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ESH CML/MPN 2025 | How should clinicians treating myelofibrosis in the UK select between approved JAK inhibitors?
In this video, Jennifer O’Sullivan, MB, BCh, BAO, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, provides insight into selecting between approved JAK inhibitors in the first and second-line settings for patients with myelofibrosis (MF) in the UK. Dr O’Sullivan highlights that ruxolitinib is particularly beneficial for symptomatic patients with splenomegaly, while momelotinib is suitable for those with anemia symptoms. This interview took place at the European School of Haematology (ESH) 4th How to Diagnose and Treat: CML/MPN meeting in Vienna, Austria.
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Transcript
So for frontline patients with myelofibrosis, ruxolitinib is approved particularly for patients who are symptomatic and have symptomatic constitutional symptoms or splenomegaly. Momelotinib is also approved in the first-line setting for any patient with anemia symptoms. So either ruxolitinib or momelotinib can be given in the frontline setting.
When you’re trying to decide which agent you should use in the frontline setting, ruxolitinib would be particularly beneficial with a patient who is significantly symptomatic and maybe has marked splenomegaly, and then I would probably favour momelotinib for a patient who has anemia as a predominant symptom with significant constitutional symptoms of splenomegaly, perhaps a hemoglobin less than 100, less than 90 would be the direction for considering momelotinib...
So for frontline patients with myelofibrosis, ruxolitinib is approved particularly for patients who are symptomatic and have symptomatic constitutional symptoms or splenomegaly. Momelotinib is also approved in the first-line setting for any patient with anemia symptoms. So either ruxolitinib or momelotinib can be given in the frontline setting.
When you’re trying to decide which agent you should use in the frontline setting, ruxolitinib would be particularly beneficial with a patient who is significantly symptomatic and maybe has marked splenomegaly, and then I would probably favour momelotinib for a patient who has anemia as a predominant symptom with significant constitutional symptoms of splenomegaly, perhaps a hemoglobin less than 100, less than 90 would be the direction for considering momelotinib.
Then, in the second line, if a patient started with ruxolitinib, they could consider momelotinib or fedratinib. Fedratinib may be more beneficial if someone has marked splenomegaly and then to maybe consider momelotinib if the patient has problems with anemia. If a patient started with momelotinib, they can consider ruxolitinib in the second line or fedratinib.
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Disclosures
Advisory board: Novartis, Consultancy: Karopharm.
