Ruxolitinib (Jakafi)

Indications

Alopecia Areata (see xxxx)

xxx

Myelofibrosis (see Primary Myelofibrosis)

xxxx

Polycythemia Vera (see Polycythemia Vera)

xxx

Psoriasis (see Psoriasis)

xxxx

Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis)

xxxx

Chronic Graft vs Host Disease (GVHD) (see Graft vs Host Disease)

xxxx
REACH3 Trial (NEJM 2021)

Pharmacology

Janus Kinase (JAK) Inhibitor (see Janus Kinase Inhibitors)
- Preferentially Active Against JAK-1 and JAK-2

Metabolism

xxxx

Administration

xxxx

Dose Adjustment

Hepatic:
Renal:

Adverse Effects

Hematologic Adverse Effects

Anemia (see Anemia)
Thrombocytopenia (see Thrombocytopenia)

Infectioius Adverse Effects

Cryptococcosis (see Cryptococcosis)
- Epidemiology
  - Case Reports (Chest, 2013) [MEDLINE] (Respir Med Case Rep, 2017) [MEDLINE]
Hepatitis B Reactivation (see Hepatitis B Virus)
- Epidemiology
  - Case Reports (Am J Hematol, 2018) [MEDLINE]
Herpes Zoster (see Varicella-Zoster Virus)
- Epidemiology
  - Multiple Case Reports (Am J Hematol, 2018) [MEDLINE]
Pneumocystis Jirovecii Pneumonia (see Pneumocystis Jirovecii)
- Epidemiology
  - Case Report (BMJ Case Rep, 2014) [MEDLINE] (Am J Hematol, 2018) [MEDLINE]
Tuberculosis (see Tuberculosis)
- Epidemiology
  - Multiple Case Reports (Am J Hematol, 2018) [MEDLINE]

Pulmonary Adverse Effects

Pneumonitis/Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome)
- Epidemiology
  - Case Reports Associated with Ruxolitinib Usage (Respir Med Case Rep, 2017) [MEDLINE]
  - Multiple Case Reports Associated with Ruxolitinib Withdrawal Syndrome (Int J Hematol, 2014) [MEDLINE] (Oncologist, 2021) [MEDLINE]
Cryptococcosis (see Cryptococcosis)
- Epidemiology
  - Case Reports (Chest, 2013) [MEDLINE] (Respir Med Case Rep, 2017) [MEDLINE]
Exacerbation of Pulmonary Hypertension (see Pulmonary Hypertension)
- Epidemiology
  - Case Report (Haematologica, 2015) [MEDLINE]
Pleural Effusion (see xxxx)
- Epidemiology
  - Reported in Association with Ruxolitinib Withdrawal Syndrome (Mayo Clin Proc, 2011) [MEDLINE]
Pneumocystis Jirovecii Pneumonia (see Pneumocystis Jirovecii)
- Epidemiology
  - Case Reports (BMJ Case Rep, 2014) [MEDLINE] (Am J Hematol, 2018) [MEDLINE]
Tuberculosis (see Tuberculosis)
- Epidemiology
  - Multiple Case Reports (Am J Hematol, 2018) [MEDLINE]

Other Adverse Effects

Ruxolitinib Withdrawal Syndrome
- Epidemiology
  - Occurs from 1 Day-3 wks Following Ruxolitinib Withdrawal
- Physiology
  - Due to Abrupt Rebound in Serum Concentrations of IL-6, TNFα, and Macrophage Inflammatory Protein 1B
- Clinical
  - Accelerated Splenomegaly (see Splenomegaly)
  - Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome)
  - Hypotension/Sepsis-Like Syndrome (see Hypotension)
  - Pleural Effusion (Mayo Clin Proc, 2011) [MEDLINE]
  - Tumor Lysis Syndrome (see Tumor Lysis Syndrome)
  - Worsened Cytopenias
- Prevention
  - Corticosteroids
  - Tapering Ruloxitinib

