The Challenge of Managing Both Disease Symptoms and Drug Side Effects in Myelofibrosis

The significant symptom burden of myelofibrosis requires treatment to control symptoms, but the Janus kinase (JAK) inhibitors being used today can cause significant side effects that are hard to manage through dose adjustment or reduction and may require patients to switch to a different class of drug to maintain disease control of myeloproliferative neoplasms (MPNs), explained Firas El Chaer, MD, associate professor of medicine, University of Virginia School of Medicine.

This transcript has been lightly edited for clarity.

Transcript

What impact do the symptoms of MPNs have on the quality of life of patients?

Unfortunately, untreated myelofibrosis can be associated with significant symptom burden, and without treatment, those symptoms don't usually improve on their own. We're very lucky that we have drugs right now that can control those symptoms. However, unfortunately, in a lot of instances, the disease can relapse with these symptoms, progressing on further therapy, requiring additional therapeutic agents in the future. Those symptoms can be quite debilitating, so controlling them is very important.

What are common adverse events from MPN treatment and how can they best be managed?

Many of the JAK inhibitors that we use nowadays can have significant side effects, such as severe thrombocytopenia, severe anemia, and sometimes they can have GI [gastrointestinal] side effects. One drug, momelotinib, for instance, can have neuropathy side effects. And in some instances, these side effects can be very hard to manage. They might require dose reduction and drugs, which ultimately can lead to a subtherapeutic effect of those drugs. So, knowing how to dose adjust these medications to prevent further side effects is very important.

However, unfortunately, in a lot of instances, we cannot really dose reduce or dose adjust while keeping control of the disease, forcing us to switch to a different drug or different class of drugs to be able to treat those patients.