INDICATIONS
Indications
  • KYPROLIS® (carfilzomib) is indicated in combination with dexamethasone, or with lenalidomide plus dexamethasone, or with daratumumab plus dexamethasone, or with daratumumab plus hyaluronidase-fihj plus dexamethasone, or with isatuximab plus dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy.Read More
  • KYPROLIS® is indicated as a single agent for the treatment of patients with relapsed or refractory multiple myeloma who have received one or more lines of therapy.Close
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KYPROLIS® (carfilzomibz) for injection logo
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KRd:

KYPROLIS® + lenalidomide + dexamethasone

Furthering efficacy to help patients achieve a longer-lasting remission

KRd vs Rd study design (ASPIRE): Randomized, open-label, multicenter, phase 3 study in relapsed or refractory multiple myeloma patients who had received 1 to 3 prior lines of therapy. 792 patients were randomized 1:1 to receive KRd (n=396) or Rd (n=396). Per protocol, patients received up to 18 cycles of KYPROLIS® 27 mg/m2 twice-weekly with Rd, unless discontinued for toxicity or disease progression, and then continued treatment with Rd alone to progression or unacceptable toxicity. The primary endpoint was PFS. Select secondary endpoints included OS and ORR.1

Adding KYPROLIS® to Rd significantly prolonged PFS and OS1,2

KRd vs Rd: progression-free survival graph
+7.9 month improvement in median overall survival

48.3 months with KRd (n=396) vs 40.4 months with Rd (n=396)

(HR=0.79; 95% CI: 0.67-0.95; P=0.0091, two-sided)3

Adding KYPROLIS® to Rd delivered deeper responses3

Higher ORR: Nearly 9 out of every 10 patients treated with KRd achieved a response.3

OS: 48.3 months with KRd (n=396) vs 40.4 months with Rd (n=396) (HR=0.79; 95% CI: 0.67-0.95; P=0.0091, two-sided)3

KRd = carfilzomib + lenalidomide + dexamethasone; Rd = lenalidomide = dexamethasone; Kd = carfilzomib + dexamethasone; PFS = progression-free survival; OS = overall survival; HR = hazard ratio; CI = confidence interval; VGPR = very good partial response; CR = complete response; ORR = overall response rate.

KRd Patient Profile*

Meet Allen, a standard risk patient with multiple myeloma at first relapse

*Hypothetical patient profile.

Study Design

KRd vs Rd in RRMM (ASPIRE)1

KRd vs Rd in RRMM ASPIRE study design

Randomized, open-label, multicenter, phase 3 study in relapsed or refractory multiple myeloma patients who had received 1 to 3 prior lines of therapy. 792 patients were randomized 1:1 to receive KRd (n=396) or Rd (n=396). Per protocol, patients received up to 18 cycles of KYPROLIS® with Rd, unless discontinued for toxicity or disease progression, and then continued treatment with Rd alone to progression or unacceptable toxicity. The primary endpoint was PFS. Select secondary endpoints included OS and ORR.1

Study schema1,2

Key eligibility criteria (N = 792):

  • Adults with relapsed or refractory MM
  • 1 to 3 prior treatments
  • At least MR to ≥ 1 prior regimen
  • Adequate hepatic, hematologic, and renal function

Key exclusion criteria:

  • PD while on prior bortezomib†
  • Grade 3 or 4 peripheral neuropathy (or Grade 2 with pain) ≤ 14 days prior to randomization
  • NYHA Class III or IV heart failure‡
  • If previously treated with Rd:
    • PD during the first 3 months of any Tx
    • PD at any time if Rd was most recent Tx
  • Lenalidomide or dexamethasone intolerant

*Stratified by serum β2-microglobulin (< 2.5 vs ≥ 2.5 mg/L), prior bortezomib (yes vs no), and prior lenalidomide (yes vs no).

†If a patient progressed during any bortezomib-containing regimen, he/she was eligible to enroll if the progression date occurred after discontinuation of bortezomib.

