Dr David Snyder Outlines Use of Ruxolitinib After Approval of Fedratinib

After the approval of fedratinib, familiarity may keep people using ruxolitinib to treat myelofibrosis or polycythemia vera, but it’s good to know there is a back-up if needed for patients who don’t respond adequately, said David Snyder, MD, associate chair of the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope.

How are you using ruxolitinib in light of the recent approval of fedratinib?

So, fedratinib was just approved as first line and as second line for salvage after ruxolitinib, so I have to say that since fedratinib was just approved, I don’t have much direct experience using it. So, from what I understand the toxicity profiles are fairly similar in terms of risk of myelosuppression. Fedratinib may have more in the way of [gastrointestinal] toxicity. So, I certainly have more familiarity with ruxolitinib, and I would tend maybe to go to that drug as first-line choice, but certainly there are many patients who either don’t respond adequately to ruxolitinib or do respond, but start to break through, and it’s good to know that there’s an option for those patients as well.

And, I’m always thinking about “Well, is this patient potentially a transplant candidate, and if so, it would be good to treat them with a JAK inhibitor to which they’re responding to help reduce their spleen size, control their systemic symptoms, improve their performance status,” which we think would help improve their outcomes, ultimately, after transplant.