For steroid-refractory acute graft-versus-host disease (GVHD) in adult and pediatric patients 12 years of age and older

Individualized Dosing
for Jakafi in Acute GVHD (aGVHD)

For steroid-refractory acute graft-versus-host disease (GVHD) in adult and pediatric patients 12 years of age and older

Individualized Dosing
for Jakafi in Acute GVHD (aGVHD)

Getting Started With Jakafi in aGVHD

Image of the number 1

START with the appropriate dose1

Image of the number 1

START with the appropriate dose1

Evaluate blood parameters before and during treatment with Jakafi.

Image of 5 mg bottle of Jakafi Image of 5 mg bottle of Jakafi

Consider increasing dose to 10 mg twice daily after ≥3 days of treatment if absolute neutrophil count (ANC) and platelet counts are not decreased by 50% or more relative to the first day of dosing.

Image of the number 2

MONITOR: Monitoring patients after initiation of Jakafi is essential1

Image of the number 2

MONITOR: Monitoring patients after initiation of Jakafi is essential1

Dose reductions should be considered for platelet counts, ANCs, or bilirubin elevation as described below (see Jakafi Dose Modifications below) and in the Full Prescribing Information.

Image of the number 3

OPTIMIZE: Individualize dosing of Jakafi to optimize the balance between safety and efficacy1

Image of the number 3

OPTIMIZE: Individualize dosing of Jakafi to optimize the balance between safety and efficacy1

Doses may be modified based on safety and efficacy; doses of 5 mg once daily to 10 mg twice daily may be given.

  • Dose reductions may be used to manage side effects:
    • 10 mg twice daily may be reduced to 5 mg twice daily
    • 5 mg twice daily may be reduced to 5 mg once daily
  • Patients who are unable to tolerate Jakafi at 5 mg once daily should have treatment interrupted until their clinical and/or laboratory parameters recover
  • Tapering may be considered after 6 months of treatment as clinically indicated in patients who have discontinued therapeutic doses of steroids
    • Taper Jakafi by 1 dose level approximately every 8 weeks (10 mg twice daily to 5 mg twice daily to 5 mg once daily)
    • If aGVHD signs or symptoms recur during or after the taper of Jakafi, consider retreatment

Jakafi Dose Modifications

View the dosing modifcations for patients with cytopenias, elevated total bilirubin (with or without liver GVHD), hepatic or renal impairment and when used with strong CYP3A4 inhibitors/inducers or fluconazole.

Learn about the mechanism of action.

Reference

  1. Jakafi Prescribing Information. Wilmington, DE: Incyte Corporation.

Indications and Usage

Jakafi is indicated for treatment of polycythemia vera (PV) in adults who have had an inadequate response to or are intolerant of hydroxyurea.

Jakafi is indicated for treatment of intermediate or high‐risk myelofibrosis (MF), including primary MF, post–polycythemia vera MF and post–essential thrombocythemia MF in adults.

Jakafi is indicated for treatment of steroid‐refractory acute graft‐versus‐host disease (GVHD) in adult and pediatric patients 12 years and older.

Important Safety Information

  • Treatment with Jakafi® (ruxolitinib) can cause thrombocytopenia, anemia and neutropenia, which are each dose‐related effects. Perform a pre-treatment complete blood count (CBC) and monitor CBCs every 2 to 4 weeks until doses are stabilized, and then as clinically indicated
  • Manage thrombocytopenia by reducing the dose or temporarily interrupting Jakafi. Platelet transfusions may be necessary
  • Patients developing anemia may require blood transfusions and/or dose modifications of Jakafi
  • Severe neutropenia (ANC <0.5 × 109/L) was generally reversible by withholding Jakafi until recovery
  • Serious bacterial, mycobacterial, fungal and viral infections have occurred. Delay starting Jakafi until active serious infections have resolved. Observe patients receiving Jakafi for signs and symptoms of infection and manage promptly. Use active surveillance and prophylactic antibiotics according to clinical guidelines
  • Tuberculosis (TB) infection has been reported. Observe patients taking Jakafi for signs and symptoms of active TB and manage promptly. Prior to initiating Jakafi, evaluate patients for TB risk factors and test those at higher risk for latent infection. Consult a physician with expertise in the treatment of TB before starting Jakafi in patients with evidence of active or latent TB. Continuation of Jakafi during treatment of active TB should be based on the overall risk‐benefit determination
  • Progressive multifocal leukoencephalopathy (PML) has occurred with Jakafi treatment. If PML is suspected, stop Jakafi and evaluate
  • Advise patients about early signs and symptoms of herpes zoster and to seek early treatment
  • Increases in hepatitis B viral load with or without associated elevations in alanine aminotransferase and aspartate aminotransferase have been reported in patients with chronic hepatitis B virus (HBV) infections. Monitor and treat patients with chronic HBV infection according to clinical guidelines
  • When discontinuing Jakafi, myeloproliferative neoplasm-related symptoms may return within one week. After discontinuation, some patients with myelofibrosis have experienced fever, respiratory distress, hypotension, DIC, or multi‐organ failure. If any of these occur after discontinuation or while tapering Jakafi, evaluate and treat any intercurrent illness and consider restarting or increasing the dose of Jakafi. Instruct patients not to interrupt or discontinue Jakafi without consulting their physician. When discontinuing or interrupting Jakafi for reasons other than thrombocytopenia or neutropenia, consider gradual tapering rather than abrupt discontinuation
  • Non-melanoma skin cancers including basal cell, squamous cell, and Merkel cell carcinoma have occurred. Perform periodic skin examinations
  • Treatment with Jakafi has been associated with increases in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Assess lipid parameters 8-12 weeks after initiating Jakafi. Monitor and treat according to clinical guidelines for the management of hyperlipidemia
  • In myelofibrosis and polycythemia vera, the most common nonhematologic adverse reactions (incidence ≥15%) were bruising, dizziness, headache, and diarrhea. In acute graft-versus-host disease, the most common nonhematologic adverse reactions (incidence >50%) were infections and edema
  • Dose modifications may be required when administering Jakafi with strong CYP3A4 inhibitors or fluconazole or in patients with renal or hepatic impairment. Patients should be closely monitored and the dose titrated based on safety and efficacy
  • Use of Jakafi during pregnancy is not recommended and should only be used if the potential benefit justifies the potential risk to the fetus. Women taking Jakafi should not breastfeed during treatment and for 2 weeks after the final dose

Please see Full Prescribing Information for Jakafi.