate":"30%","severity":"serious","_validated":true},{"effect":"Neutropenia","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Thrombocytopenia","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Leukopenia","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Anemia","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Pneumonia","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Urinary tract infection","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Bruising","drugRate":"14%","severity":"common","_validated":true},{"effect":"Diarrhea","drugRate":"23%","severity":"common","_validated":true},{"effect":"Constipation","drugRate":"13%","severity":"common","_validated":true},{"effect":"Hypertension","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Hypokalemia","drugRate":"14.1%","severity":"common","_validated":true},{"effect":"Cough","drugRate":"12%","severity":"mild","_validated":true},{"effect":"Hyperuricemia","drugRate":"6%","severity":"mild","_validated":true},{"effect":"Headache","drugRate":"4.2%","severity":"mild","_validated":true}],"specialPopulations":{"Lactation":"There are no data on the presence of zanubrutinib or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production. Because of the potential for serious adverse reactions from BRUKINSA in breastfed child, advise lactating women not to breastfeed during treatment with BRUKINSA and for two weeks following the last dose.","Pregnancy":"Based on findings in animals, BRUKINSA can cause fetal harm when administered to pregnant women. There are no available data on BRUKINSA use in pregnant women to evaluate for drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Women should be advised to avoid pregnancy while taking BRUKINSA. If BRUKINSA is used during pregnancy, or if the patient becomes pregnant while taking BRUKINSA, the patient should be apprised of the potential hazard to the fetus.","Geriatric use":"Of the 847 patients in clinical studies with BRUKINSA, 53% were >= 65 years of age, and 20% were >= 75 years of age. No overall differences in safety or effectiveness were observed between younger and older patients.","Paediatric use":"Safety and effectiveness in pediatric patients have not been established."}},"trials":[],"aliases":["Zanubrutinib","Brukinsa"],"company":"Beigene Usa Inc","patents":[{"source":"FDA Orange Book via DrugCentral","expires":"2037-08-15","territory":"US","patentNumber":"10927117"},{"source":"FDA Orange Book via DrugCentral","expires":"2037-08-15","territory":"US","patentNumber":"11591340"},{"source":"FDA Orange Book via DrugCentral","expires":"2034-04-22","territory":"US","patentNumber":"10570139"},{"source":"FDA Orange Book via DrugCentral","expires":"2034-04-22","territory":"US","patentNumber":"11142528"},{"source":"FDA Orange Book via DrugCentral","expires":"2034-04-22","territory":"US","patentNumber":"9447106"}],"pricing":[],"_sources":{"trials":{"url":"https://clinicaltrials.gov/search?intr=BGB-3111","method":"api_direct","source":"ClinicalTrials.gov","rawText":"","confidence":1,"sourceType":"ctgov","retrievedAt":"2026-04-19T23:58:40.083929+00:00"},"patents":{"url":"","method":"deterministic","source":"FDA Orange Book","rawText":"","confidence":1,"sourceType":"fda_orange_book","retrievedAt":"2026-04-19T23:58:32.991889+00:00"},"regulatory.ca":{"url":"","method":"api_direct","source":"Health Canada DPD","rawText":"","confidence":1,"sourceType":"health_canada_dpd","retrievedAt":"2026-04-19T23:58:45.939310+00:00"},"regulatory.eu":{"url":"","method":"api_direct","source":"European