Ruxolitinib (Jakafi®)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • indicated for the treatment of patients with intermediate or high risk myelofibrosis (MF): primary MF, post-polycythemia vera MF, and post essential thrombocythemia MF

Patients must meet the following criteria for the indication(s) above:

  • Patients with active serious infections should not be treated until the infection resolves. A complete baseline blood count must be done prior to initiation of therapy and every two-four weeks until the dose is stabilized

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee:

  • All non-FDA approved uses not listed in the approved indications

Dosing:

Patient dosing based on platelet count

platelet count

100-200 x 109/L

>200 x 109/L

starting dose 15 mg twice daily 20 mg twice daily
  • Dose may be increased in increments of 5 mg twice daily up to a maximum dose of 25 mg twice daily (50 mg per day) Dosing must be adjusted for both renal and hepatic impairment
  • Ruxolitinib should be tapered on discontinuation. The recommendation is to reduce the dose by 5 mg twice daily each week
  • Dose taper is not recommend if discontinuation is due to thrombocytopenia

Approval:

Six months; Treatment should be discontinued at 6 months if no spleen size reduction is seen


 

Last review date: December 2, 2013