Carfilzomib side effects: what 28,114 FDA adverse event reports show
Drug class
Proteasome Inhibitor
Brand names
Kyprolis
Who reports
28,114 reports · 77% serious · 4,377 with death outcome · 45% female
Used for
Kyprolis is a proteasome inhibitor that is indicated: for the treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy in combination with Lenalidomide and dexamethasone; or Dexamethasone; or Daratumumab and dexamethasone; or Daratumumab and hyaluronidase-fihj and dexamethasone; or Isatuximab and dexamethasone.
What it is
Carfilzomib is a proteasome inhibitor.
Boxed warning
None in the current label
Causality screen of the 40 strongest signals
What the badges mean
- Labeled adverse reaction The exact term appears in the label's warnings or adverse-reactions sections: a known, expected effect. The FAERS signal confirms the label rather than discovering anything.
- Labeled (related wording) The label describes this effect under different wording (e.g. 'neutropenia' for 'neutrophil count decreased'). Treated as known.
- Likely indication confounding The term appears in the label's indications: reports probably describe the disease being treated (or its progression), not a drug effect. Classic confounding by indication.
- Reporting / coding artifact An administrative, monitoring or exposure term (product issue, off-label use, 'test normal', overdose...). Not a biological reaction; a high PRR here reflects how reports are coded.
- Lab value / disease marker A laboratory result, investigation or disease-activity marker (antibody positive, CRP abnormal, swollen joint count) not described in the label. These usually mirror the monitored disease or testing protocol rather than a drug effect; not screened further.
- Not in label — unassessed Not found in the label text, not an artifact pattern. This is a genuine candidate for a formal causality assessment (Bradford Hill / WHO-UMC); it has NOT had one here.
Strongest disproportionality signals
Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 1,036 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Sars-cov-2 sepsis | 15 | 524.9 270.6–1,018.2ROR 525.2 · χ² 4,275 / p <1e-300 | 220.7 EB05 142.0 · IC025 +3.9 3/3 methods agree | Not in label — unassessed | serious n=15 | not reported in cached trials |
| Plasma cell myeloma refractory | 459 | 411.4 367.2–460.9ROR 418.2 · χ² 120,215 / p <1e-300 | 261.2 EB05 241.8 · IC025 +7.5 3/3 methods agree | Labeled (related wording) related wording | serious n=459 · 96% clinician | not reported in cached trials |
| Global longitudinal strain abnormal | 14 | 294.0 158.2–546.3ROR 294.1 · χ² 2,714 / p <1e-300 | 163.7 EB05 103.7 · IC025 +3.8 3/3 methods agree | Not in label — unassessed | – | not reported in cached trials |
| Plasma cell leukaemia | 119 | 185.3 151.6–226.5ROR 186.1 · χ² 17,273 / p <1e-300 | 144.8 EB05 124.2 · IC025 +6.2 3/3 methods agree | Not in label — unassessed | serious n=119 · 94% clinician | not reported in cached trials |
| Plasma cells increased | 14 | 177.4 99.0–318.0ROR 177.5 · χ² 1,838 / p <1e-300 | 120.1 EB05 76.0 · IC025 +3.7 3/3 methods agree | Lab value / disease marker | serious n=14 | not reported in cached trials |
| Myeloma cast nephropathy | 23 | 142.0 90.9–221.9ROR 142.2 · χ² 2,582 / p <1e-300 | 108.7 EB05 76.3 · IC025 +4.4 3/3 methods agree | Likely indication confounding shares a disease stem with the indications wording | serious n=23 · 91% clinician | not reported in cached trials |
| Light chain disease | 23 | 138.6 88.8–216.3ROR 138.7 · χ² 2,528 / p <1e-300 | 106.6 EB05 74.8 · IC025 +4.4 3/3 methods agree | Not in label — unassessed | serious n=23 · ♀ 0% (drug 45%) | not reported in cached trials |
