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Patients With Myelofibrosis and Anemia Treated With Ruxolitinib Have Higher Health Care Resource Utilization, Clinical Burdens
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Treatment with ruxolitinib in patients with myelofibrosis and anemia was associated with more inpatient medical center and emergency department visits while increasing health care-related financial burdens compared with nonanemic patients.
According to a real-world analysis of treatment patterns and health care resource utilization (HCRU) in ruxolitinib (Jakafi; Incyte Corporation)-treated patients with myelofibrosis (MF) with and without anemia, patients with each of these conditions who initiate ruxolitinib have higher HRCU and clinical burdens compared with nonanemic patients also treated with ruxolitinib.1
Anemia can worsen survival in patients with myelofibrosis. | Image Credit: © Spectral-Design - stock.adobe.com
These results provide further context to the known risks of initiating ruxolitinib treatment in patients with MF and anemia, indicating that complications can stretch beyond clinical impacts, further reducing patient quality of life (QoL). Past literature, including a retrospective cohort study of 629 patients, demonstrated that patients with MF and anemia receiving ruxolitinib experience heightened anemia burden and reduced overall survival.1,2
A separate real-world analysis, featuring a cohort of 286 patients with MF who were separated into anemic and nonanemic groups, found that patients with MF and anemia have poorer overall survival outcomes compared with nonanemic patients when treated with ruxolitinib. Despite the benefits that JAK inhibitors like ruxolitinib provide in terms of spleen volume reductions and symptom improvement, the possibility of causing or worsening anemia—even with lower doses—necessitated a thorough evaluation from the current investigators of impacts to patients beyond clinical outcomes, mainly in QoL, HCRU, and health care costs.1,3
The investigators utilized health care claims data from the IQVIA PharMetrics Plus database and, based on the FDA approval of ruxolitinib, determined an analysis period of January 2011 to December 2022. Patients with a diagnosis of MF were identified from the database, and had to have been treated with ruxolitinib for inclusion in the analysis. Anemia stratification was determined through patient insurance claims for anemia treatment, while HCRU and health care cost outcomes were assessed over a multi-year follow-up period.1
In total, 11,499 patients with a diagnosis of primary or secondary MF were identified in the database during the study period, of which 481 patients met eligibility criteria and were included in the analysis. Among the eligible patients at baseline, 257 (53.4%) were considered anemic, while 224 (46.6%) were considered nonanemic, according to the study authors.1
Investigators observed significantly higher annual all-cause HCRU in anemic patients compared with nonanemic patients. The median number of annual visits to a health care center were twice as high for anemic compared with nonanemic patients (40.0 versus 20.0, respectively; P <.001), with median annual inpatient admissions and emergency department visits also significantly higher among anemic patients (0.3 versus 0.0, P <.001 and 0.4 versus 0.0, P <.010, respectively), the investigators found. Additionally, the proportion of patients with any all-cause inpatient admissions and emergency department visits was meaningfully higher in anemic compared with nonanemic patients.1
Moving to an analysis of health care costs, anemic patients had numerically, though not statistically significantly, higher median annual all-cause total health care costs and total medical costs. Interestingly, anemic patients had significantly lower median total all-cause pharmacy costs than nonanemic patients, though the investigators note that it is a relatively small difference. Similarly to all-cause medical costs, MF-related medical costs were higher among anemic patients compared with nonanemic.1
Ruxolitinib treatment patterns among the population were further elucidated. Across patients who continued ruxolitinib treatment throughout the follow-up period, rates of receiving doses less than 20 mg per day were numerically higher among anemic than nonanemic patients at both 3 months (20.9% versus 15.2%, respectively) and 6 months (13.3% versus 12.6%, respectively) post-index point, the investigators found. Importantly, anemic patients were observed to discontinue ruxolitinib treatment almost 1 year earlier than their nonanemic counterparts.1
The observations in this retrospective analysis conform with results from past literature that suggest worsened survival outcomes in patients with MF and anemia treated with ruxolitinib. Research should focus on alternative methods for improving survival in patients with MF treated with ruxolitinib; leveraging the strong spleen and symptom benefits provided with JAK inhibitors while avoiding worsened anemia-related complications could help improve patient outcomes across the disease spectrum.1-3
“Evaluating alternative treatments and adjusting for other confounders with the potential to drive HCRU and costs, such as baseline comorbidities, should be explored in future analyses,” the study authors concluded.1
