Maintaining ruxolitinib treatment and adding another agent to address anemia in patients with myelofibrosis (MF) is appropriate in some instances, while “switching to another drug has merit” in others, according to a consensus paper published in Expert Opinion on Pharmacotherapy.

Ruxolitinib, a Janus kinase (JAK) inhibitor approved in 2011 by the US Food and Drug Administration (FDA) to treat MF, has been the main treatment option for patients with the disease. In recent years, the agency has approved new JAK inhibitors such as fedratinib, pacritinib, and momelotinib for the treatment of MF, and others are in development. 

Read more about MF guidelines

Here, a multidisciplinary panel of academic and community physician experts, a pharmacist, and an advanced practice provider discussed problems that should be considered when treating patients with MF whose disease is refractory or has relapsed following ruxolitinib treatment or who are intolerant to ruxolitinib treatment.

Following the discussion, several areas of consensus were identified, including the needs to define and identify a clear definition of first-line treatment failure with ruxolitinib, optimize second-line treatment with newly approved treatments, and involve patients in the second-line treatment of the disease.

“In this article, based on an expert panel discussion on practical strategies for recognizing and addressing treatment failure among patients with MF who receive initial ruxolitinib therapy, we hope to help close these gaps in knowledge and competence,” the authors wrote.

The clinical presentation of MF is so heterogenous that treatment is usually based on the needs of each patient, making it difficult to develop consensus guidelines. However, with the approval of novel agents, guidelines are essential to provide a structure for decision-making about the treatment of the disease.

MF is a rare disease characterized by bone marrow fibrosis, which interferes with the normal production of blood cells.


Bose P, Kuykendall AT, Miller C, et al. Moving beyond ruxolitinib failure in myelofibrosis: evolving strategies for second line therapy. Expert Opin Pharmacother. Published online May 10, 2023. doi:10.1080/14656566.2023.2213435