VAF vs time for Rux, plot in the report cited by Manouche

[EPguy]

This post from Manouche had a reference with (maybe) this first ever plot for Rux VAF (mutation) vs time for PV. I figured this is worth another mention.

healthunlocked.com/mpnvoice...

I had some selected comments there.

We have seen many VAF vs time plots for IFN. The absence of any for Rux may be that until recently, PV data were not available while VAF reductions are now known to be common with PV. I added the gray plot for a conversion of the Ropeg absolute VAF data to % decrease to match this Rux plot. These are unrelated trials and thus this comparison is only to suggest the relative trends. For example Rux pts were HU resist/intol while IFN pts were not selected for that.

IFN has a steeper reduction, HU status could be one reason but this is not addressed. In another recent post it was discussed that Rux can take years but reductions can continue.

I will soon post my latest results that can compare these trends for me.

--

Reproduced here are some of my notes from the other thread.

In one trial, (not the one plotted) after 8 years VAF on Rux was 68% to 3.5%.

pubmed.ncbi.nlm.nih.gov/388...

Shingles: this risk consistently shows up, Hazard ratio is over 7. They and other reports recommend the vaccine, preferably before starting. For pts with prior Shingles consider antiviral valacyclovir.

Weight Gain They call this common adverse event at least a grade 3, while no unusual hazard is cited. So those upset about it can know these authors don't like it either.

Skin Cancer (MNSC) This report cites no clear added risk with Rux, while prior MNSC is a risk.

[Hopetohelp]

Thank you for the information. Very interesting

[gjh8733]

Thanks so much for sharing ! Really interesting and promising. I will post my VAF after I have been on Jakafi for a year

[ainslie]

“For pts with prior Shingles consider antiviral valacyclovir.”

I hadn’t heard that valacyclovir is better for patients with prior shingles, is that written somewhere?. I’ve had shingles but got Shingrix afterwards and so far so good.

[EPguy in reply to ainslie]

Here is the report that came from. It's worth a post in its own right.

pmc.ncbi.nlm.nih.gov/articl...

"we prefer vaccination with RZV over valacyclovir prophylaxis awaiting the results of the pending studies on the effect of RZV (the new shingles vax) in patients treated with JAK inhibitors. However, because it is uncertain whether RZV is effective enough, it should be considered to give valacyclovir prophylaxis in patients with additional risk factors, that is, a previous history of HZ"

One member here is getting this antiviral.

They have these plots. They appear to show approaching 50% pts getting shingles, with the risk maxed out at 5 years. But I find the text confusing vs the plot. It's full of info and a deep dive might pull out a more coherent story.

hz

[ainslie in reply to EPguy]

I think the drug manufacturers stated 6% on Rux get shingles, I suspected it was higher but 40-50% is quite a jump.

[EPguy in reply to ainslie]

They had this:

...25 of 128 patients (19,5%) developed HZ during ruxolitinib treatment". This is ~20%.

So less than the plots show; it does need more scrutiny to figure out. But this part is clear:

"We also found a much higher incidence in real life as compared to the ruxolitinib registration studies"

They and/or others imply there is some sort of ongoing study for effectiveness of the vax while on Rux.