Dr. Mesa on Challenges With JAK Inhibitors in Myelofibrosis

Ruben Mesa, MD, the director of the Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, discusses the challenges with using JAK inhibitors in myelofibrosis.

The use of JAK inhibitors can lead to the development of cytopenias in patients with myelofibrosis, but that can be managed by adjusting the dosage of these agents. With fedratinib (Inrebic), patients need to have their thiamine levels monitored and possibly receive thiamine replacement. Low thiamine levels are not a barrier in terms of using these agents, but thiamine levels must be monitored due to a small percentage of patients in the past developing Wernicke encephalopathy.

Furthermore, JAK inhibitors can cause some gastrointestinal adverse events (AEs). However, prophylaxis can be used for diarrhea and nausea, and those AEs are usually well managed. In fact, some patients do not experience any AEs associated with these agents, but one should be mindful of these toxicities, concludes Mesa.