How to prevent the risk of infection (such as herpes zoster) during treatment with ruxolitinib tablets?

Ruxolitinib tablets/ruxolitinib(JAKAVI), as a JAK1/JAK2 inhibitor, is widely used in the treatment of myelodysplasia-related diseases such as polycythemia vera (PV), primary myelofibrosis (PMF) and secondary myelofibrosis (sMF). Although the drug has shown good efficacy in controlling disease-related symptoms and reducing spleen volume, its immunosuppressive effect may also lead to an increased risk of certain infections, especially the recurrence or activation of herpes zoster (HZ), which has become an important safety issue of clinical concern.

Ruxolitinib interferes with the downstream signals of various cytokines by inhibiting theJAK signaling pathway, thereby affecting the body's immune response ability, especially inhibiting the functions of T cells and natural killer cells (NK cells). While this immune regulation helps control abnormal cell proliferation, it also makes patients more susceptible to latent viruses, the most common of which is activation of the herpes zoster virus. Herpes zoster usually presents as unilateral band-like rash and severe neuralgia. If not treated in time, it may develop into post-herpetic neuralgia, which has a significant impact on quality of life.

In order to effectively prevent the risk of herpes zoster infection associated with ruxolitinib, it is usually clinically recommended to assess the patient's past history of viral infection, especially chickenpox-herpes zoster virus (VZV) infection, before treatment. Among those at higher risk, such as those who are elderly, have low immune function, and have a history of herpes zoster, vaccination with a recombinant herpes zoster vaccine that is not a live vaccine may be considered before starting treatment to enhance the body's specific immunity.

In addition, patients should be closely monitored throughout treatment for signs of infection, such as skin tingling, localized pain, or blister formation. Once herpes zoster is suspected, antiviral treatment, such as acyclovir or valacyclovir, should be initiated as soon as possible, and whether the ruxolitinib dose needs to be adjusted or temporarily discontinued based on the patient's clinical response is assessed.

Reference materials:https://www.jakavi.com/