‡NYHA classification of heart failure III is defined as: Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea (shortness of breath). IV is defined as: Unable to carry out any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

KRd = carfilzomib + lenalidomide + dexamethasone; Rd = lenalidomide + dexamethasone; R = randomization; mg/m2 = milligrams per meter squared body surface area; BIW = twice a week; mg = milligram; PFS = progression-free survival; ORR = overall response rate; VGPR = very good partial response; MRD = minimal residual disease; CR = complete response; OS = overall survival; MM = multiple myeloma; NYHA = New York Heart Association; MR = median response; PD = progressive disease; Tx = treatment.

Patient demographics and baseline characteristics1,3
Baseline disease characteristics and prior treatments were balanced between study arms
Characteristics KRd (n=396) Rd (n=396)
Median age, years (range) 64 (38-87) 65 (31-91)
0 165 (42) 175 (44)
ECOG PS, n (%) 1 191 (48) 186 (47)
2 40 (10) 35 (9)
I 167 (42) 154 (39)
ISS stage at study entry, n (%) II 148 (37) 153 (39)
III 73 (18) 82 (21)
High-risk cytogenetics 48 (12) 52 (13)
Cytogenetics,* n (%) Standard-risk cytogenetics 147 (37) 170 (43)
Unknown 201 (51) 174 (44)
Median, mL/min (range) 79 (39-212) 79 (30-208)
Creatinine clearance 30 to < 50 mL/min, n (%) 19 (5) 32 (8)
50 to < 80 mL/min, n (%) 185 (47) 170 (43)
Transplant 217 (55) 229 (58)
Bortezomib, Refractory at any time to bortezomib 261 (66), 60 (15) 260 (66), 58 (15)
Prior therapies, n (%) Lenalidomide, Refractory at any time to lenalidomide 79 (20), 29 (7) 78 (20), 28 (7)
Any IMiD, Refractory to any IMiD in any prior regimen 233 (59), 85 (22) 229 (58), 88 (22)
Bortezomib and IMiD, Refractory at any time to bortezomib and IMiD 146 (37), 24 (6) 139 (35), 27 (7)
Refractory to last therapy 110 (28) 119 (30)
Number of prior regimens, median (range) 2 (1-3)† 2 (1-3)†
Characteristics KRd (n=396) Rd (n=396)
Median age, years (range) 64 (38-87) 65 (31-91)
ECOG PS, n (%)
0 165 (42) 175 (44)
1 191 (48) 186 (47)
2 40 (10) 35 (9)
ISS stage at study entry, n (%)
I 167 (42) 154 (39)
II 148 (37) 153 (39)
III 73 (18) 82 (21)
Cytogenetics,* n (%)
High-risk cytogenetics 48 (12) 52 (13)
Standard-risk cytogenetics 147 (37) 170 (43)
Unknown 201 (51) 174 (44)
Creatinine clearance
Median, mL/min (range) 79 (39-212) 79 (30-208)
30 to < 50 mL/min, n (%) 19 (5) 32 (8)
50 to < 80 mL/min, n (%) 185 (47) 170 (43)
Prior therapies, n (%)
Transplant 217 (55) 229 (58)
Bortezomib, Refractory at any time to bortezomib 261 (66), 60 (15) 260 (66), 58 (15)
Lenalidomide, Refractory at any time to lenalidomide 79 (20), 29 (7) 78 (20), 28 (7)
Any IMiD, Refractory to any IMiD in any prior regimen 233 (59), 85 (22) 229 (58), 88 (22)
Bortezomib and IMiD, Refractory at any time to bortezomib and IMiD 146 (37), 24 (6) 139 (35), 27 (7)
Refractory to last therapy 110 (28) 119 (30)
Number of prior regimens, median (range) 2 (1-3)† 2 (1-3)†

*The high-risk group consisted of patients with the genetic subtypes t(4;14), t(14;16) or deletion 17p in ≥ 60% of plasma cells based on central review of bone marrow samples obtained at study entry; the standard-risk group consisted of patients without t(4;14), t(14;16) and < 60% of plasma cells with deletion 17p.1

†One patient in each group received four previous regimens.1

ISS = International Staging System; IMiD = immunomodulatory agent.

SafetySafety

Safety

Learn more about KRd safety information
Infusion bag and syringeInfusion bag and syringe

Dosing

With KRd KYPROLIS® is dosed 2x weekly3

KRd = carfilzomib + lenalidomide + dexamethasone.

