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Fedratinib in myelofibrosis.

Ann Mullally1,2,3, John Hood4, Claire Harrison5

  • 1Division of Hematology, Department of Medicine, Brigham and Women's Hospital, and.

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|April 29, 2020
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Fedratinib, a JAK2 inhibitor, treats myelofibrosis (MF) by reducing spleen size and symptoms. Despite a temporary FDA hold due to Wernicke encephalopathy concerns, it was approved with a warning for this risk.

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Area of Science:

  • Pharmacology
  • Oncology
  • Hematology

Background:

  • The JAK2V617F mutation is a key driver in myeloproliferative neoplasms.
  • Fedratinib was developed as a selective JAK2 inhibitor.
  • Myelofibrosis (MF) is a serious myeloproliferative neoplasm characterized by bone marrow fibrosis and extramedullary hematopoiesis.

Purpose of the Study:

  • To evaluate the efficacy and safety of fedratinib in patients with myelofibrosis.
  • To assess fedratinib's impact on spleen size and MF-related symptoms.
  • To investigate fedratinib's role in patients resistant or intolerant to other therapies.

Main Methods:

  • Phase 3 (JAKARTA) and Phase 2 (JAKARTA-2) clinical trials were conducted.
  • Patients received fedratinib for intermediate-2 or high-risk MF.
  • Efficacy endpoints included spleen volume reduction and symptom response.

Main Results:

  • Fedratinib demonstrated significant spleen and symptom responses in MF patients.
  • Approximately 35-40% of JAK2 inhibitor-naive patients (JAKARTA) and 25-30% of ruxolitinib-resistant patients (JAKARTA-2) met primary endpoints.
  • A rare but serious risk of Wernicke encephalopathy was identified, leading to a temporary clinical hold.

Conclusions:

  • Fedratinib is an effective treatment option for intermediate-2 or high-risk MF.
  • Risk factors for Wernicke encephalopathy were identified, and a "black box warning" is included in its approval.
  • Fedratinib offers a valuable therapeutic choice for MF patients, particularly those with unmet needs.