| Plasmacytoma | 188 | 82.9 71.4–96.4ROR 83.5 · χ² 13,602 / p <1e-300 | 74.1 EB05 65.6 · IC025 +5.7 3/3 methods agree | Not in label — unassessed | serious n=180 | NCT01568866: 5/463 (1.1%) on Carfilzomib (serious AE) |
| Plasma cell myeloma recurrent | 322 | 81.5 72.6–91.3ROR 82.4 · χ² 22,968 / p <1e-300 | 73.1 EB05 66.7 · IC025 +5.9 3/3 methods agree | Likely indication confounding shares a disease stem with the indications wording | serious n=305 | not reported in cached trials |
| Refractory cancer | 18 | 67.5 41.7–109.4ROR 67.5 · χ² 1,020 / p 4e-224 | 58.3 EB05 39.0 · IC025 +3.8 3/3 methods agree | Likely indication confounding shares a disease stem with the indications wording | serious n=18 | not reported in cached trials |
| Light chain analysis increased | 84 | 66.5 53.2–83.1ROR 66.6 · χ² 4,906 / p <1e-300 | 60.2 EB05 50.2 · IC025 +5.1 3/3 methods agree | Not in label — unassessed | serious n=46 | not reported in cached trials |
| Plasma cell myeloma | 3,028 | 62.6 60.4–64.8ROR 70.0 · χ² 169,373 / p <1e-300 | 57.7 EB05 56.0 · IC025 +5.8 3/3 methods agree | Likely indication confounding shares a disease stem with the indications wording | serious PRR 45.1 · 94% clinician | NCT01818752: 2/470 (0.4%) on Carfilzomib (serious AE) |
| Pulmonary interstitial emphysema syndrome | 10 | 56.1 29.5–106.7ROR 56.1 · χ² 453 / p 9e-101 | 47.8 EB05 27.7 · IC025 +2.8 3/3 methods agree | Labeled (related wording) related wording | serious n=10 | not reported in cached trials |
| Pneumonia parainfluenzae viral | 12 | 55.8 31.0–100.4ROR 55.8 · χ² 550 / p 5e-122 | 48.2 EB05 29.4 · IC025 +3.1 3/3 methods agree | Labeled (related wording) related wording | serious n=12 | not reported in cached trials |
| Blood stem cell harvest failure | 10 | 53.6 28.2–101.9ROR 53.7 · χ² 434 / p 1e-96 | 46.0 EB05 26.7 · IC025 +2.8 3/3 methods agree | Not in label — unassessed | serious n=9 | not reported in cached trials |
| Atypical haemolytic uraemic syndrome | 53 | 52.4 39.7–69.3ROR 52.5 · χ² 2,448 / p <1e-300 | 48.2 EB05 38.3 · IC025 +4.6 3/3 methods agree | Labeled (related wording) related wording | serious n=53 · 96% clinician | not reported in cached trials |
| Monoclonal immunoglobulin increased | 18 | 50.7 31.4–81.7ROR 50.7 · χ² 774 / p 1e-170 | 45.4 EB05 30.4 · IC025 +3.6 3/3 methods agree | Lab value / disease marker | serious n=15 | not reported in cached trials |
| Light chain analysis abnormal | 13 | 50.0 28.5–87.7ROR 50.0 · χ² 540 / p 1e-119 | 44.1 EB05 27.4 · IC025 +3.2 3/3 methods agree | Reporting / coding artifact | serious n=10 | not reported in cached trials |
| Paraproteinaemia | 18 | 45.5 28.2–73.2ROR 45.5 · χ² 696 / p 1e-153 | 41.1 EB05 27.5 · IC025 +3.5 3/3 methods agree | Not in label — unassessed | serious n=14 | not reported in cached trials |
| Microangiopathic haemolytic anaemia | 39 | 39.4 28.6–54.4ROR 39.5 · χ² 1,350 / p 8e-296 | 36.9 EB05 28.1 · IC025 +4.1 3/3 methods agree | Not in label — unassessed | serious n=39 · 100% clinician | not reported in cached trials |
| Minimal residual disease | 23 | 38.4 25.3–58.4ROR 38.4 · χ² 761 / p 7e-168 | 35.6 EB05 25.0 · IC025 +3.7 3/3 methods agree | Not in label — unassessed | serious n=21 · 100% clinician | not reported in cached trials |
| Hyperviscosity syndrome | 14 | 37.8 22.1–64.7ROR 37.8 · χ² 443 / p 1e-98 | 34.5 EB05 21.8 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious n=14 | not reported in cached trials |
| Morganella infection | 14 | 37.3 21.8–63.8ROR 37.3 · χ² 436 / p 3e-97 | 34.0 EB05 21.5 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious n=14 | not reported in cached trials |
| Bronchopneumopathy | 16 | 33.7 20.4–55.6ROR 33.7 · χ² 455 / p 4e-101 | 31.2 EB05 20.3 · IC025 +3.2 3/3 methods agree | Not in label — unassessed | serious n=16 | NCT01568866: 1/456 (0.2%) on Carfilzomib (serious AE) |