EXPAND

IMPORTANT SAFETY INFORMATION FOR KYPROLIS®

Cardiac Toxicities

  • New onset or worsening of pre-existing cardiac failure (e.g., congestive heart failure, pulmonary edema, decreased ejection fraction), cardiomyopathy, myocardial ischemia, and myocardial infarction including fatalities have occurred following administration of KYPROLIS®. Some events occurred in patients with normal baseline ventricular function. Death due to cardiac arrest has occurred within one day of administration.
  • Monitor patients for signs or symptoms of cardiac failure or ischemia. Evaluate promptly if cardiac toxicity is suspected. Withhold KYPROLIS® for Grade 3 or 4 cardiac adverse reactions until recovery, and consider whether to restart at 1 dose level reduction based on a benefit/risk assessment.
  • While adequate hydration is required prior to each dose in Cycle 1, monitor all patients for evidence of volume overload, especially patients at risk for cardiac failure. Adjust total fluid intake as clinically appropriate.
  • For patients ≥ 75 years, the risk of cardiac failure is increased. Patients with New York Heart Association Class III and IV heart failure, recent myocardial infarction, conduction abnormalities, angina, or arrhythmias may be at greater risk for cardiac complications and should have a comprehensive medical assessment prior to starting treatment with KYPROLIS® and remain under close follow-up with fluid management.

Acute Renal Failure

  • Cases of acute renal failure, including some fatal renal failure events, and renal insufficiency (including renal failure) have occurred. Acute renal failure was reported more frequently in patients with advanced relapsed and refractory multiple myeloma who received KYPROLIS® monotherapy. Monitor renal function with regular measurement of the serum creatinine and/or estimated creatinine clearance. Reduce or withhold dose as appropriate.

Tumor Lysis Syndrome

  • Cases of Tumor Lysis Syndrome (TLS), including fatal outcomes, have occurred. Patients with a high tumor burden should be considered at greater risk for TLS. Adequate hydration is required prior to each dose in Cycle 1, and in subsequent cycles as needed. Consider uric acid lowering drugs in patients at risk for TLS. Monitor for evidence of TLS during treatment and manage promptly, and withhold until resolved.

Pulmonary Toxicity

  • Acute Respiratory Distress Syndrome (ARDS), acute respiratory failure, and acute diffuse infiltrative pulmonary disease such as pneumonitis and interstitial lung disease have occurred. Some events have been fatal. In the event of drug-induced pulmonary toxicity, discontinue KYPROLIS®.

Pulmonary Hypertension

  • Pulmonary arterial hypertension (PAH) was reported. Evaluate with cardiac imaging and/or other tests as indicated. Withhold KYPROLIS® for PAH until resolved or returned to baseline and consider whether to restart based on a benefit/risk assessment.

Dyspnea

  • Dyspnea was reported in patients treated with KYPROLIS®. Evaluate dyspnea to exclude cardiopulmonary conditions including cardiac failure and pulmonary syndromes. Stop KYPROLIS® for Grade 3 or 4 dyspnea until resolved or returned to baseline. Consider whether to restart based on a benefit/risk assessment.

Hypertension

  • Hypertension, including hypertensive crisis and hypertensive emergency, has been observed, some fatal. Control hypertension prior to starting KYPROLIS®. Monitor blood pressure regularly in all patients. If hypertension cannot be adequately controlled, withhold KYPROLIS® and evaluate. Consider whether to restart based on a benefit/risk assessment.

Venous Thrombosis

  • Venous thromboembolic events (including deep venous thrombosis and pulmonary embolism) have been observed. Provide thromboprophylaxis for patients being treated with the combination of KYPROLIS® with dexamethasone or with lenalidomide plus dexamethasone or with daratumumab and dexamethasone. The thromboprophylaxis regimen should be based on an assessment of the patient’s underlying risks.
  • For patients using hormonal contraception associated with a risk of thrombosis, consider an alternative method of effective contraception during treatment.

