Ruxolitinib adherence in patients with MF or PV

The efficacy of ruxolitinib (RUX) is dependent on continuous administration in patients with myeloproliferative neoplasms.¹ Discontinuation is associated with splenomegaly re-expansion and disease symptoms in myelofibrosis (MF) and increased hematocrit levels and disease symptoms in polycythemia vera (PV).¹ Overall, poor adherence increases the risk of treatment failure.

Recently, Palandri et al.¹ published results from the RAMP study (NCT06078319) in the Annals of Hematology, evaluating the incidence of low adherence to RUX and associated factors, including psychological stress, in patients with MF and PV.

Study design¹

• This was a prospective multicenter study that enrolled patients diagnosed with MF or PV between January 1985 and December 2021.
• Patients completed the validated Adherence to Refills and Medications Scale (ARMS) and Distress Thermometer and Problem List (DTPL).
  • The ARMS is made up of 12 questions to patients that require answers via a 4-point Likert scale, with scores of 1 equaling never and 4 equaling always.
  • Eight items investigate intentional or non-intentional non-adherence, while four items investigate logistical or financial drug supply influences.
  • For the DTPL analysis, patients were asked to indicate their level of distress on a scale of 0 (no emotional distress/stress) to 10 (maximum distress/stress) on an analog scale.

Key findings¹

• A total of 189 patients completed at least one ARMS/DPTL test.
• 141 patients had MF, and 48 patients had PV.

Observations at Week 0

• 49.7% of patients reported low adherence in Week 0, and of these patients:
  • 48.9% indicated issues with the RUX supply process; and
  • 46.8% reported unintentional non-adherence.
• Globally, low adherence was comparable between patients with MF and PV (48.2% vs 54.2, respectively).
• The percentage of patients with high psychological distress was similar in those with MF (39.7%) and PV (41.7%).

Adherence and distress over time

• Among patients who completed all tests (n = 138):
  • Adherence and distress varied over the 48-week observation period but on the whole remained consistent (Figure 1).
  • 36.9% consistently reported low adherence through to Week 48.
    • Stable low adherence was more frequent in patients with PV vs MF (52.6% vs 31%, respectively; p = 0.02)
  • Cases of unintentional non-take decreased from 47.8% (Week 0) to 26% (Week 48).

MF, myelofibrosis; PV, polycythemia vera.
*Adapted from Palandri, et al.¹

• 22.5% of patients reported always having high distress; this was comparable between MF and PV (p = 0.83).
• Overall, 61 patients with MF consistently reported high adherence from Week 0 to Week 24.
• The probability of achieving a spleen response was higher among patients with MF who always reported low distress (n = 69; p = 0.04)

Key learnings

ln this study, almost half of patients reported low adherence to RUX (n=94). Most cases of low adherence were unintentional and caused by difficulty in obtaining RUX itself. Strategies to address system and organizational barriers, as well as improving patient awareness, are needed. The amelioration of the psychological condition of patients with MF is particularly important given the association with better treatment responses and superior outcomes.