| Thrombotic microangiopathy | 415 | 33.4 30.2–36.8ROR 33.8 · χ² 12,432 / p <1e-300 | 31.9 EB05 29.4 · IC025 +4.8 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 23.8 · 98% clinician | NCT01568866: 2/463 (0.4%) on Carfilzomib (serious AE) |
| Monoclonal immunoglobulin present | 32 | 32.5 22.8–46.3ROR 32.6 · χ² 906 / p 2e-199 | 30.7 EB05 22.8 · IC025 +3.8 3/3 methods agree | Lab value / disease marker | serious n=12 | not reported in cached trials |
| Haemolytic uraemic syndrome | 96 | 31.8 25.9–39.0ROR 31.9 · χ² 2,715 / p <1e-300 | 30.4 EB05 25.6 · IC025 +4.4 3/3 methods agree | Labeled adverse reaction exact term | serious n=96 · 97% clinician | NCT01818752: 1/474 (0.2%) on Carfilzomib (serious AE) |
| Body dysmorphic disorder | 15 | 31.3 18.7–52.5ROR 31.3 · χ² 394 / p 7e-88 | 29.1 EB05 18.7 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious n=15 | not reported in cached trials |
| B-cell aplasia | 10 | 30.5 16.2–57.4ROR 30.5 · χ² 246 / p 8e-56 | 27.8 EB05 16.0 · IC025 +2.6 3/3 methods agree | Not in label — unassessed | serious n=10 | not reported in cached trials |
| Infestation | 10 | 29.8 15.8–56.0ROR 29.8 · χ² 240 / p 2e-54 | 27.2 EB05 15.6 · IC025 +2.6 3/3 methods agree | Labeled adverse reaction exact term | serious n=10 | not reported in cached trials |
| Febrile infection | 44 | 29.6 21.9–40.0ROR 29.6 · χ² 1,141 / p 2e-250 | 28.2 EB05 21.9 · IC025 +3.9 3/3 methods agree | Labeled (related wording) related wording | serious n=44 · ♀ 67% (drug 45%) · 98% clinician | NCT01568866: 2/463 (0.4%) on Carfilzomib (serious AE) |
| Therapy partial responder | 555 | 28.5 26.2–31.0ROR 29.1 · χ² 14,164 / p <1e-300 | 27.5 EB05 25.6 · IC025 +4.6 3/3 methods agree | Reporting / coding artifact | serious PRR 23.7 · 99% clinician | not reported in cached trials |
| Osteolysis | 73 | 27.5 21.8–34.7ROR 27.6 · χ² 1,771 / p <1e-300 | 26.4 EB05 21.7 · IC025 +4.1 3/3 methods agree | Not in label — unassessed | serious n=72 · 93% clinician | not reported in cached trials |
| Bronchial haemorrhage | 11 | 26.9 14.8–49.2ROR 27.0 · χ² 241 / p 1e-54 | 24.9 EB05 14.6 · IC025 +2.6 3/3 methods agree | Not in label — unassessed | serious n=11 | not reported in cached trials |
| Bone marrow infiltration | 13 | 26.0 14.9–45.1ROR 26.0 · χ² 278 / p 1e-62 | 24.2 EB05 14.9 · IC025 +2.8 3/3 methods agree | Not in label — unassessed | serious n=13 | not reported in cached trials |
| Cerebral toxoplasmosis | 30 | 24.7 17.2–35.5ROR 24.7 · χ² 637 / p 7e-141 | 23.6 EB05 17.3 · IC025 +3.5 3/3 methods agree | Not in label — unassessed | serious n=30 · 97% clinician | not reported in cached trials |
| B-cell type acute leukaemia | 23 | 24.6 16.3–37.3ROR 24.7 · χ² 482 / p 4e-107 | 23.5 EB05 16.4 · IC025 +3.3 3/3 methods agree | Not in label — unassessed | serious n=23 · 100% clinician | not reported in cached trials |
| Intercepted product preparation error | 367 | 23.1 20.9–25.7ROR 23.4 · χ² 7,522 / p <1e-300 | 22.4 EB05 20.6 · IC025 +4.3 3/3 methods agree | Not in label — unassessed | 94% clinician | not reported in cached trials |
| Tumour lysis syndrome | 242 | 21.2 18.7–24.1ROR 21.4 · χ² 4,515 / p <1e-300 | 20.6 EB05 18.5 · IC025 +4.1 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 15.5 · 97% clinician | NCT01818752: 3/474 (0.6%) on Carfilzomib (serious AE) |
| Pneumonia influenzal | 33 | 21.1 15.0–29.9ROR 21.2 · χ² 596 / p 6e-132 | 20.4 EB05 15.1 · IC025 +3.4 3/3 methods agree | Labeled adverse reaction exact term | serious n=33 · 100% clinician | NCT01568866: 1/463 (0.2%) on Carfilzomib (serious AE) |
Trial evidence (ClinicalTrials.gov)
✓ Trial adverse-event data found on ClinicalTrials.gov
Largest completed trials with posted results that list Carfilzomib as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (8 of 40 signal terms matched).