Medicines Agency","rawText":"","confidence":1,"sourceType":"ema_api","retrievedAt":"2026-04-19T23:58:40.156051+00:00"},"publicationCount":{"url":"https://pubmed.ncbi.nlm.nih.gov/?term=BGB-3111","method":"api_direct","source":"PubMed/NCBI","rawText":"","confidence":1,"sourceType":"pubmed","retrievedAt":"2026-04-19T23:58:46.163642+00:00"},"mechanism.drugClass":{"url":"https://api.fda.gov/drug/label.json","method":"deterministic","source":"FDA Label (EPC)","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:58:31.108951+00:00"},"administration.route":{"url":"","method":"deterministic","source":"FDA Label","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:58:31.108988+00:00"},"safety.boxedWarnings":{"url":"","method":"deterministic","source":"FDA Label (no boxed warning)","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:58:31.108994+00:00"},"mechanism.target_chembl":{"url":"","method":"api_direct","source":"ChEMBL mechanism: Tyrosine-protein kinase BTK inhibitor","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-19T23:58:47.191018+00:00"},"crossReferences.chemblId":{"url":"https://www.ebi.ac.uk/chembl/compound_report_card/CHEMBL3936761/","method":"api_direct","source":"ChEMBL (EMBL-EBI)","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-19T23:58:46.857202+00:00"},"regulatory.fda_application":{"url":"","method":"deterministic","source":"FDA Label","rawText":"NDA213217, NDA218785","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:58:31.109000+00:00"}},"allNames":"brukinsa","offLabel":[],"synonyms":["zanubrutinib","BGB-3111","brukinsa"],"timeline":[{"date":"2019-11-14","type":"positive","source":"DrugCentral","milestone":"FDA approval (Beigene Usa Inc)"},{"date":"2021-11-22","type":"positive","source":"DrugCentral","milestone":"EMA approval (Beigene Ireland Ltd)"}],"aiSummary":"Brukinsa (BGB-3111) is a small molecule kinase inhibitor developed by BEIGENE USA INC, targeting the tyrosine-protein kinase BTK. It is FDA-approved for the treatment of various types of non-Hodgkin lymphoma, including chronic lymphocytic leukemia, mantle cell lymphoma, marginal zone lymphoma, and Waldenström macroglobulinemia. Brukinsa works by inhibiting the activity of BTK, a protein involved in the activation of B cells, thereby reducing tumor growth and proliferation. As a patented product, Brukinsa is not yet available as a generic medication. Key safety considerations include potential risks of infections, bleeding, and liver damage.","brandName":"Brukinsa","ecosystem":[{"indication":"Chronic lymphoid leukemia, disease","otherDrugs":[{"name":"bendamustine","slug":"bendamustine","company":"Cephalon"},{"name":"chlorambucil","slug":"chlorambucil","company":"Aspen Global Inc"},{"name":"cyclophosphamide","slug":"cyclophosphamide","company":"Baxter Hlthcare"},{"name":"duvelisib","slug":"duvelisib","company":"Verastem Inc"}],"globalPrevalence":null},{"indication":"Mantle cell lymphoma","otherDrugs":[{"name":"acalabrutinib","slug":"acalabrutinib","company":"Acerta Pharma Bv"},{"name":"bortezomib","slug":"bortezomib","company":"Millennium Pharms"},{"name":"fludarabine phosphate","slug":"fludarabine-phosphate","company":""},{"name":"ibrutinib","slug":"ibrutinib","company":"Pharmacyclics Inc"}],"globalPrevalence":15000},{"indication":"Marginal zone lymphoma","otherDrugs":[{"name":"ibrutinib","slug":"ibrutinib","company":"Pharmacyclics Inc"},{"name":"lenalidomide","slug":"lenalidomide","company":"Celgene"}],"globalPrevalence":null},{"indication":"Waldenström