Infusion-Related Reactions

  • Infusion-related reactions, including life-threatening reactions, have occurred. Signs and symptoms include fever, chills, arthralgia, myalgia, facial flushing, facial edema, laryngeal edema, vomiting, weakness, shortness of breath, hypotension, syncope, chest tightness, or angina. These reactions can occur immediately following or up to 24 hours after administration. Premedicate with dexamethasone to reduce the incidence and severity of infusion-related reactions.

Hemorrhage

  • Fatal or serious cases of hemorrhage have been reported. Hemorrhagic events have included gastrointestinal, pulmonary, and intracranial hemorrhage and epistaxis. Promptly evaluate signs and symptoms of blood loss. Reduce or withhold dose as appropriate.

Thrombocytopenia

  • KYPROLIS® causes thrombocytopenia with recovery to baseline platelet count usually by the start of the next cycle. Monitor platelet counts frequently during treatment. Reduce or withhold dose as appropriate.

Hepatic Toxicity and Hepatic Failure

  • Cases of hepatic failure, including fatal cases, have occurred. KYPROLIS® can cause increased serum transaminases. Monitor liver enzymes regularly regardless of baseline values. Reduce or withhold dose as appropriate.

Thrombotic Microangiopathy

  • Cases of thrombotic microangiopathy, including thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), including fatal outcome, have occurred. Monitor for signs and symptoms of TTP/HUS. Discontinue if diagnosis is suspected. If the diagnosis of TTP/HUS is excluded, KYPROLIS® may be restarted. The safety of reinitiating KYPROLIS® is not known.

Posterior Reversible Encephalopathy Syndrome (PRES)

  • Cases of PRES have occurred in patients receiving KYPROLIS®. If PRES is suspected, discontinue and evaluate with appropriate imaging. The safety of reinitiating KYPROLIS® is not known.

Progressive Multifocal Leukoencephalopathy (PML)

  • Cases of PML, including fatal cases, have occurred. In addition to KYPROLIS®, other contributary factors may include prior or concurrent use of immunosuppressive therapy. Consider PML in any patient with new onset of or changes in pre-existing neurological signs or symptoms. If PML is suspected, discontinue and initiate evaluation for PML including neurology consultation.

Increased Fatal and Serious Toxicities in Combination with Melphalan and Prednisone in Newly Diagnosed Transplant-ineligible Patients

  • In a clinical trial of transplant-ineligible patients with newly diagnosed multiple myeloma comparing KYPROLIS®, melphalan, and prednisone (KMP) vs bortezomib, melphalan, and prednisone (VMP), a higher incidence of serious and fatal adverse reactions was observed in patients in the KMP arm. KMP is not indicated for transplant-ineligible patients with newly diagnosed multiple myeloma.

Embryo-fetal Toxicity

  • KYPROLIS® can cause fetal harm when administered to a pregnant woman.
  • Advise pregnant women of the potential risk to a fetus. Females of reproductive potential should use effective contraception during treatment with KYPROLIS® and for 6 months following the final dose. Males of reproductive potential should use effective contraception during treatment with KYPROLIS® and for 3 months following the final dose.

Adverse Reactions

  • The most common adverse reactions occurring in at least 20% of patients taking KYPROLIS® in the combination therapy trials: anemia, diarrhea, hypertension, fatigue, upper respiratory tract infection, thrombocytopenia, pyrexia, cough, dyspnea, and insomnia.
  • The most common adverse reactions occurring in at least 20% of patients taking KYPROLIS® in monotherapy trials: anemia, fatigue, thrombocytopenia, nausea, pyrexia, dyspnea, diarrhea, headache, cough, edema peripheral.

Please see accompanying full Prescribing Information.

INDICATIONS

  • KYPROLIS® (carfilzomib) is indicated in combination with dexamethasone, or with lenalidomide plus dexamethasone, or with daratumumab plus dexamethasone, or with daratumumab plus hyaluronidase-fihj plus dexamethasone, or with isatuximab plus dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy.
  • KYPROLIS® is indicated as a single agent for the treatment of patients with relapsed or refractory multiple myeloma who have received one or more lines of therapy.

