Idarubicin
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Idarubicin: From Acute Myeloid Leukaemia to Bulbar Polio
One-Sentence Summary
Idarubicin is an anthracycline chemotherapy drug originally used to treat acute myeloid leukaemia (AML) and related myeloid conditions. The TxGNN model predicts it may be effective for bulbar polio, but no clinical trials and no publications currently support this prediction. The prediction is purely computational, and the mechanism makes it biologically implausible.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Acute myeloid leukaemia (AML) and related subtypes (the Singapore licence entries carry no indication text; this indication comes from the knowledge graph) |
| Predicted New Indication | Bulbar polio |
| TxGNN Prediction Score | 97.05% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 2 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the compiled data. Based on general pharmacological knowledge, idarubicin is a topoisomerase II inhibitor and DNA intercalator. Its efficacy in AML comes from cytotoxic damage to rapidly dividing leukaemic cells.
Bulbar polio is an acute viral infection of the nervous system caused by poliovirus. Idarubicin has no known antiviral activity against poliovirus, and giving a cytotoxic anthracycline for an acute viral neurological infection is biologically implausible. The high TxGNN score (rank 21,090 among all predictions) most likely reflects a network-based artefact rather than a real therapeutic link.
Other top-ranked predictions show the same pattern. Most (e.g., 5q35 microduplication syndrome, neuralgic amyotrophy, reactive thrombocytosis) have no supporting evidence and no plausible mechanism. A few have class-level plausibility only, based on anthracyclines in general rather than idarubicin: ganglioneuroblastoma and Hodgkin lymphoma (listed as the obsolete term "Hodgkin's granuloma"). Retroperitoneal neoplasm (rank 8) has one weakly linked case report on myeloid sarcoma.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature available for bulbar polio.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN12455P | ZAVEDOS SOLUTION FOR INJECTION 10 mg/10 ml | Injection | Not stated in the licence data |
| SIN12456P | ZAVEDOS SOLUTION FOR INJECTION 5 mg/5 ml | Injection | Not stated in the licence data |
Both are valid single-ingredient licences. The manufacturers are Bridgewest Perth Pharma Pty Ltd and Zydus Hospira Oncology Private Limited.
Cytotoxicity
| Item | Content |
|---|---|
| Cytotoxicity Classification | Conventional cytotoxic (anthracycline; topoisomerase II inhibitor and DNA intercalator) |
| Myelosuppression Risk | High (severe myelosuppression is expected with anthracycline therapy) |
| Emetogenicity Classification | Moderate |
| Monitoring Items | CBC with differential, liver and renal function, cardiac function (e.g., LVEF), electrolytes |
| Handling Protection | Must follow cytotoxic drug handling regulations |
Please also refer to the package insert warnings and precautions.
Safety Considerations
- Disease-level cautions (from the knowledge graph, not label text): The following conditions are linked to idarubicin as contraindications: kidney disease, liver disease, gallbladder disease, anaemia (including macrocytic anaemia), sudden cardiac arrest, heart conduction disease, cardiomyopathy (including hypertrophic), endomyocardial fibrosis, myocardial disorders, myocarditis, pericarditis, enterocolitis and gastroenteritis. Cardiac and haematological risks are especially relevant to anthracyclines.
- Drug Interactions: 100 interactions were identified in total; 20 are listed in the compiled data. Major-level interactions include dolasetron, cisapride, papaverine, deferiprone and macimorelin. Moderate-level interactions include famotidine, loperamide, clarithromycin, levofloxacin, ondansetron, granisetron, palonosetron, promethazine, rolapitant, eliglustat, palifermin and several bowel-preparation agents (picosulfuric acid, sodium sulfate, polyethylene glycol). Metronidazole is a minor interaction.
Please refer to the package insert for the full warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction rests on a graph-based score alone, with no trials or publications. Idarubicin has no known antiviral action, and its toxicity (myelosuppression, cardiotoxicity) is unacceptable for an acute viral infection. Evidence is at the lowest level (L5).
To proceed, the following is needed:
- Mechanism of action data, and evidence of any activity against poliovirus or neuroprotective effect
- Package insert warnings and contraindications from the HSA
- Preclinical (in vitro or in vivo) data supporting a link to bulbar polio
- If repurposing is pursued, a better-supported prediction such as ganglioneuroblastoma or Hodgkin lymphoma should be reviewed, with idarubicin-specific evidence
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.