Drug Action
Ruxolitinib is a selective inhibitor of the Janus-associated tyrosine kinases JAK1 and JAK2.
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Drug reference
Ruxolitinib is a selective inhibitor of the Janus-associated tyrosine kinases JAK1 and JAK2.
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Disease-related splenomegaly or symptoms [in patients with primary myelofibrosis, post-polycythaemia vera myelofibrosis, or post-essential thrombocythaemia myelofibrosis] (specialist use only) | Polycythaemia vera [in patients resistant to, or intolerant of, hydroxyurea] (specialist use only) ▶BY MOUTH Immune system and malignant disease ▶Adult: (consult product literature or local protocols)
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Assess risk of developing infection before treatment—do not initiate until active serious infections are resolved CAUTIONS, FURTHER INFORMATION ▶Tuberculosis Patients should be evaluated for latent and active tuberculosis before starting treatment and monitored for signs and symptoms of tuberculosis during treatment.
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NICE decisions ▶Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis (March 2016) NICE TA386 Ruxolitinib (Jakavi ®) is recommended as an option for treating disease-related splenomegaly or symptoms in adults with primary myelofibrosis (also known as chronic idiopathic myelofibrosis), post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis, only if the patient has intermediate-2 or high-risk disease, and if the manufacturer provides ruxolitinib with the discount agreed in the patient access scheme. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta386 Scottish Medicines Consortium (SMC) decisions SMC No. SMC2213 The Scottish Medicines Consortium has advised (December 2019) that ruxolitinib phosphate (Jakavi ®) is accepted for use within NHS Scotland for the treatment of adults with polycythaemia vera who are resistant to or intolerant of hydroxyurea (hydroxycarbamide). This advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is Immune system and malignant disease equivalent or lower.
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: ruxolitinib
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▶Common or very common Anaemia. bruising. constipation . dizziness. dyslipidaemia. flatulence. haemorrhage. headache. hypertension. increased risk of infection. intracranial haemorrhage. neutropenia. sepsis. thrombocytopenia. weight increased
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Contraceptive advice required, see Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Avoid—toxicity in animal studies.
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Avoid—present in milk in animal studies.
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Manufacturer advises caution. Dose adjustments Manufacturer advises initial dose reduction—consult product literature.
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Dose adjustments Reduce dose in severe impairment (consult product literature).
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▶Monitor full blood count (including differential white cell count) before treatment, then every 2–4 weeks until dose stabilised, then as clinically indicated. ▶Monitor for infection during treatment. ▶Monitor for symptoms of progressive multifocal leucoencephalopathy (presenting as new or worsening neurological, cognitive or psychiatric signs or symptoms)—withhold treatment if suspected.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Jakavi (Novartis Pharmaceuticals UK Ltd) Ruxolitinib (as Ruxolitinib phosphate) 5 mg Jakavi 5mg tablets | 56 tablet P £1,428.00 DT = £1,428.00 Ruxolitinib (as Ruxolitinib phosphate) 10 mg Jakavi 10mg tablets | 56 tablet P £2,856.00 DT = £2,856.00 Ruxolitinib (as Ruxolitinib phosphate) 15 mg Jakavi 15mg tablets | 56 tablet P £2,856.00 DT = £2,856.00 Ruxolitinib (as Ruxolitinib phosphate) 20 mg Jakavi 20mg tablets | 56 tablet P £2,856.00 DT = £2,856.00
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(consult product literature or local protocols)
First-line fragment. Read the complete Indications and Dose section above.
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