IMPORTANT SAFETY INFORMATION FOR KYPROLIS®

Cardiac Toxicities

  • New onset or worsening of pre-existing cardiac failure (e.g., congestive heart failure, pulmonary edema, decreased ejection fraction), cardiomyopathy, myocardial ischemia, and myocardial infarction including fatalities have occurred following administration of KYPROLIS®. Some events occurred in patients with normal baseline ventricular function. Death due to cardiac arrest has occurred within one day of administration.
  • Monitor patients for signs or symptoms of cardiac failure or ischemia. Evaluate promptly if cardiac toxicity is suspected. Withhold KYPROLIS® for Grade 3 or 4 cardiac adverse reactions until recovery, and consider whether to restart at 1 dose level reduction based on a benefit/risk assessment.
  • While adequate hydration is required prior to each dose in Cycle 1, monitor all patients for evidence of volume overload, especially patients at risk for cardiac failure. Adjust total fluid intake as clinically appropriate.
  • For patients ≥ 75 years, the risk of cardiac failure is increased. Patients with New York Heart Association Class III and IV heart failure, recent myocardial infarction, conduction abnormalities, angina, or arrhythmias may be at greater risk for cardiac complications and should have a comprehensive medical assessment prior to starting treatment with KYPROLIS® and remain under close follow-up with fluid management.

Acute Renal Failure

  • Cases of acute renal failure, including some fatal renal failure events, and renal insufficiency (including renal failure) have occurred. Acute renal failure was reported more frequently in patients with advanced relapsed and refractory multiple myeloma who received KYPROLIS® monotherapy. Monitor renal function with regular measurement of the serum creatinine and/or estimated creatinine clearance. Reduce or withhold dose as appropriate.

Tumor Lysis Syndrome

  • Cases of Tumor Lysis Syndrome (TLS), including fatal outcomes, have occurred. Patients with a high tumor burden should be considered at greater risk for TLS. Adequate hydration is required prior to each dose in Cycle 1, and in subsequent cycles as needed. Consider uric acid lowering drugs in patients at risk for TLS. Monitor for evidence of TLS during treatment and manage promptly, and withhold until resolved.

Pulmonary Toxicity

  • Acute Respiratory Distress Syndrome (ARDS), acute respiratory failure, and acute diffuse infiltrative pulmonary disease such as pneumonitis and interstitial lung disease have occurred. Some events have been fatal. In the event of drug-induced pulmonary toxicity, discontinue KYPROLIS®.

Pulmonary Hypertension

  • Pulmonary arterial hypertension (PAH) was reported. Evaluate with cardiac imaging and/or other tests as indicated. Withhold KYPROLIS® for PAH until resolved or returned to baseline and consider whether to restart based on a benefit/risk assessment.

Dyspnea

  • Dyspnea was reported in patients treated with KYPROLIS®. Evaluate dyspnea to exclude cardiopulmonary conditions including cardiac failure and pulmonary syndromes. Stop KYPROLIS® for Grade 3 or 4 dyspnea until resolved or returned to baseline. Consider whether to restart based on a benefit/risk assessment.

Hypertension

  • Hypertension, including hypertensive crisis and hypertensive emergency, has been observed, some fatal. Control hypertension prior to starting KYPROLIS®. Monitor blood pressure regularly in all patients. If hypertension cannot be adequately controlled, withhold KYPROLIS® and evaluate. Consider whether to restart based on a benefit/risk assessment.

Venous Thrombosis

  • Venous thromboembolic events (including deep venous thrombosis and pulmonary embolism) have been observed. Provide thromboprophylaxis for patients being treated with the combination of KYPROLIS® with dexamethasone or with lenalidomide plus dexamethasone or with daratumumab and dexamethasone. The thromboprophylaxis regimen should be based on an assessment of the patient’s underlying risks.
  • For patients using hormonal contraception associated with a risk of thrombosis, consider an alternative method of effective contraception during treatment.

Infusion-Related Reactions

  • Infusion-related reactions, including life-threatening reactions, have occurred. Signs and symptoms include fever, chills, arthralgia, myalgia, facial flushing, facial edema, laryngeal edema, vomiting, weakness, shortness of breath, hypotension, syncope, chest tightness, or angina. These reactions can occur immediately following or up to 24 hours after administration. Premedicate with dexamethasone to reduce the incidence and severity of infusion-related reactions.

