Dr Amanam on the Optimal Use of JAK Inhibitors in the Current Myelofibrosis Treatment Paradigm

Idoroenyi Amanam, MD, assistant professor, Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, discusses the current treatment paradigm for patients with myelofibrosis, highlighting patients who may derive the most benefit from treatment with JAK inhibitors in this therapeutic landscape.

Current treatments for patients with myelofibrosis can be broadly categorized into 2 groups: those that alleviate symptoms and potentially improve survival, or those classified as disease-modifying therapies, Amanam begins. Although agents in the latter category may confer a long-term survival benefit, they are often associated with a higher risk of adverse effects (AEs), he explains.

The development of ruxolitinib (Jakafi) has greatly improved the management of myelofibrosis, and was the first FDA-approved JAK inhibitor, Amanam states. Its approval was based on data from the phase 3 COMFORT-I and COMFORT-II studies (NCT00952289; NCT00934544) showing symptom relief and reduction in splenic volume, both of which are highly relevant for patients, he notes.

Ideal candidate for a JAK inhibitor like ruxolitinib will typically present with an enlarged spleen and significant symptoms, Amanam continues. Patients who meet both criteria are more likely to experience a meaningful benefit from the treatment, he emphasizes. These benefits may include symptom management and improvement in spleen size, providing enhanced quality of life, Amanam adds.

However, the potential benefits of a JAK inhibitor may be limited for patients who do not meet these criteria, Amanam notes. In such cases, the risks may outweigh the therapeutic benefits. It is crucial to have an open and honest conversation with these patients, explaining that they may not derive as much benefit from JAK inhibitors and could face more AEs, he says. Personalized treatment decisions based on these individual factors can help optimize outcomes for patients with myelofibrosis and minimize unnecessary risks, Amanam concludes.