References

Serious adverse events during ruxolitinib treatment discontinuation in patients with myelofibrosis. Mayo Clin Proc 2011;86:1188–1191 [MEDLINE]
JAK inhibition with ruxolitinib versus best available therapy for myelofibrosis. N Engl J Med 2012;366:787–798
A double-blind, placebo-controlled trial of ruxolitinib for myelofibrosis. N Engl J Med 2012;366:799–807
Disseminated tuberculosis in a patient treated with a JAK2 selective inhibitor: a case report. BMC Res Notes. 2012 Oct 5;5:552. doi: 10.1186/1756-0500-5-552 [MEDLINE]
Efficacy, safety and survival with ruxolitinib in patients with myelofibrosis: results of a median 2-year follow-up of COMFORT-I. Haematologica 2013;98: 1865–1871
Ruxolitinib withdrawal syndrome leading to tumor lysis. J Clin Oncol 2013;31:e430–e432
An opportunistic infection associated with ruxolitinib, a novel janus kinase 1,2 inhibitor. Chest. 2013 May;143(5):1478-1479. doi: 10.1378/chest.12-1604 [MEDLINE]
Disseminated tuberculosis associated with ruxolitinib. Leukemia. 2014 Aug;28(8):1750-1. doi: 10.1038/leu.2014.104. Epub 2014 Mar 13 [MEDLINE]
Recurrent hypoxemic respiratory failure. Beyond the usual suspects. Ann Am Thorac Soc. 2014 Sep;11(7):1145-8. doi: 10.1513/AnnalsATS.201403-127CC [MEDLINE]
Acute respiratory distress syndrome in a patient with primary myelofibrosis after ruxolitinib treatment discontinuation. Int J Hematol. 2014 Nov;100(5):498-501. doi: 10.1007/s12185-014-1628-5. Epub 2014 Jul 18 [MEDLINE]
Pneumocystis jiroveci pneumonitis complicating ruxolitinib therapy. BMJ Case Rep. 2014 Jun 2;2014. pii: bcr2014204950. doi: 10.1136/bcr-2014-204950 [MEDLINE]
Pulmonary arterial hypertension exacerbated by ruxolitinib. Haematologica. 2015 Jun;100(6):e244-5. doi: 10.3324/haematol.2014.120816. Epub 2015 Feb 14 [MEDLINE]
Recurrent hypoxemic respiratory failure. Beyond the usual suspect. Ann Am Thorac Soc. 2014 Sep;11(7):1145-8. doi: 10.1513/AnnalsATS.201403-127CC [MEDLINE]
Pulmonary tuberculosis reactivation following ruxolitinib treatment in a patient with primary myelofibrosis. Leuk Lymphoma. 2015 May;56(5):1528-9. doi: 10.3109/10428194.2014.963082. Epub 2014 Nov 5 [MEDLINE]
Ruxolitinib-associated tuberculosis: a case of successful ruxolitinib rechallenge. Ann Hematol. 2015 Mar;94(3):519-20. doi: 10.1007/s00277-014-2183-0. Epub 2014 Aug 30 [MEDLINE]
Ruxolitinib versus standard therapy for the treatment of polycythemia vera. N Engl J Med. 2015 Jan 29;372(5):426-35. doi: 10.1056/NEJMoa1409002 [MEDLINE]
Reactivation of Pulmonary Tuberculosis following Treatment of Myelofibrosis with Ruxolitinib. Case Rep Hematol. 2016;2016:2389038. Epub 2016 Oct 23 [MEDLINE]
Pulmonary cryptococcosis in a ruxolitinib-treated patient with primary myelofibrosis. Respir Med Case Rep. 2017 Jul 4;22:87-90. doi: 10.1016/j.rmcr.2017.06.015. eCollection 2017 [MEDLINE]
Acute respiratory distress syndrome; A rare complication caused by usage of ruxolitinib. Respir Med Case Rep. 2017 Sep 18;22:243-245. doi: 10.1016/j.rmcr.2017.09.003. eCollection 2017 [MEDLINE]
Ruxolitinib-associated infections: A systematic review and meta-analysis. Am J Hematol. 2018 Mar;93(3):339-347. doi: 10.1002/ajh.24976 [MEDLINE]
Hypoxemic Respiratory Failure Following Ruxolitinib Discontinuation in Allogeneic Hematopoietic Cell Transplantation Recipients. Oncologist. 2021 Jul 17. doi: 10.1002/onco.13903 [MEDLINE]