Hemorrhage

  • Fatal or serious cases of hemorrhage have been reported. Hemorrhagic events have included gastrointestinal, pulmonary, and intracranial hemorrhage and epistaxis. Promptly evaluate signs and symptoms of blood loss. Reduce or withhold dose as appropriate.

Thrombocytopenia

  • KYPROLIS® causes thrombocytopenia with recovery to baseline platelet count usually by the start of the next cycle. Monitor platelet counts frequently during treatment. Reduce or withhold dose as appropriate.

Hepatic Toxicity and Hepatic Failure

  • Cases of hepatic failure, including fatal cases, have occurred. KYPROLIS® can cause increased serum transaminases. Monitor liver enzymes regularly regardless of baseline values. Reduce or withhold dose as appropriate.

Thrombotic Microangiopathy

  • Cases of thrombotic microangiopathy, including thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), including fatal outcome, have occurred. Monitor for signs and symptoms of TTP/HUS. Discontinue if diagnosis is suspected. If the diagnosis of TTP/HUS is excluded, KYPROLIS® may be restarted. The safety of reinitiating KYPROLIS® is not known.

Posterior Reversible Encephalopathy Syndrome (PRES)

  • Cases of PRES have occurred in patients receiving KYPROLIS®. If PRES is suspected, discontinue and evaluate with appropriate imaging. The safety of reinitiating KYPROLIS® is not known.

Progressive Multifocal Leukoencephalopathy (PML)

  • Cases of PML, including fatal cases, have occurred. In addition to KYPROLIS®, other contributary factors may include prior or concurrent use of immunosuppressive therapy. Consider PML in any patient with new onset of or changes in pre-existing neurological signs or symptoms. If PML is suspected, discontinue and initiate evaluation for PML including neurology consultation.

Increased Fatal and Serious Toxicities in Combination with Melphalan and Prednisone in Newly Diagnosed Transplant-ineligible Patients

  • In a clinical trial of transplant-ineligible patients with newly diagnosed multiple myeloma comparing KYPROLIS®, melphalan, and prednisone (KMP) vs bortezomib, melphalan, and prednisone (VMP), a higher incidence of serious and fatal adverse reactions was observed in patients in the KMP arm. KMP is not indicated for transplant-ineligible patients with newly diagnosed multiple myeloma.

Embryo-fetal Toxicity

  • KYPROLIS® can cause fetal harm when administered to a pregnant woman.
  • Advise pregnant women of the potential risk to a fetus. Females of reproductive potential should use effective contraception during treatment with KYPROLIS® and for 6 months following the final dose. Males of reproductive potential should use effective contraception during treatment with KYPROLIS® and for 3 months following the final dose.

Adverse Reactions

  • The most common adverse reactions occurring in at least 20% of patients taking KYPROLIS® in the combination therapy trials: anemia, diarrhea, hypertension, fatigue, upper respiratory tract infection, thrombocytopenia, pyrexia, cough, dyspnea, and insomnia.
  • The most common adverse reactions occurring in at least 20% of patients taking KYPROLIS® in monotherapy trials: anemia, fatigue, thrombocytopenia, nausea, pyrexia, dyspnea, diarrhea, headache, cough, edema peripheral.

Please see accompanying full Prescribing Information.

INDICATIONS

  • KYPROLIS® (carfilzomib) is indicated in combination with dexamethasone, or with lenalidomide plus dexamethasone, or with daratumumab plus dexamethasone, or with daratumumab plus hyaluronidase-fihj plus dexamethasone, or with isatuximab plus dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy.
  • KYPROLIS® is indicated as a single agent for the treatment of patients with relapsed or refractory multiple myeloma who have received one or more lines of therapy.
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References: 1. Stewart AK, Rajkumar SV, Dimopoulos MA, et al. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med. 2015;372(2):142-152. 2. Siegel DS, Dimopoulos MA, Ludwig H, et al. Improvement in overall survival with carfilzomib, lenalidomide, and dexamethasone in patients with relapsed or refractory multiple myeloma. J Clin Oncol. 2018;36(8):728-734. 3. KYPROLIS® (carfilzomib) prescribing information, Onyx Pharmaceuticals Inc., an Amgen Inc. subsidiary.