Patterns of Care for Older Patients With Myelofibrosis: A Population-based Study |
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| Authors: | Shelby Meckstroth Rong Wang Xiaomei Ma Nikolai Podoltsev |
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| Institution: | 1. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT;2. Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT;3. Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT;1. Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI;2. University of Michigan College of Pharmacy, Ann Arbor, MI;3. Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI;1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA;2. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA;3. Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany;4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA;5. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan;6. Department Obstetrics and Gynecology, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan;1. Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada;2. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada;1. Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. Department of Hematology/Oncology, Children''s Hospital of Soochow University, Suzhou, Jiangsu Province, China;1. Department of Haematology, Epworth HealthCare, Melbourne, Victoria, Australia;2. Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia;3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia;4. Department of Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia |
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| Abstract: | BackgroundCurrent treatments for myelofibrosis (MF) are largely palliative, with the JAK inhibitor ruxolitinib being the breakthrough approved for higher-risk patients by the United States Food and Drug Administration in November 2011. There are limited data on the “real-world” clinical experiences among patients with MF who are treated in the JAK inhibitor era.Patients and MethodsWe evaluated patterns of care for older patients with MF before and after ruxolitinib approval, using the Surveillance, Epidemiology, and End Results-Medicare database. Treatment patterns were assessed using Medicare part B and D claims.ResultsThis study included 528 patients diagnosed during 2007 to 2015, with a median age at diagnosis of 76 years. Among 298 patients diagnosed in the ruxolitinib era (2012-2015), 113 (37.9%) were ruxolitinib users. Similar numbers of users started ruxolitinib at 5, 10, 15, or 20 milligrams twice a day (BID). Among 31 patients starting at 5 milligrams BID or less, 48.4% were unable to escalate the dose, and < 11 users could increase the dose to the maximum 25 mg BID. Approximately one-half of ruxolitinib users took hydroxyurea and/or prednisone simultaneously with ruxolitinib. The median time on ruxolitinib was 11.9 months (interquartile range, 4.2-21.7 months).ConclusionIt would be important to optimize the use of ruxolitinib and develop new drugs that may be administered together with or after ruxolitinib to accomplish better outcomes in older patients with MF. |
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| Keywords: | Older adults Real-world Ruxolitinib SEER-Medicare Treatment |
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