Population pharmacokinetic analyses in patients with ulcerative colitis or Crohn's disease indicated that the clearance of mirikizumab was not impacted by concomitant administration of

• aminosalicylates
• corticosteroids, or
• oral immunomodulators, such as 6-mercaptopurine, azathioprine, methotrexate, and tioguanine.1 

Based on a clinical drug-drug interaction study conducted in patients with another condition, multiple subcutaneous doses of mirikizumab 250 mg every 4 weeks did not result in changes in the exposure of

• midazolam (CYP3A substrate)
• warfarin (CYP2C9 substrate)
• dextromethorphan (CYP2D6 substrate)
• omeprazole (CYP2C19 substrate), or
• caffeine (CYP1A2 substrate).1

Increased concentrations of cytokines, such as interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor (TNF) α, and interferon, during chronic inflammation associated with certain diseases including Crohn’s disease may suppress the formation of CYP450 enzymes. Therapeutic proteins, including mirikizumab-mrkz, that decrease the concentrations of these proinflammatory cytokines may increase the formation of CYP450 enzymes resulting in decreased CYP450 substrate exposure.1

Upon initiation or discontinuation of mirikizumab in patients treated with concomitant CYP450 substrates, monitor drug concentrations or other therapeutic parameters, and adjust the dosage of the CYP450 substrate as needed.1

See the prescribing information of specific CYP450 substrates.1

OMVOH® (mirikizumab-mrkz) injection, for intravenous or subcutaneous use, Lilly