macroglobulinemia","otherDrugs":[{"name":"ibrutinib","slug":"ibrutinib","company":"Pharmacyclics Inc"}],"globalPrevalence":null}],"mechanism":{"target":"Tyrosine-protein kinase BTK","novelty":"Follow-on","targets":[{"gene":"BTK","source":"DrugCentral","target":"Tyrosine-protein kinase BTK","protein":"Tyrosine-protein kinase BTK"},{"gene":"BLK","source":"DrugCentral","target":"Tyrosine-protein kinase Blk","protein":"Tyrosine-protein kinase Blk"},{"gene":"ERBB4","source":"DrugCentral","target":"Receptor tyrosine-protein kinase erbB-4","protein":"Receptor tyrosine-protein kinase erbB-4"},{"gene":"TEC","source":"DrugCentral","target":"Tyrosine-protein kinase Tec","protein":"Tyrosine-protein kinase Tec"},{"gene":"TXK","source":"DrugCentral","target":"Tyrosine-protein kinase TXK","protein":"Tyrosine-protein kinase TXK"},{"gene":"BMX","source":"DrugCentral","target":"Cytoplasmic tyrosine-protein kinase BMX","protein":"Cytoplasmic tyrosine-protein kinase BMX"},{"gene":"EGFR","source":"DrugCentral","target":"Epidermal growth factor receptor","protein":"Epidermal growth factor receptor"},{"gene":"PTK6","source":"DrugCentral","target":"Protein-tyrosine kinase 6","protein":"Protein-tyrosine kinase 6"},{"gene":"ITK","source":"DrugCentral","target":"Tyrosine-protein kinase ITK/TSK","protein":"Tyrosine-protein kinase ITK/TSK"},{"gene":"ERBB2","source":"DrugCentral","target":"Receptor tyrosine-protein kinase erbB-2","protein":"Receptor tyrosine-protein kinase erbB-2"}],"moaClass":"Brutons Tyrosine Kinase Inhibitors","modality":"Small Molecule","drugClass":"Kinase Inhibitor [EPC]","explanation":"Zanubrutinib is small-molecule inhibitor of Brutons tyrosine kinase (BTK). Zanubrutinib forms covalent bond with cysteine residue in the BTK active site, leading to inhibition of BTK activity. BTK is signaling molecule of the B-cell antigen receptor (BCR) and cytokine receptor pathways. In B-cells, BTK signaling results in activation of pathways necessary for B-cell proliferation, trafficking, chemotaxis and adhesion. In nonclinical studies, zanubrutinib inhibited malignant B-cell proliferation and reduced tumor growth.","oneSentence":"Brukinsa blocks the BTK protein, which is involved in the activation of B cells.","technicalDetail":"Brukinsa (BGB-3111) is a selective, irreversible inhibitor of Bruton's tyrosine kinase (BTK), a non-receptor tyrosine kinase essential for B cell receptor signaling and cell survival."},"commercial":{"launchDate":"2019","revenueYear":2024,"_launchSource":"DrugCentral (FDA 2019-11-14, BEIGENE USA INC)","annualRevenue":2700,"revenueSource":"Verified: BeiGene 10-K","revenueCurrency":"USD","revenueConfidence":"verified"},"references":[{"id":1,"url":"https://drugcentral.org/drugcard/5353","fields":["approvals","synonyms","ATC","PK","indications","contraindications","DDIs","targets","patents","FAERS"],"source":"DrugCentral"},{"id":2,"url":"https://clinicaltrials.gov/search?intr=BGB-3111","fields":["trials"],"source":"ClinicalTrials.gov"},{"id":3,"url":"https://pubmed.ncbi.nlm.nih.gov/?term=BGB-3111","fields":["publications"],"source":"PubMed/NCBI"}],"_emaChecked":true,"_enrichedAt":"2026-03-30T02:54:12.292085","_validation":{"fieldsValidated":0,"lastValidatedAt":"2026-04-19T23:58:50.748377+00:00","fieldsConflicting":7,"overallConfidence":0.8},"biosimilars":[],"competitors":[{"drugName":"ibrutinib","drugSlug":"ibrutinib","fdaApproval":"2013-11-13","patentExpiry":"Sep 3, 