title: The impact of ruxolitinib on thrombosis in patients with polycythemia vera and myelofibrosis: a meta-analysis.
abstract: The Food and Drug Administration approval of ruxolitinib for treatment of myelofibrosis and polycythemia vera has changed the management of patients with myeloproliferative neoplasms. Yet the impact of this therapy on risk of thrombosis, a major cause of morbidity and mortality among these patients, remains unknown. The aim of this study was to evaluate the impact of ruxolitinib on the risk of thrombosis among patients with polycythemia vera or myelofibrosis. Following identification of randomized controlled trials comparing ruxolitinib to standard care or placebo, rates of thrombosis, including venous and arterial thrombosis, were analyzed using fixed effects models. Rates of thrombosis were significantly lower among patients treated with ruxolitinib [risk ratio 0.45, 95% confidence interval (CI) 0.23-0.88]. Subgroup analysis of venous and arterial thrombosis demonstrated similar risk ratios, which did not reach statistical significance (risk ratio 0.46, 95% CI 0.14-1.48 and RR 0.42, 95% CI 0.18-1.01, respectively). In conclusion, our analysis suggests that JAK2 inhibition with ruxolitinib decreases the risk of arterial and/or venous thrombosis in patients with polycythemia vera or myelofibrosis. These findings will require confirmation in a prospective study.
authors.affiliation: aDivision of Hematology, University of Washington, Seattle, Washington bDepartment of Biostatistics and Epidemiology, University of Oklahoma, Norman, Oklahoma, USA cDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Bethany T
authors.initials: BT
authors.lastname: Samuelson
authors.forename: Sara K
authors.initials: SK
authors.lastname: Vesely
authors.forename: Chatree
authors.initials: C
authors.lastname: Chai-Adisaksopha
authors.forename: Bart L
authors.initials: BL
authors.lastname: Scott
authors.forename: Mark
authors.initials: M
authors.lastname: Crowther
authors.forename: David
authors.initials: D
authors.lastname: Garcia
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D053614:Janus Kinase 2 / Q000037:antagonists & inhibitors / Q000378:metabolism; D009570:Nitriles; D016017:Odds Ratio; D011087:Polycythemia Vera / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D055728:Primary Myelofibrosis / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011720:Pyrazoles / Q000627:therapeutic use*; D011743:Pyrimidines; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D009570:Nitriles; D047428:Protein Kinase Inhibitors; D011720:Pyrazoles; D011743:Pyrimidines; C540383:ruxolitinib; C507924:JAK2 protein, human; D053614:Janus Kinase 2