- NCT01818752 — Phase 3 Study of Carfilzomib, Melphalan, Prednisone vs Bortezomib, Melphalan, Prednisone in Newly Diagnosed Mu (N=955, PHASE3; 345 AE terms posted; arms: Bortezomib, Melphalan, Prednisone; Carfilzomib, Melphalan, Prednisone)
- NCT01568866 — Phase 3 Study With Carfilzomib and Dexamethasone Versus Bortezomib and Dexamethasone for Relapsed Multiple Mye (N=929, PHASE3; 379 AE terms posted; arms: Bortezomib; Carfilzomib)
Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.
Most frequently reported reactions
By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Plasma cell myeloma | 3,028 | 62.6 60.4–64.8ROR 70.0 · χ² 169,373 / p <1e-300 | 57.7 EB05 56.0 · IC025 +5.8 3/3 methods agree | Likely indication confounding shares a disease stem with the indications wording | serious PRR 45.1 · 94% clinician | NCT01818752: 2/470 (0.4%) on Carfilzomib (serious AE) |
| Off label use (used outside approved label) | 2,394 | 2.1 2.0–2.1ROR 2.2 · χ² 1,358 / p 2e-297 | 2.1 EB05 2.0 · IC025 +1.0 | Reporting / coding artifact | serious PRR 1.9 · 92% clinician | not reported in cached trials |
| Death | 1,763 | 1.5 1.5–1.6ROR 1.6 · χ² 334 / p 7e-75 | 1.5 EB05 1.5 · IC025 +0.5 | Outcome field, not a reaction | serious PRR 1.1 · 91% clinician | NCT01818752: 1/470 (0.2%) on Carfilzomib (serious AE) |
| Thrombocytopenia (low platelets) | 1,543 | 10.5 10.0–11.0ROR 11.0 · χ² 13,064 / p <1e-300 | 10.3 EB05 9.9 · IC025 +3.3 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 7.7 · 95% clinician | NCT01818752: 5/474 (1.1%) on Carfilzomib (serious AE) |
| Fatigue (tiredness) | 1,542 | 1.5 1.4–1.6ROR 1.5 · χ² 249 / p 2e-56 | 1.5 EB05 1.4 · IC025 +0.5 | Labeled adverse reaction exact term | serious PRR 1.2 | NCT01818752: 1/474 (0.2%) on Carfilzomib (serious AE) |
| Pneumonia (lung infection) | 1,389 | 3.2 3.1–3.4ROR 3.3 · χ² 2,140 / p <1e-300 | 3.2 EB05 3.1 · IC025 +1.6 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 2.5 · 91% clinician | NCT01818752: 46/474 (9.7%) on Carfilzomib (serious AE) |
| Pyrexia (fever) | 1,167 | 2.5 2.4–2.7ROR 2.6 · χ² 1,082 / p 2e-237 | 2.5 EB05 2.4 · IC025 +1.2 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 2.1 | NCT01818752: 16/474 (3.4%) on Carfilzomib (serious AE) |
| Diarrhoea (diarrhea) | 1,123 | 1.3 1.2–1.4ROR 1.3 · χ² 81 / p 1e-19 | 1.3 EB05 1.2 · IC025 +0.3 | Labeled adverse reaction exact term | serious PRR 1.3 | NCT01818752: 3/474 (0.6%) on Carfilzomib (serious AE) |
| Dyspnoea (shortness of breath) | 1,117 | 1.5 1.4–1.6ROR 1.5 · χ² 174 / p 5e-40 | 1.5 EB05 1.4 · IC025 +0.5 | Labeled adverse reaction exact term | serious PRR 1.2 | NCT01818752: 9/474 (1.9%) on Carfilzomib (serious AE) |
| Anaemia (low red blood cells) | 1,117 | 4.4 4.1–4.6ROR 4.5 · χ² 2,924 / p <1e-300 | 4.4 EB05 4.1 · IC025 +2.0 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 3.4 · 91% clinician | NCT01818752: 11/474 (2.3%) on Carfilzomib (serious AE) |
| Neutropenia (low neutrophils (infection-fighting cells)) | 1,114 | 6.2 5.8–6.5ROR 6.4 · χ² 4,817 / p <1e-300 | 6.1 EB05 5.8 · IC025 +2.5 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 4.6 · 95% clinician | NCT01818752: 4/474 (0.8%) on Carfilzomib (serious AE) |
