From the Guidelines
After stopping Jakavi, prophylaxis should be continued for at least 1 week, considering the symptoms may return to pretreatment levels over a period of approximately one week following discontinuation or interruption of ruxolitinib. When discontinuing or interrupting therapy with ruxolitinib for reasons other than thrombocytopenia or neutropenia, it is recommended to taper the dose of ruxolitinib gradually 1. The following are key considerations for prophylaxis after stopping Jakavi:
- Tapering the dose of ruxolitinib gradually to minimize the risk of symptoms returning to pretreatment levels
- Monitoring spleen size either by palpation or imaging, as recommended in the guidelines for the use of ruxolitinib 1
- Considering the use of prophylactic measures, such as corticosteroids, to mitigate the risk of cytokine rebound syndrome, although the specific details of such prophylaxis are not provided in the guidelines 1
- Close monitoring of patients during the period after stopping Jakavi for signs of disease rebound, including fever, worsening splenomegaly, or constitutional symptoms. It is essential to note that the guidelines emphasize the importance of individualized care, and the approach to prophylaxis after stopping Jakavi may vary depending on the specific patient circumstances, including the reason for discontinuation and the patient's overall clinical condition 1.
From the Research
Stopping Jakavi and Continuing Prophylaxis
- The duration of prophylaxis after stopping Jakavi (ruxolitinib) is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that ruxolitinib is effective in reducing the risk of thrombosis in patients with polycythemia vera and myelofibrosis 4, 6.
- A meta-analysis found that ruxolitinib decreases the risk of arterial and/or venous thrombosis in patients with polycythemia vera or myelofibrosis 6.
- Another study found that switching from hydroxyurea to ruxolitinib in patients with essential thrombocythaemia who are intolerant or refractory to hydroxyurea could improve abnormal haematologic values 3.
- The use of antiplatelet agents and anticoagulants in patients with elevated blood pressure is also discussed in one of the studies, but it does not provide direct evidence for the duration of prophylaxis after stopping Jakavi 5.
- It is essential to note that the provided studies do not offer a clear answer to the question of how long prophylaxis should be continued after stopping Jakavi, and more research may be needed to determine the optimal duration of prophylaxis 2, 3, 4, 5, 6.