Common brand names

• Jakafi
• Jakavi
• Opzelura

How it is administered

Ruxolitinib is available as oral tablets (for conditions like myelofibrosis, polycythemia vera, and graft-versus-host disease) and as a topical cream (for skin conditions like atopic dermatitis and vitiligo).

For blood cancers and related conditions, ruxolitinib is taken by mouth, usually twice daily. The dose depends on the specific disease and your blood counts. Tablets come in strengths ranging from 5 mg to 25 mg.

For patients unable to swallow tablets, the medication can be suspended in water and administered through a nasogastric tube.

How it works

Ruxolitinib is a type of medication called a Janus kinase (JAK) inhibitor. It works by blocking the activity of two enzymes, JAK1 and JAK2, which are important in the signaling pathways that control blood cell production and immune function.

In certain blood cancers, such as myelofibrosis and polycythemia vera, these pathways are overactive, leading to abnormal blood cell growth and inflammation. By blocking JAK1 and JAK2, ruxolitinib helps to reduce the abnormal growth of blood cells, decrease inflammation, and improve symptoms such as enlarged spleen and fatigue.

This mechanism is also relevant in conditions where the immune system is overactive, such as graft-versus-host disease, by reducing the immune response and inflammation.

Who should take it

Ruxolitinib is indicated for adults with intermediate or high-risk myelofibrosis (including primary myelofibrosis, post-polycythemia vera myelofibrosis, and post-essential thrombocythemia myelofibrosis), as well as adults with polycythemia vera who have not responded to or cannot tolerate hydroxyurea.

It is also approved for the treatment of steroid-refractory acute and chronic graft-versus-host disease in adults and children 12 years and older. While ruxolitinib is not specifically approved for Large Granular Lymphocytic Leukemia, it may be considered in certain cases if other treatments are not effective, especially if the disease shares features with other blood cancers that respond to JAK inhibition.

Who should not take it

There are no absolute contraindications listed for ruxolitinib, but it should be used with caution in certain situations.

Patients with active, serious infections should not start ruxolitinib until the infection is controlled. It should also be used carefully in people with low blood counts (anemia, thrombocytopenia, or neutropenia), as the medication can further lower these counts. Patients with a history of tuberculosis, hepatitis B or C, or those at increased risk for cardiovascular events or blood clots should discuss the risks and benefits with their healthcare provider before starting ruxolitinib.

Commonly used with

Ruxolitinib may be used alongside other supportive treatments such as blood transfusions, antibiotics for infections, and medications to manage side effects.

In the setting of graft-versus-host disease, it may be used with corticosteroids and other immunosuppressive agents. It is important to inform your healthcare provider of all medications you are taking, as ruxolitinib can interact with drugs that affect liver enzymes (such as strong CYP3A4 inhibitors or inducers).

Commonly tested with

Ruxolitinib has been tested in combination with other therapies in clinical trials for myeloproliferative neoplasms and graft-versus-host disease. These may include corticosteroids, hydroxyurea, and other immunosuppressive or chemotherapy agents.

It is not recommended to use ruxolitinib with other JAK inhibitors or strong immunosuppressants unless specifically directed by your healthcare provider.