Fenofibrate Role in the Prophylaxis From Peripheral Neuropathy Induced by Bortezomib, Lenalidomide and Dexamethasone (VRd) Protocol in the Treatment of Patients With Multiple Myeloma (MM)

Exclusion Criteria

• •Patients with prior exposure to neurotoxic agents (Cis-platin, vincristine, taxanes, foscarnet, INH, etc..) in the last 6 months.
• •Concomitant use of antioxidant vitamins (vitamin A, C, E), anticonvulsants, tricyclic antidepressants, other medications used for neuropathic pain (gabapentin, lamotrigine, carbamazepine).
• •Preexisting peripheral neuropathy resulting from other causes such as diabetes and brain disorders, hypothyroidism, autoimmune diseases, hepatitis C.
• •Patients with inflammatory diseases (ulcerative colitis, rheumatoid arthritis).
• •Patients with conditions associated with oxidative stress (smoking, tuberculosis, comorbid obesity).
• •Patients with active liver disease (cirrhosis, fatty liver, hepatitis C, etc..).
• •Patients with myopathy.
• •Patients with other malignancies.
• •Patients with renal impairment, including those with end-stage renal disease and those receiving dialysis.
• •Patients with Gallbladder disease and gallstones.
• •Pregnant and breast-feeding women.
• •Patients with Known allergy to the fenofibrates.
• •Concurrent use of statin, colchicine, Ciprofibrate, idelalisib, enzyme inducers (phenytoin, phenobarbitone, carbamazepine,…), enzyme inhibitors (ketoconazole, clarithromycin,…), drugs with high plasma protein binding capacity (Sulfonamides, valproate, oral hypoglycemic, warfarin,…) to avoid potential pharmacodynamics and pharmacokinetic drug interactions.