Pharmacy Times interviewed James A. Davis, PharmD, BCOP, clinical oncology specialist, malignant hematology at the Medical University of South Carolina (MUSC) Health, on the pharmacist’s role in myelofibrosis treatment today and the potential impact of the recent FDA approval of momelotinib (Ojjaara; GSK) for treating intermediate or high-risk myelofibrosis in patients with anemia. Specifically, Davis sheds light on how the pharmacist’s role in myelofibrosis treatment has evolved over the past decade and some key research that may change treatment opportunities for myelofibrosis in the future.
Pharmacy Times: What is the pharmacist’s role in myelofibrosis treatment today, and how has that changed over the years?
- The Pharmacist’s Role Has Evolved: Over the past decade or so, the role of pharmacists in myelofibrosis treatment has evolved significantly. Historically, pharmacists primarily focused on dispensing medications, but now they are actively involved in patient care. They provide counseling, patient education, dose management, and monitor for drug interactions. Pharmacists also assist in symptom management, conduct follow-up calls, and contribute to decision-making in collaboration with health care providers.
- Impact of Momelotinib Approval for Patients: The recent FDA approval of momelotinib for treating intermediate or high-risk myelofibrosis with anemia is a significant development. Anemia is a common symptom among myelofibrosis patients, and existing JAK inhibitors can sometimes worsen it. Momelotinib offers the potential to reduce the transfusion burden and increase transfusion independence, a benefit not seen with other JAK inhibitors. This approval represents a positive step in improving the quality of life for these patients.
- Promising Research on the Horizon: Ongoing research in the myelofibrosis field focuses on developing treatments that target the disease process, potentially leading to improved overall survival and even a cure for some patients. Promising upcoming agents include pelabresib (Constellation Pharmaceuticals), imetelstat (Geron), and navitoclax (AbbVie). These agents, when used in combinations with currently approved JAK inhibitors, have shown early-phase study results in decreasing bone marrow fibrosis, which is a key aspect of the disease. This research holds promise for the future of myelofibrosis treatment.
- Pharmacists Play a Critical Role in Myelofibrosis Treatment: Overall, pharmacists play a vital role in myelofibrosis treatment by considering patients' individual characteristics, lab results, and treatment history when making recommendations for treatment. Pharmacists will continue to be integral in optimizing patient outcomes through diverse contributions to patient care.
James A. Davis, PharmD, BCOP: The pharmacist’s role in myelofibrosis treatment has really changed over the past probably 10 to 15 years. Historically, pharmacists have really played more of a dispensing role, but in recent years we have pharmacists in the clinic, we have specialty pharmacists, we have pharmacist everywhere involved in the patient's care.
For myelofibrosis specifically, I work in a clinic with patients, and I see patients with a physician and the provider. I provide counseling and patient education, and I ensure that the doses are correct, and that there's no important drug interactions. I sometimes will even have patients give me their symptom scores via symptom score forms, I often provide follow up calls, and I sometimes help in decision making with the provider. Obviously, [I also provide] supportive care to ensure patients get their vaccinations.
Specialty pharmacists also play a large role, and they help pharmacists like me in clinic. The specialty pharmacy and my team at my institution, we have technicians and specialty pharmacists that help us with prior authorizations. They also provide counseling, follow up calls, and refill management to ensure patients are compliant with these medications.
I sometimes will even have patients give me their symptom scores via symptom score forms, I often provide follow up calls, and I sometimes help in decision making with the provider. Image Credit: © saltdium - Adobe Stock
Pharmacy Times: The FDA approved momelotinib to treat intermediate or high-risk myelofibrosis in adult patients with anemia on September 15. What has been the burden of myelofibrosis on patients with anemia to date, and what does this FDA approval potentially mean for these patients?
Davis: Greater than half of patients have symptomatic anemia at the time of diagnosis of myelofibrosis. Many of these patients have trouble performing activities of daily living. For instance, 44% of patients have trouble walking out of their residence, 38% of patients report difficulties driving, and 31% of patients have difficulties going to the grocery store. So, anemia is burdensome for a lot of patients with myelofibrosis.
Current JAK inhibitor approvals can actually worsen anemia. So, the patients have anemia on diagnosis, we start these medicines, and it can actually worsen anemia along with other cytopenias. Many patients require combinations, extra visits for blood transfusions, or combinations to help improve anemia with erythropoiesis-stimulating agents. So, the momelotinib approval is really exciting for us, because now we have a JAK inhibitor that actually can decrease patients’ transfusion burden and increase transfusion independence, which has not been shown with any of the currently available JAK inhibitors.
Pharmacy Times: What are some key findings you’re watching in the myelofibrosis space and is there any upcoming research that may impact treatment decisions?
Davis: Yeah, we're really excited for upcoming research in the fact that we want agents that are targeting the disease process, and hopefully helping to improve overall survival and potentially cure patients. A lot of these upcoming studies are combinations with currently approved JAK inhibitors, and the novel agents that are used in combinations have actually been shown in early phase studies to decrease bone marrow fibrosis, which is actually the disease process. So, by improving fibrosis, we hope to potentially cure these patients.
Some of these upcoming agents are pelabresib (Constellation Pharmaceuticals), imetelstat (Geron), and navitoclax (AbbVie).
Pharmacy Times: What do you take into consideration when making myelofibrosis treatment recommendations to physicians/oncologists?
About the Author
James A. Davis, PharmD, BCOP, is a clinical oncology specialist, malignant hematology at the Hollings Cancer Center at Medical University of South Carolina (MUSC) Health, as well as an assistant professor at the MUSC College of Pharmacy.
Davis: When I make recommendations as part of the team, I always take into considerations patients’ age or fitness and their comorbidity status. So, we don't want to start a JAK inhibitor if they have XYZ comorbidity that can interact or cause harm. We always look at baseline labs, and so we have JAK inhibitors that have a niche for patients with baseline thrombocytopenia, or momelotinib, which was just approved for patients with baseline anemia, and then we always keep in mind their treatment history. So, if they failed one JAK inhibitor we don't use that same JAK inhibitor, we change things up a little.
Pharmacy Times: What is your current outlook on the future of myelofibrosis treatment and the pharmacist’s role in helping patients reach optimal outcomes?
Davis: Currently, the only chance of cure for patients with myelofibrosis is an allogeneic stem cell transplant. So, we are looking for novel treatments that can improve overall survival and potentially cure patients who aren't transplant candidates.
The pharmacist’s role in in reaching optimal outcomes involves things that I mentioned earlier. So, [patient] education, counseling, dose optimization, drug interactions, symptom scores, and follow up with patients for compliance. We're involved in decision making, supportive care, specialty pharmacy, and other pharmacy can help with prior authorizations, follow up counseling, follow up calls, and compliance, etc.