ISM

For U.S. residents only ages 18+

ISM

AdvSM

PDGFRA GIST

Talk To Your Doctor

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How often do you experience symptoms of indolent systemic mastocytosis (ISM)?

Select your answer.

Please select one of these options

This questionnaire is not medical advice and is not intended for use in the diagnosis of any disease. Your answers may help you communicate your experiences living with ISM and can facilitate a discussion with your doctor about how you can take steps to manage your condition. Remember to talk to your doctor about any symptoms or other concerns you may have about your health.

Which symptoms of ISM do you commonly experience?

Check all the boxes that apply.

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This questionnaire is not medical advice and is not intended for use in the diagnosis of any disease. Your answers may help you communicate your experiences living with ISM and can facilitate a discussion with your doctor about how you can take steps to manage your condition. Remember to talk to your doctor about any symptoms or other concerns you may have about your health.

How do your symptoms of ISM make you feel?

Check all the boxes that apply.

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Please select at least one option

This questionnaire is not medical advice and is not intended for use in the diagnosis of any disease. Your answers may help you communicate your experiences living with ISM and can facilitate a discussion with your doctor about how you can take steps to manage your condition. Remember to talk to your doctor about any symptoms or other concerns you may have about your health.

How many different medications do you use (including over-the-counter, drugstore medicines and medications prescribed by your doctors) to help manage your symptoms of ISM?

Select the number of medications that you use on average.

Please select one of these options

This questionnaire is not medical advice and is not intended for use in the diagnosis of any disease. Your answers may help you communicate your experiences living with ISM and can facilitate a discussion with your doctor about how you can take steps to manage your condition. Remember to talk to your doctor about any symptoms or other concerns you may have about your health.

Describe how your symptoms impact your daily life.

Fill out the text box below.

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Thanks! Here is a summary of your responses.

Thank you for completing the Doctor Discussion Guide questions. You may use this summary to help guide your conversation with your doctor about treatment. Your responses and the information provided are not diagnostic, so speak to your doctor for more information about indolent systemic mastocytosis (ISM).

1. How often do you experience symptoms of indolent systemic mastocytosis (ISM)?

    2. Which symptoms of ISM do you commonly experience?

      3. How do your symptoms of ISM make you feel?

        4. How many different medications do you use (including over-the-counter, drugstore medicines and medications prescribed by your doctors) to help manage your symptoms of ISM?

          5. Describe how your symptoms impact your daily life.

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          To get a copy of your responses so that you can share them with your doctor, as well as information about indolent systemic mastocytosis (ISM), AYVAKIT® (avapritinib) for ISM and Blueprint Medicines, please complete the following form.

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          Here are some questions to ask your doctor to see if AYVAKIT® may be right for you:

          1

          Are there other ways to help manage my indolent systemic mastocytosis (ISM)?

          2

          What is AYVAKIT? How did AYVAKIT help with symptoms of ISM in patients from the clinical trial?

          3

          Do you think AYVAKIT could be an appropriate treatment option for my ISM?

          4

          How do you take AYVAKIT for ISM?

          5

          What are the potential risks or side effects of treatment with AYVAKIT for ISM?

          6

          Will I still need to take other medications for my symptoms of ISM if taking AYVAKIT?

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          INDICATION

          WHAT IS AYVAKIT® (avapritinib)?

          AYVAKIT® (avapritinib) is a prescription medicine used to treat adults with indolent systemic mastocytosis (ISM). AYVAKIT is not recommended in people with low platelet counts (less than 50 X 109/L). It is not known if AYVAKIT is safe and effective in children.

          IMPORTANT SAFETY INFORMATION

          AYVAKIT® (avapritinib) may cause serious side effects, including:

          Cognitive effects. Cognitive side effects can happen during treatment with AYVAKIT and can be severe. Tell your healthcare provider if you develop any new or worsening cognitive symptoms including forgetfulness, confusion, getting lost, trouble thinking, drowsiness, trouble staying awake (somnolence), word finding problems, seeing objects or hearing things that are not there (hallucinations), or a change in mood or behavior.

          Skin sensitivity to sunlight (photosensitivity). Your skin may be sensitive to the sun or other forms of light (photosensitivity) during treatment with AYVAKIT. Avoid or limit exposure to direct sunlight, sunlamps, and other sources of ultraviolet radiation during treatment and for 1 week after stopping treatment with AYVAKIT. Use sunscreen or wear clothes that cover your skin if you need to be out in the sun.

          Before taking AYVAKIT, tell your healthcare provider about all of your medical conditions, including if you:

          • history of bulging or weakening of a blood vessel wall (aneurysm) or bleeding in your brain
          • have a history of stroke within the last year
          • have low platelet counts
          • have or have had liver problems
          • are pregnant or plan to become pregnant. AYVAKIT can cause harm to your unborn baby
          • Females who are able to become pregnant: Your healthcare provider should do a pregnancy test before you start AYVAKIT. You should use effective birth control (contraception) during treatment with AYVAKIT and for 6 weeks after the final dose of AYVAKIT. Talk to your healthcare provider about birth control methods that may be right for you. Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with AYVAKIT.
          • Males with female partners who are able to become pregnant should use effective birth control (contraception) during treatment and for 6 weeks after the final dose of AYVAKIT.
          • are breastfeeding or plan to breastfeed. It is not known if AYVAKIT passes into your breast milk. Do not breastfeed during treatment with AYVAKIT and for at least 2 weeks after the final dose of AYVAKIT. Talk to your healthcare provider about the best way to feed your baby during this time

          Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. AYVAKIT may affect the way other medicines work, and certain other medicines may affect how AYVAKIT works. Especially tell your healthcare provider if you take estrogen-containing hormonal birth control or medicines that prevent blood clots.

