Ruxolitinib and Surgical Interventions

Harry P. Erba, MD, PhD: Jamile, for the sake of time, I want to ask a few directed questions about practical management of patients on ruxolitinib. I often get asked, “What do you do with the drug prior to a surgical intervention?” Or “How about if the patient is admitted for some other inflammatory disorder: pneumonia, infection? How do you manage ruxolitinib during that time? Do you abruptly stop it? Do you taper it? How do we do this?”

Jamile M. Shammo, MD, FASCP, FACP: I try to avoid abrupt stoppage of the drug as much as possible, but if someone is having surgery, and they’re going to be unable to take PO medications, then you can hold the drug for a few days. I try not to extend this over a week if I can help it. I try to avoid dose interruption as much as possible.

Harry P. Erba, MD, PhD: Sometimes when a patient gets admitted and they’re sick or they’re intubated, I cannot continue ruxolitinib. And you can’t taper it, so I’ll give them a low dose of prednisone. Does anyone else do that? Is there any science behind it?

Ruben A. Mesa, MD, FACP: There’s no question that prednisone, in certain circumstances, can provide a bit of additional relief, but there can be low-grade rheumatologic conditions and other things they might have that might benefit from that as well. Prednisone certainly has some impact, without question, with all the limitations that exist in terms of chronic use of corticosteroids.

Transcript Edited for Clarity