2036","patentStatus":"Patent protected","relationship":"same-class"},{"drugName":"acalabrutinib","drugSlug":"acalabrutinib","fdaApproval":"2017-10-31","patentExpiry":"Nov 24, 2026","patentStatus":"Patent protected","relationship":"same-class"}],"genericName":"bgb-3111","indications":{"approved":[{"name":"Chronic lymphoid leukemia, disease","source":"DrugCentral","snomedId":92814006,"regulator":"FDA"},{"name":"Mantle cell lymphoma","source":"DrugCentral","snomedId":443487006,"regulator":"FDA","usPrevalence":null,"globalPrevalence":15000,"prevalenceMethod":"curated","prevalenceSource":"Lancet Haematology, 2023"},{"name":"Marginal zone lymphoma","source":"DrugCentral","snomedId":447100004,"regulator":"FDA"},{"name":"Waldenström macroglobulinemia","source":"DrugCentral","snomedId":190818004,"regulator":"FDA"}],"offLabel":[],"pipeline":[]},"drugCategory":"active","labelChanges":[],"relatedDrugs":[{"drugId":"ibrutinib","brandName":"ibrutinib","genericName":"ibrutinib","approvalYear":"2013","relationship":"same-class"},{"drugId":"acalabrutinib","brandName":"acalabrutinib","genericName":"acalabrutinib","approvalYear":"2017","relationship":"same-class"}],"trialDetails":[{"nctId":"NCT04840602","phase":"PHASE2","title":"Testing the Combination of Venetoclax and Rituximab, in Comparison to the Usual Treatment (Ibrutinib Plus Rituximab or Zanubrutinib Alone) for Waldenstrom's Macroglobulinemia/Lymphoplasmacytic Lymphoma","status":"RECRUITING","sponsor":"National Cancer Institute (NCI)","startDate":"2022-01-05","conditions":["Lymphoplasmacytic Lymphoma","Waldenstrom Macroglobulinemia"],"enrollment":92,"completionDate":"2028-03-31"},{"nctId":"NCT04277637","phase":"PHASE1","title":"Study of Bcl-2 Inhibitor Sonrotoclax (BGB-11417) in Participants With Mature B-Cell Malignancies","status":"ACTIVE_NOT_RECRUITING","sponsor":"BeOne Medicines","startDate":"2020-03-24","conditions":["Mature B-Cell Malignancies"],"enrollment":437,"completionDate":"2027-05-31"},{"nctId":"NCT05068440","phase":"PHASE2","title":"Treatment of CD79B Mutant Relapsed/Refractory Diffuse Large B-Cell Lymphoma With Bruton Tyrosine Kinase Inhibitor Zanubrutinib","status":"COMPLETED","sponsor":"BeiGene","startDate":"2021-08-11","conditions":["Relapsed Diffuse Large B-cell Lymphoma","Refractory Diffuse Large B-cell Lymphoma"],"enrollment":65,"completionDate":"2025-03-31"},{"nctId":"NCT07141511","phase":"PHASE1","title":"A Study to Investigate the Relative Bioavailability and Food Effect of a Fixed-Dose Combination Tablet Containing Zanubrutinib and Sonrotoclax (BG-71332) in Healthy Adults","status":"COMPLETED","sponsor":"BeOne Medicines","startDate":"2025-09-24","conditions":["Healthy Volunteers"],"enrollment":24,"completionDate":"2026-02-23"},{"nctId":"NCT06637501","phase":"PHASE2","title":"A Study to Investigate Sonrotoclax Combined With Zanubrutinib Versus Zanubrutinib Alone in Participants With Previously Untreated Chronic Lymphocytic Leukemia","status":"ACTIVE_NOT_RECRUITING","sponsor":"BeOne Medicines","startDate":"2024-11-14","conditions":["Chronic Lymphocytic Leukemia"],"enrollment":94,"completionDate":"2029-09"},{"nctId":"NCT06073821","phase":"PHASE3","title":"Study of Sonrotoclax (BGB-11417) Plus Zanubrutinib (BGB-3111) Compared With Venetoclax Plus Obinutuzumab in Participants With Chronic Lymphocytic Leukemia (CLL)","status":"ACTIVE_NOT_RECRUITING","sponsor":"BeOne Medicines","startDate":"2023-11-11","conditions":["CLL"],"enrollment":652,"completionDate":"2032-12"},{"nctId":"NCT04458610","phase":"PHASE2","title":"Zanubrutinib