generic dasatinib or scemblix?

Both dasatinib and asciminib are excellent drugs. Asciminib is at least as effective as dasatinib, and very likely more effective based on fairly recent data.

To me there is no bad option out of those choices medically speaking. But, if starting asciminib rules out dasatinib in the future there is some merit to following “the flowchart” and trying dasatinib first. I have taken both dasatinib (for a long time) and asciminib, and I do feel that asciminib is kinder on me than dasatinib was. But it’s just one person’s experience. Lots of people do really well on low-dose (50mg or less) dasatinib.

Out of interest, which country are you treated in? It’s an unusual sequencing of medication … bosutinib is typically in the same “generation” as nilotinib and dasatinib, and ponatinib is usually reserved for t315i and pre-transplant preparation.

One thing that might be important is that dasatinib does need an acidic stomach to work fully, but asciminib doesn’t have the same constraints. So if you need to take stomach acid reducing medication then that would have a big impact on your decision.

David.

Hello David, thank you for the answer, now im struggling to treat bille reflux ( I took out the gallbladder 12 yeras ago), which is more difficult to manage than gastric reflux, constant heat senzation in my neck its affects me mentally. Normaly bille reflux its not being treated with a antiacid, butt in this moment i dont now if in the reflux exist a acid component.
Here in Romania where i live, the treament plan for CML seems to by illogicaly, butt it's good that still exists. I now about 50 mg dasatinib dose it is just as effective as 100 mg, and i thik to cutt the pill in half. Normaly i would have chosen dasantinib, butt in this situation, hard choice..

bile reflux-wise, you may be helped by this 4/17/2023 by a Dr. axe. the article is 4/17/2023, recent. I go to Dr. axe's site for advice regarding supplements for various things.

Acid Reflux Diet: Best and Worst Foods plus Supplements
Dr axe's site is legitimate.

I may be doing so well on scemblix/asciminib because it is not generic. I did notice my generic dasatinibs were coming from different manufacturers. the fillers in the med were different. I blamed my skipped heart beats and face swelling on the fillers. I had gotten down to 40 mg dasatinib and was doing well blood bcr/abl wise. I tolerated the skipped heart beats. but not the swollen face.
your doc mention fasting 2 -3 hrs before asciminib dose, 1 hr after. I take my pill at 1 am, middle of my sleep.

thanks for the help, starting today, i'm on scemblix 2x40 mg/day.
I wish you only well!

In my experience Scemblix is performing better, less side effects and an excellent response, my BCRABL is now at 0.000. If you do go on Facebook there is an excellent group…CML Scemblix (ABL001/Asciminib) patient group. The moderator was one of the first people to ever be put on Asciminib in clinical trials. I hope you’re able to access it , a lot of good information from the patients themselves.

I am now taking 120 mg.for the first year or so I was on 80 but I was not getting to zeros I was bouncing around between .05 and .01 when my hematologist up my dose it brought my numbers down to 0.000. The worst side effect for me has been musculoskeletal pain and fatigue in the afternoon. But I also have severe arthritis so I never know which is which

I need to correct some misconceptions about generics and excipients (and I do so from knowledge and professional experience of both generics, reference products (the originals) and the regulatory system).

First, generics do not simply have to have the same active ingredient (in the same quantity). In order to obtain regulatory approval they also have to establish, by human trial, that they are bioequivalent. This means that their absorption curve must be the same as the original drug - same amount of active reaching the blood at precisely the same rate. This is done by using the same or equivalent excipients, all of which must come from approved lists of pharmaceutically acceptable excipients. Changes from the original are generally not made (and in fact the generic TKIs are either identical or all but identical). The cost difference between generics and the original is nothing to do with excipients. All small molecule pharmaceuticals (ie not biologicals eg antibodies) are inexpensive and relatively easy to make. The cost difference between the original is related to research costs (the minor part) and development costs (by far the biggest part). Development costs include the extensive clinical trials that a new drug must undergo to establish efficacy and safety. It is these latter costs that generics do not have because they can piggyback on the original product’s regulatory file data, so long as they establish bioequivalence as I say. Hence they are much much cheaper. Generics form an essential part of the public healthcare systems because without them there wouldn’t be public (or insurance) funds for new, innovative medicines that meet unmet needs.

Many generic companies are very substantial. Teva, Dr Reddy’s, Cipla are just three you will come across. They make many different medicines ubiquitous in all major healthcare systems, in all medical areas. And in some cases the company makes exactly the same product as the original. Sandoz is one - it used to be part of Novartis, which makes imatinib and nilotinib (now both generic) and asciminib (not yet generic).

As I say, in the TKI area where there are excipient differences, and there aren’t in many cases, these are very small and swaps for equivalent things. They are all, by law, bioequivalent to the original, reference product. There are some widely held misconceptions about generic medicines unfortunately just because they are cheaper at the point of sale. Their manufacturing costs and quality are not different.

I meant oncology doc., not once doc. I believe A1 corrected my onc to once.
I 1-finger type.