TY - JOUR
T1 - Moving beyond ruxolitinib failure in myelofibrosis
T2 - evolving strategies for second line therapy
AU - Bose, Prithviraj
AU - Kuykendall, Andrew T.
AU - Miller, Carole
AU - Kurtin, Sandra
AU - Farina, Kyle
AU - Harting, Donald M.
AU - Mascarenhas, John O.
AU - Mesa, Ruben A.
N1 - Publisher Copyright:
© 2023 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023
Y1 - 2023
N2 - Introduction: Ruxolitinib has been the cornerstone of pharmacologic therapy for myelofibrosis for over a decade. However, the last several years have witnessed the regulatory approval of other Janus kinase (JAK) inhibitors for myelofibrosis, i.e. fedratinib, pacritinib, and US approval of momelotinib is widely anticipated in 2023. Areas covered: Due to the multifaceted clinical presentation of myelofibrosis, a watertight definition of ruxolitinib failure has remained elusive, as “progression” on ruxolitinib can take many forms and management is highly nuanced. Yet, the availability of other JAK inhibitors and potential future availability of non-JAK inhibitor agents for myelofibrosis make a consensus on management of ruxolitinib failure critically important. This consensus paper summarizes a discussion between multiple academic and community physician experts, a pharmacist and an advanced practice provider around the issues to be considered for the optimal care of patients with myelofibrosis whose disease is refractory to or does not respond adequately to ruxolitinib, or who exhibit intolerance to ruxolitinib. Expert opinion: The panel identified several areas of consensus, as well as some areas where more data to inform evidence-based practice are needed. In some situations, maintaining ruxolitinib while adding another agent, e.g. to address anemia, is appropriate, whereas in others, switching to a different drug has merit.
AB - Introduction: Ruxolitinib has been the cornerstone of pharmacologic therapy for myelofibrosis for over a decade. However, the last several years have witnessed the regulatory approval of other Janus kinase (JAK) inhibitors for myelofibrosis, i.e. fedratinib, pacritinib, and US approval of momelotinib is widely anticipated in 2023. Areas covered: Due to the multifaceted clinical presentation of myelofibrosis, a watertight definition of ruxolitinib failure has remained elusive, as “progression” on ruxolitinib can take many forms and management is highly nuanced. Yet, the availability of other JAK inhibitors and potential future availability of non-JAK inhibitor agents for myelofibrosis make a consensus on management of ruxolitinib failure critically important. This consensus paper summarizes a discussion between multiple academic and community physician experts, a pharmacist and an advanced practice provider around the issues to be considered for the optimal care of patients with myelofibrosis whose disease is refractory to or does not respond adequately to ruxolitinib, or who exhibit intolerance to ruxolitinib. Expert opinion: The panel identified several areas of consensus, as well as some areas where more data to inform evidence-based practice are needed. In some situations, maintaining ruxolitinib while adding another agent, e.g. to address anemia, is appropriate, whereas in others, switching to a different drug has merit.
KW - clinical trials
KW - consensus
KW - emerging agents
KW - fedratinib
KW - JAK inhibitor failure
KW - momelotinib
KW - myelofibrosis
KW - pacritnib
KW - ruxolitinib failure
KW - therapeutic options
KW - treatment failure definitions
KW - treatment selection
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U2 - 10.1080/14656566.2023.2213435
DO - 10.1080/14656566.2023.2213435
M3 - Article
C2 - 37163478
AN - SCOPUS:85160873119
SN - 1465-6566
VL - 24
SP - 1091
EP - 1100
JO - Expert opinion on pharmacotherapy
JF - Expert opinion on pharmacotherapy
IS - 9
ER -