and Rituximab for the Treatment of Previously Untreated Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma","status":"ACTIVE_NOT_RECRUITING","sponsor":"M.D. Anderson Cancer Center","startDate":"2020-05-26","conditions":["Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma"],"enrollment":60,"completionDate":"2026-05-26"},{"nctId":"NCT06742996","phase":"PHASE3","title":"A Study to Investigate the Efficacy and Safety of Sonrotoclax Plus Zanubrutinib Compared With Placebo Plus Zanubrutinib in Adults With Relapsed/Refractory Mantle Cell Lymphoma (CELESTIAL-RRMCL)","status":"RECRUITING","sponsor":"BeOne Medicines","startDate":"2025-03-05","conditions":["Mantle Cell Lymphoma","B Cell Lymphoma"],"enrollment":300,"completionDate":"2032-03-30"},{"nctId":"NCT07277231","phase":"PHASE3","title":"A Study to Investigate Sonrotoclax (BGB-11417) Plus Zanubrutinib (BGB-3111) Compared With Venetoclax Plus Acalabrutinib in Adults With Previously Untreated Chronic Lymphocytic Leukemia","status":"RECRUITING","sponsor":"BeOne Medicines","startDate":"2026-01-22","conditions":["Chronic Lymphocytic Leukemia"],"enrollment":500,"completionDate":"2031-11"},{"nctId":"NCT05100862","phase":"PHASE3","title":"A Study of Zanubrutinib Plus Anti-CD20 Versus Lenalidomide Plus Rituximab in Participants With Relapsed/Refractory Follicular or Marginal Zone Lymphoma","status":"RECRUITING","sponsor":"BeiGene","startDate":"2022-03-10","conditions":["Relapsed/Refractory Follicular Lymphoma","Marginal Zone Lymphoma"],"enrollment":780,"completionDate":"2030-06"},{"nctId":"NCT03336333","phase":"PHASE3","title":"A Study Comparing Zanubrutinib With Bendamustine Plus Rituximab in Participants With Previously Untreated CLL or SLL","status":"ACTIVE_NOT_RECRUITING","sponsor":"BeiGene","startDate":"2017-10-31","conditions":["Chronic Lymphocytic Leukemia","Small Lymphocytic Lymphoma"],"enrollment":590,"completionDate":"2027-10-31"},{"nctId":"NCT05707377","phase":"PHASE2,PHASE3","title":"A Study to Examine the Efficacy and Safety of Zanubrutinib Given to Adults With Primary Membranous Nephropathy","status":"ACTIVE_NOT_RECRUITING","sponsor":"BeOne Medicines","startDate":"2023-04-17","conditions":["Primary Membranous Nephropathy"],"enrollment":178,"completionDate":"2027-10"},{"nctId":"NCT05640102","phase":"","title":"Observational Study Evaluating the Efficacy and Safety of Zanubrutinib in Participants With Waldenström Macroglobulinemia","status":"RECRUITING","sponsor":"BeiGene","startDate":"2023-03-03","conditions":["Waldenstrom Macroglobulinemia"],"enrollment":111,"completionDate":"2027-12"},{"nctId":"NCT05873712","phase":"PHASE2","title":"Zanubrutinib and Lisocabtagene Maraleucel for the Treatment of Richter's Syndrome","status":"RECRUITING","sponsor":"Aseel Alsouqi","startDate":"2023-07-28","conditions":["Recurrent Transformed Chronic Lymphocytic Leukemia","Refractory Transformed Chronic Lymphocytic Leukemia","Transformed Chronic Lymphocytic Leukemia to Diffuse Large B-Cell Lymphoma","Recurrent Transformed B-Cell Non-Hodgkin Lymphoma","Recurrent Transformed Non-Hodgkin Lymphoma","Refractory Transformed Non-Hodgkin Lymphoma","Refractory Transformed B-cell Non-Hodgkin Lymphoma","Refractory Transformed"],"enrollment":24,"completionDate":"2026-12-31"},{"nctId":"NCT06854003","phase":"PHASE2","title":"BRAZAN: A Randomized Phase 2 Study of Bendamustine, Rituximab, Cytarabine (AraC) Induction With Zanubrutinib (BRAZAN) Followed by Zanubrutinib/Rituximab +/- Sonrotoclax