| Nausea | 1,082 | 1.0 1.0–1.1ROR 1.0 · χ² 1 / p 0.230 | 1.0 EB05 1.0 · IC025 -0.1 PRR-only: not supported by EBGM or IC | Labeled adverse reaction exact term | serious PRR 1.0 | NCT01818752: 2/474 (0.4%) on Carfilzomib (serious AE) |
| Acute kidney injury (sudden kidney damage) | 862 | 4.2 4.0–4.5ROR 4.3 · χ² 2,134 / p <1e-300 | 4.2 EB05 4.0 · IC025 +2.0 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 3.1 · 96% clinician | NCT01818752: 19/474 (4.0%) on Carfilzomib (serious AE) |
| Drug ineffective (drug did not work) | 854 | 0.5 0.5–0.5ROR 0.5 · χ² 502 / p 2e-111 | 0.5 EB05 0.5 · IC025 -1.2 PRR-only: not supported by EBGM or IC | Reporting / coding artifact | serious PRR 0.8 | not reported in cached trials |
| Hypertension (high blood pressure) | 714 | 2.5 2.3–2.7ROR 2.6 · χ² 655 / p 8e-145 | 2.5 EB05 2.4 · IC025 +1.2 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 1.9 · 92% clinician | NCT01818752: 1/474 (0.2%) on Carfilzomib (serious AE) |
Unlabeled candidate signals
These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.
- Plasma cell leukaemia — n=119, PRR 185.3
- Light chain disease — n=23, PRR 138.6
- Plasmacytoma — n=188, PRR 82.9 (also seen in trial arm)
- Light chain analysis increased — n=84, PRR 66.5
- Microangiopathic haemolytic anaemia — n=39, PRR 39.4
- Minimal residual disease — n=23, PRR 38.4
- Osteolysis — n=73, PRR 27.5
- Cerebral toxoplasmosis — n=30, PRR 24.7
- B-cell type acute leukaemia — n=23, PRR 24.6
- Intercepted product preparation error — n=367, PRR 23.1
Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.
Common questions
What are the most reported side effects of Carfilzomib?
In FDA FAERS, the most frequently co-reported reaction terms for Carfilzomib are plasma cell myeloma, thrombocytopenia, fatigue, pneumonia, pyrexia, diarrhoea. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.
Does Carfilzomib have an FDA boxed warning?
No. The FDA label retrieved for Carfilzomib has no boxed warning; see the label's Warnings and Precautions for the recognised risks.
Do FAERS signals prove that Carfilzomib causes these side effects?
No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.
Sources & methods
- FDA label via openFDA (set ID ea66eb30-e665-4693-99a1-a9d3b4bbe2d6, effective 20250618; matched on
openfda.generic_name.exact:"CARFILZOMIB") - Bayesian shrinkage measures computed offline over all 1,317,300 cached pairs: BCPNN information component (IC, with Norén closed-form IC025) and MGPS empirical-Bayes geometric mean (EBGM, EB05) with a two-component gamma prior fitted by maximum marginal likelihood (α₁=0.57, β₁=0.02, α₂=1.42, β₂=0.70, w=0.17); unstratified
- FAERS pair statistics from the OpenPV build of 2026-09-14 (openFDA
count=aggregation, fieldpatient.drug.openfda.generic_name.exact, 1,076 reaction terms, min 3 co-reports); PRR/ROR with 95% CI, chi-square with Yates correction - Serious-only and stratified counts (serious:1, patient.patientsex, primarysource.qualification) from openFDA count queries; serious-only PRR uses the drug serious report total and the term global serious total (N_serious=11,882,979); strata shown only when n ≥ 20
- Seriousness and sex counts from openFDA
count=serious,patient.patientsex,seriousnessdeath - ClinicalTrials.gov API v2 (query
CARFILZOMIB, results-bearing studies sorted by enrollment)
Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.