Mayo Clinic proceedings
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Mayo Clinic proceedings · Dec 2011
Case ReportsSerious adverse events during ruxolitinib treatment discontinuation in patients with myelofibrosis.
Ruxolitinib (INCB018424) is a JAK1 and JAK2 inhibitor recently evaluated for the treatment of myelofibrosis (MF) in early- and advanced-phase clinical trials. In 2 recent communications that focused on short-term and long-term ruxolitinib treatment outcome, respectively, the drug was shown to be effective in controlling constitutional symptoms and splenomegaly but was also associated with important adverse effects, including moderate to severe thrombocytopenia and anemia. The most recent of the 2 communications focused on 51 Mayo Clinic patients who participated in the original phase 1/2 ruxolitinib clinical trial and highlighted a high treatment discontinuation rate (92% after a median time of 9.2 months), primarily for loss of treatment benefit but also because of drug-associated adverse effects. ⋯ This "ruxolitinib withdrawal syndrome" was characterized by acute relapse of disease symptoms, accelerated splenomegaly, worsening of cytopenias, and occasional hemodynamic decompensation, including a septic shocklike syndrome. In the current sponsor-independent analysis, we describe the details of these events in 5 severely affected cases (11%) among 47 Mayo Clinic patients with MF in whom ruxolitinib therapy had been discontinued. Our experience calls for full disclosure of the ruxolitinib withdrawal syndrome to patients with MF before initiating ruxolitinib therapy, and treatment discontinuation must be done under close physician supervision and preferably in a tapering schedule.
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Mayo Clinic proceedings · Dec 2011
Comparative StudyHerpes zoster and postherpetic neuralgia surveillance using structured electronic data.
To develop electronic algorithms for rapid, automated surveillance for herpes zoster and postherpetic neuralgia (PHN) using codified electronic health data. ⋯ Novel algorithms incorporating multiple streams of electronic health data can reasonably detect herpes zoster and PHN. These algorithms could facilitate meaningful public health surveillance using electronic health data. The incidence of PHN may be increasing.