Maintenance in Treatment-Naïve Mantle Cell Lymphoma","status":"RECRUITING","sponsor":"Christine Ryan","startDate":"2025-04-22","conditions":["Mantle Cell Lymphoma","Lymphoma"],"enrollment":60,"completionDate":"2039-11-01"},{"nctId":"NCT04282018","phase":"PHASE1,PHASE2","title":"Study of BGB-10188 as Monotherapy, and in Combination With Zanubrutinib, and Tislelizumab","status":"COMPLETED","sponsor":"BeiGene","startDate":"2020-04-29","conditions":["Chronic Lymphocytic Leukemia","Small Lymphocytic Lymphoma","Follicular Lymphoma","Marginal Zone Lymphoma","Mantle Cell Lymphoma","Diffuse Large B Cell Lymphoma","Advanced Solid Tumor"],"enrollment":97,"completionDate":"2024-08-28"},{"nctId":"NCT03332017","phase":"PHASE2","title":"A Study Comparing Obinutuzumab and BGB-3111 Versus Obinutuzumab Alone in Treating R/R Follicular Lymphoma","status":"COMPLETED","sponsor":"BeiGene","startDate":"2017-11-14","conditions":["Relapsed/Refractory Follicular Non-Hodgkin Lymphoma"],"enrollment":217,"completionDate":"2024-12-27"},{"nctId":"NCT06558604","phase":"PHASE2","title":"Phase II Study of Glofitamab With Venetoclax +/- Zanubrutinib in High-risk Mantle-cell Lymphoma","status":"RECRUITING","sponsor":"The Lymphoma Academic Research Organisation","startDate":"2025-02-21","conditions":["Lymphoma, Mantle-Cell"],"enrollment":100,"completionDate":"2032-03"},{"nctId":"NCT04850495","phase":"PHASE1","title":"Zanubrutinib in Combination With R-PolaCHP (ZaR-PolaCHP) for Newly Diagnosed Diffuse Large B-Cell Lymphoma","status":"SUSPENDED","sponsor":"Yazeed Sawalha","startDate":"2021-11-16","conditions":["Diffuse Large B-Cell Lymphoma","Transformed Follicular Lymphoma to Diffuse Large B-Cell Lymphoma","Transformed Marginal Zone Lymphoma to Diffuse Large B-Cell Lymphoma"],"enrollment":38,"completionDate":"2026-06-15"},{"nctId":"NCT04116437","phase":"PHASE2","title":"Zanubrutinib (BGB-3111) in Participants With Previously Treated B-Cell Lymphoma Intolerant of Prior Bruton Tyrosine Kinase Inhibitor (BTKi) Treatment","status":"COMPLETED","sponsor":"BeiGene","startDate":"2019-10-15","conditions":["Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma","Mantle Cell Lymphoma","Marginal Zone Lymphoma","Waldenstrom Macroglobulinemia"],"enrollment":96,"completionDate":"2026-01-09"},{"nctId":"NCT06492837","phase":"PHASE2","title":"Study With Mosunetuzumab and Zanubrutinib in R/R Follicular Lymphoma Patients","status":"RECRUITING","sponsor":"Fondazione Italiana Linfomi - ETS","startDate":"2024-10-23","conditions":["Follicular Lymphoma"],"enrollment":56,"completionDate":"2033-09-15"},{"nctId":"NCT03740529","phase":"PHASE1,PHASE2","title":"A Study of Oral LOXO-305 in Patients With Previously Treated CLL/SLL or NHL","status":"COMPLETED","sponsor":"Loxo Oncology, Inc.","startDate":"2019-03-15","conditions":["Chronic Lymphocytic Leukemia","Waldenstrom Macroglobulinemia","Mantle Cell Lymphoma","Marginal Zone Lymphoma","B-cell Lymphoma","Small Lymphocytic Lymphoma"],"enrollment":803,"completionDate":"2025-12-23"},{"nctId":"NCT05952037","phase":"PHASE2","title":"A Study to Investigate Efficacy and Safety of BCL2 Inhibitor Sonrotoclax as Monotherapy and in Combination With Zanubrutinib in Adults With Waldenström Macroglobulinemia","status":"ACTIVE_NOT_RECRUITING","sponsor":"BeOne Medicines","startDate":"2023-10-23","conditions":["Waldenstrom Macroglobulinemia","Waldenstrom's Macroglobulinemia Recurrent","Waldenstrom's Macroglobulinemia 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