From the Guidelines
After stopping Jakavi, prophylaxis should be continued for at least 2 weeks to minimize the risk of rebound effects and cytokine release syndrome, as recommended by recent guidelines 1. When discontinuing Jakavi therapy, it is crucial to maintain prophylactic measures against potential rebound effects for a minimum of 2 weeks following the last dose. This typically includes gradually tapering the medication rather than abrupt discontinuation, and may involve temporary use of corticosteroids such as prednisone (starting at approximately 10-20 mg daily) during this transition period. The extended prophylaxis is necessary because ruxolitinib has a prolonged effect on JAK-STAT signaling pathways, and sudden withdrawal can lead to a cytokine rebound syndrome characterized by return of disease symptoms, fever, and potential hemodynamic instability, as noted in the management of myeloproliferative neoplasms 1.
Some key considerations for prophylaxis after stopping Jakavi include:
- Gradually tapering the dose of ruxolitinib to minimize rebound effects, as suggested by the NCCN guidelines 1
- Monitoring patients closely for signs of disease flare, such as worsening symptoms, fever, or other concerning developments
- Considering temporary use of corticosteroids, such as prednisone, to mitigate potential rebound effects
- Ensuring patients have a sufficient supply of medications and minimizing pharmacy visits, especially in the context of the COVID-19 pandemic 1
Overall, the goal of prophylaxis after stopping Jakavi is to minimize the risk of rebound effects and cytokine release syndrome, while also ensuring that patients receive effective disease-directed treatment and minimizing the risk of contracting SARS-CoV-2 and reducing the severity of ensuing COVID-19 1.
From the Research
Prophylaxis after Stopping Jakavi
- The provided studies do not directly address the duration of prophylaxis after stopping Jakavi, specifically in the context of Jakavi treatment.
- However, the studies discuss the importance of prophylaxis in preventing venous thromboembolism (VTE) in various patient populations 2, 3, 4.
- The decision to continue prophylaxis for at least 2 weeks after stopping Jakavi may depend on individual patient risk factors and the underlying condition being treated.
- Studies suggest that the risk of recurrence after stopping anticoagulant therapy is largely determined by the patient's intrinsic risk of having a new episode of VTE 2.
- The duration of anticoagulant treatment is currently framed based on the estimated individual risk for recurrent VTE, and patients with acute VTE should receive oral anticoagulant treatment for at least three months 2.
- Extended thromboprophylaxis for up to 45 days following an acute hospitalization may be beneficial in key patient subgroups 3.
- The choice of oral anticoagulant did not impact bleeding rates in patients on triple antithrombotic therapy, but use of prasugrel and a low baseline hemoglobin were associated with increased bleed rates 5.
- Ruxolitinib, a medication used to treat polycythemia vera, has been shown to reduce the risk of thrombosis, but evidence regarding its efficacy is uncertain 6.