Should You Stop JAK2 Inhibitors If You Become Anemic?

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Topics include: Treatments

Patients on JAK2 inhibitors often become anemic or experience a drop in their platelet count, which can be worrisome for patients with myelofibrosis and their doctors. However, according to leading researcher, Dr. Srdan Verstovsek, it is important not to stop this therapy. Watch now as Dr. Verstovsek discusses solutions to this issue, so patients can continue treatment with the best possible results.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello.  I'm Andrew Schorr for Patient Power.  When a patient is put on the first approved JAK2 inhibitor, ruxolitinib (Jakafi and Jakavi), their blood counts are watched very carefully, and in some quarters, when they become anemic or their platelets are low, the drug use is stopped.  A lead investigator for the drug is Dr. Srdan Verstovsek from MD Anderson Cancer Center.  He joins us now from a medical conference in Madrid. 

Thank you for being with us Dr. Verstovsek. 

Dr. Verstovsek:

My pleasure.  Thank you. 

Andrew Schorr:

Is it your opinion, Dr. Verstovsek, that if someone becomes anemic, or has low platelets, or has started out that way, that the drug should either not be used or should be stopped? 

Dr. Verstovsek:

This is a very good and a very important question for everyday practice.  And it is very well known now that JAK inhibitors and ruxolitinib (Jakafi and Jakavi), in particular, causes suppression of the red blood cells and platelets.  And what we learned from experiencing clinical studies is that the proactive adjustments of the dose, meaning decreasing the dose of ruxolitinib (Jakafi and Jakavi), would prevent significant drop in blood red blood cells or platelets, and one would be able to maintain patients on the therapy, which is very important, not to interrupt. 

So, maintenance of the patients on the therapy, at a lower dose, is what we advise, practicing oncologists, and patients in the community, because interruption of the therapy leads to a recurrence of the symptoms within about 10 days, so you lose all the benefits.  In the other words, proactive monitoring of the patients within a period of about the first three months, when things happen, and adjustments of the doses, if necessary, to prevent significant anemia and thrombocytopenia, is the way to go. 

The alternative question, that is frequently asked, is how to treat the patients that already have a low blood cell count, which is very important.  Many patients with advanced myelofibrosis already have anemia or already have low platelets.  Now, there is no contraindication to use ruxolitinib (Jakafi and Jakavi), so in patients who are already anemic and have a symptomatic spleen or symptomatic disease itself, it is proven to use JAK inhibitors to counteract the big spleen and improve quality of life. 

Now, anemia is not going to improve.  It might even worsen.  Now, in that situation, in common practice, we would suggest to add another agent that would potentially improve anemia, like testosterone-like medications, like a medication called danazol (Danocrine), or hormones that stimulate the production of red blood cells, like erythropoietin, or thalidomide (Thalomid).  A low dose is effective sometimes in improving the red blood cell count.  So, in everyday practice, a combination therapy for patients with low blood cell count that would potentially benefit with the use of ruxolitinib (Jakafi and Jakavi), is advised. 

In patients that have low platelets, starting dose of ruxolitinib (Jakafi and Jakavi) should be 5 milligrams, twice a day, with intention to go up on the dose to 10 milligrams, twice a day, that in our experience, long-term is very good for the patients. 

There are ways with adjustments of the dosage, particular focus on and close follow-up of the patients over the first two or three months of therapy for long-term success. 

Andrew Schorr:

Dr. Verstovsek, thank you so much for your perspective. 

Dr. Verstovsek:

It was a pleasure.  Thank you for the opportunity. 

Andrew Schorr:

We'll have much more with Dr. Verstovsek, including a discussion of how a patient can best be prepared for transplant.  Be sure to be signed up for alerts, so you know as we post new MPN programs. 

I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on January 26, 2016