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Naveen Pemmaraju, MD: Managing Anemia with Ruxolitinib Care

The common, concerning adverse effect requires a careful eye from clinicians and new therapy options.

As ruxolitinib (Jakafi) becomes more greatly embedded in treatment of rare conditions such as myelofibrosis, prescribing physicians need to navigate the greatest concern surrounding the JAK1 inhibitor: its association with anemic adverse events in patients.

In an interview with MD Magazine® while at the American Society of Clinical Oncology (ASCO) 2019 Annual Meeting in Chicago, IL, Naveen Pemmaraju, MD, of the Department of Medicine, Division of Leukemia at MD Anderson Center, explained the currently understood risks of ruxolitinib, and what potential therapies may correct it.

MD Mag: How can risks of anemia be managed in patients taking ruxolitinib?

Pemmaraju: One of the most important, common, and challenging problems for our patients with myelofibrosis—as well as both doctors and nurses—is the development of anemia, low hemoglobin levels which can occur at baseline because of the disease or later on in therapy, either because of the therapies that we're giving or disease progression. This is a huge problem for our patients.

Outside of the usual known supportive care measures such as blood transfusions and growth factor supplementation, we really don't have many tools available to us. There are some medications, older medications such as danazol and other medicines that have been used to varying levels of effectiveness.

I think one exciting area of research here is coming up with other therapies—possibly chemotherapy or other agents that may help to promote blood cell formation in different ways. One of these areas is the sotatercept-luspatercept story, which is being investigated in both myelodysplastic syndromes as well as myelofibrosis. And there was recent plenary session-level data presented for luspatercept in a subset of myelodysplastic syndrome. And those trials are active and ongoing in our field of myelofibrosis. So I'd like us to keep our eye on that.

And then other areas again, just as we mentioned, are combining drugs—either older drugs or newer drugs to either offset the JAK inhibition causing anemia, or the development of novel JAK inhibitors that may not cause as much anemia as the ones that we have now in the clinic. So these are all sort of different areas of research, and they pose new and important ways to address this issue.