Madan Jagasia, MBBS, MS, on Ruxolitinib to Treat Steroid Refractory GvHD

Madan Jagasia, MBBS, MS, of the Vanderbilt University Medical Center discussed the next steps in treating acute graft versus host disease with ruxolitinib.

Madan Jagasia, MBBS, MS, talks about the data relating to non-responders of ruxolitinib (Jakafi), and emphasizes the importance of integrating ruxolitinib into treatment as soon as a patient is steroid refractory in acute graft versus host disease.


So, ruxolitinib is a JAK1/JAK2 inhibitor that is very effective in steroid refractory acute graft versus host disease, but it comes with a price because you’re suppressing the immune system. And the worry is that with suppression of the immune system, we will be exposing the patient to more infections. Data will be coming out in the form of a manuscript where we try to address this in a more granular manner. What it appears, that when ruxolitinib works, and the patient responds from a GvHD standpoint, the risk of infection actually decreases.

It is the non-responders for ruxolitinib that is really giving the signal of the high infection rate. Thus, ruxolitinib non-responders is really the group that now we need the scientific focus on to see how we can improve the outcomes of these patients. Again, patients who respond to ruxolitinib with the current anti-infective strategies that we have, I don’t think those patients are going to get into a whole lot of trouble with ruxolitinib.

Only thing to keep in mind is ruxolitinib is approved for steroid refractory, so what I would request physicians is: As soon as a patient is steroid refractory, start the next line of therapy in the form of ruxolitinib. Don’t wait out too long. Don’t expose the patient to unnecessary steroids because unnecessary steroids generate the milieu of ongoing infections as well.