Why Check CMP Before Kesimpta (Ofatumumab)
A complete metabolic panel (CMP) should be obtained before starting Kesimpta (ofatumumab) to assess baseline renal and hepatic function, identify any preexisting abnormalities, and ensure safe administration of the medication.
Rationale for CMP Testing Before Kesimpta
Baseline Assessment
- A CMP provides critical baseline information about:
- Renal function (BUN, creatinine)
- Hepatic function (ALT, AST, bilirubin)
- Electrolyte balance (sodium, potassium, chloride, bicarbonate)
- Glucose levels
- Protein levels
Safety Considerations
- Baseline laboratory values are essential before initiating therapeutic agents that may have:
- Nephrotoxic effects
- Hepatotoxic effects
- Effects requiring dosage adjustment in patients with renal or hepatic dysfunction 1
Monitoring for Potential Complications
- Abnormal baseline values may indicate:
- Preexisting liver injury
- Renal insufficiency
- Metabolic abnormalities that could affect treatment safety
- Elevated total protein that might suggest monoclonal gammopathies 2
Specific Parameters to Monitor
Hepatic Function
- Liver enzymes (ALT, AST)
- Total bilirubin
- Albumin and total protein
- Alkaline phosphatase
Renal Function
- BUN (blood urea nitrogen)
- Creatinine
- Estimated glomerular filtration rate (eGFR)
Metabolic Status
- Glucose levels
- Electrolytes (sodium, potassium, chloride, bicarbonate)
- Calcium levels
Clinical Implications of Abnormal Results
Elevated Liver Enzymes
- May indicate underlying liver disease
- Could affect medication metabolism
- May require dose adjustment or alternative treatment
Abnormal Renal Function
- May affect drug clearance
- Could increase risk of adverse effects
- May necessitate dose adjustment
Elevated Total Protein
- Could indicate underlying monoclonal gammopathies
- May require further investigation with serum protein electrophoresis 2
Follow-up Testing
If abnormalities are detected on the initial CMP:
- Repeat testing may be required to confirm findings
- Additional specialized testing may be necessary based on specific abnormalities
- Consultation with specialists (nephrology, hepatology) may be warranted for significant abnormalities
Common Pitfalls to Avoid
Failure to obtain baseline values: Without baseline values, it becomes difficult to determine if abnormalities during treatment are new or preexisting.
Ignoring borderline abnormalities: Even mild abnormalities may become significant during treatment.
Not considering drug interactions: Other medications may affect CMP parameters and should be considered in the interpretation.
Overlooking the need for follow-up testing: Abnormal results should prompt appropriate follow-up rather than immediate treatment discontinuation.
By obtaining a CMP before starting Kesimpta, clinicians can establish baseline values, identify potential contraindications, and develop appropriate monitoring strategies to optimize treatment safety and efficacy.