Dr Gangat on Ruxolitinib as the Standard of Care in Myelofibrosis

“The new JAK inhibitors have been on the market for the last couple of years, specifically momelotinib, which was approved specifically for anemia related to myelofibrosis, and it does have a superior anemia profile compared with ruxolitinib, but with respect to spleen and tolerability, it is inferior to ruxolitinib.”

Naseema Gangat, MBBS, a professor of medicine and a consultant in hematology at Mayo Clinic, discussed the role of ruxolitinib (Jakafi) compared with other JAK inhibitors for the treatment of patients with myelofibrosis.

Ruxolitinib was first FDA-approved in November 2011 as the first JAK inhibitor for the treatment of patients with myelofibrosis, Gangat began. Ever since its approval, the JAK inhibitor has been a cornerstone of treatment for patients with myelofibrosis and continues to remain the standard of care, she explained. Before its approval, there were no other effective treatments, she added. The potent agent is able to reduce spleen size and improve symptoms, which can improve a patient’s appetite, help with weight gain, relieve itching, and bone pain, she noted. However, there are still existing limitations with ruxolitinib, as it does not treat anemia or thrombocytopenia, Gangat asserted. Yet, combining ruxolitinib with other therapies has helped address this limitation, she added.

Furthermore, ruxolitinib in combination with novel agents has helped increase the potency of ruxolitinib, Gangat continued. There are current investigations on combination strategies by adding anti-anemia agents to ruxolitinib, she emphasized. Additionally, new JAK inhibitors have emerged within the myelofibrosis treatment landscape, most recently momelotinib (Ojjaara), which was FDA-approved in September 2023 for the treatment of patients with intermediate- or high-risk myelofibrosis and anemia, she said. Of note, momelotinib has demonstrated a superior anemia profile compared with ruxolitinib. Nevertheless, spleen volume response and tolerability were shown to be better with ruxolitinib compared with momelotinib, according to Gangat. Therefore, ruxolitinib continues to show its strengths as a JAK inhibitor, she concluded.