          Do not drive or operate hazardous machinery if you have confusion or trouble thinking during treatment with AYVAKIT.

          The most common side effects of AYVAKIT in people with ISM include: swelling around your eyes, dizziness, swelling of your arms and legs, and flushing.

          Your healthcare provider may change your dose, temporarily stop, or permanently stop treatment with AYVAKIT if you develop certain side effects. AYVAKIT may cause fertility problems in females and males. Talk to your healthcare provider if this is a concern for you.

          These are not all of the possible side effects of AYVAKIT. Call your doctor for medical advice about side effects. You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

          Please click here to see the full Prescribing Information and Patient Information for AYVAKIT.

          INDICATION & IMPORTANT SAFETY INFORMATION

          AYVAKIT® (avapritinib) may cause serious side effects, including:

          Cognitive effects. Cognitive side effects can happen during treatment with AYVAKIT and can be severe. Tell your healthcare provider if you develop any new or worsening cognitive symptoms including forgetfulness, confusion, getting lost, trouble thinking, drowsiness, trouble staying awake (somnolence),

          INDICATION & IMPORTANT SAFETY INFORMATION

          Warning: AYVAKIT® (avapritinib) may cause serious side effects, including cognitive effects, skin sensitivity to sunlight (photosensitivity), harm to your unborn baby.

          INDICATION & IMPORTANT SAFETY INFORMATION

          Warning: AYVAKIT® (avapritinib) may cause serious side effects, including cognitive effects, skin sensitivity to sunlight (photosensitivity), harm to your unborn baby.

          INDICATION

          WHAT IS AYVAKIT® (avapritinib)?

          AYVAKIT® (avapritinib) is a prescription medicine used to treat adults with indolent systemic mastocytosis (ISM). AYVAKIT is not recommended in people with low platelet counts (less than 50 X 109/L). It is not known if AYVAKIT is safe and effective in children.

          IMPORTANT SAFETY INFORMATION

          AYVAKIT® (avapritinib) may cause serious side effects, including:

          Cognitive effects. Cognitive side effects can happen during treatment with AYVAKIT and can be severe. Tell your healthcare provider if you develop any new or worsening cognitive symptoms including forgetfulness, confusion, getting lost, trouble thinking, drowsiness, trouble staying awake (somnolence), word finding problems, seeing objects or hearing things that are not there (hallucinations), or a change in mood or behavior.

          Skin sensitivity to sunlight (photosensitivity). Your skin may be sensitive to the sun or other forms of light (photosensitivity) during treatment with AYVAKIT. Avoid or limit exposure to direct sunlight, sunlamps, and other sources of ultraviolet radiation during treatment and for 1 week after stopping treatment with AYVAKIT. Use sunscreen or wear clothes that cover your skin if you need to be out in the sun.

          Before taking AYVAKIT, tell your healthcare provider about all of your medical conditions, including if you:

          • history of bulging or weakening of a blood vessel wall (aneurysm) or bleeding in your brain
          • have a history of stroke within the last year
          • have low platelet counts
          • have or have had liver problems
          • are pregnant or plan to become pregnant. AYVAKIT can cause harm to your unborn baby
          • Females who are able to become pregnant: Your healthcare provider should do a pregnancy test before you start AYVAKIT. You should use effective birth control (contraception) during treatment with AYVAKIT and for 6 weeks after the final dose of AYVAKIT. Talk to your healthcare provider about birth control methods that may be right for you. Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with AYVAKIT.
          • Males with female partners who are able to become pregnant should use effective birth control (contraception) during treatment and for 6 weeks after the final dose of AYVAKIT.
          • are breastfeeding or plan to breastfeed. It is not known if AYVAKIT passes into your breast milk. Do not breastfeed during treatment with AYVAKIT and for at least 2 weeks after the final dose of AYVAKIT. Talk to your healthcare provider about the best way to feed your baby during this time

          Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. AYVAKIT may affect the way other medicines work, and certain other medicines may affect how AYVAKIT works. Especially tell your healthcare provider if you take estrogen-containing hormonal birth control or medicines that prevent blood clots.

          Do not drive or operate hazardous machinery if you have confusion or trouble thinking during treatment with AYVAKIT.

          The most common side effects of AYVAKIT in people with ISM include: swelling around your eyes, dizziness, swelling of your arms and legs, and flushing.

          Your healthcare provider may change your dose, temporarily stop, or permanently stop treatment with AYVAKIT if you develop certain side effects. AYVAKIT may cause fertility problems in females and males. Talk to your healthcare provider if this is a concern for you.

          These are not all of the possible side effects of AYVAKIT. Call your doctor for medical advice about side effects. You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

          Please click here to see the full Prescribing Information and Patient Information for AYVAKIT.