How to safely reduce or discontinue Momelotinib and precautions

Molotinib is an JAK1/JAK2 and ACVR1 inhibitor, mainly used to improve anemia and control spleen and symptoms in patients with moderate to severe myelofibrosis. Since this drug has the effect of continuously inhibiting inflammatory pathways and regulating hematopoiesis, you cannot stop the drug at will or suddenly reduce the dose, otherwise it may lead to a rebound in symptoms, an aggravation of anemia, or a rapid increase in spleen volume. Generally speaking, if the patient's condition is stable or the treatment plan needs to be adjusted, the doctor will make a tapering plan based on the blood picture, symptom changes, and the degree of adverse reactions, rather than discontinuing the drug directly.

The usual reduction method is Gradually reduce the daily dose or the frequency of dosing, for example, reduce the standard dose to a lower dose for observation 1–2 weeks, and then further adjust according to blood images and clinical manifestations. If the patient needs to reduce the dose due to adverse reactions (such as worsening of anemia, increased risk of infection, elevated liver enzymes, neurological symptoms, etc.), doctors will be more cautious and need to closely monitor blood routine, liver and kidney function, and symptom changes after each dose reduction. Patients should not reduce the dosage on their own, as too rapid a reduction in dosage may cause fatigue rebound, an increase in bone marrow inflammatory factors, and an unstable condition.

Discontinuation of medication requires a clear medical basis. Common reasons include: disease progression, intolerable toxic reactions, severe infection, continued enlargement of the spleen, or deterioration of the blood picture, etc. If medication needs to be discontinued due to adverse reactions, clinical practice usually adopts a "temporary discontinuation - review - assessment of whether to resume low-dose treatment" model, rather than permanent discontinuation. If it is determined that molotinib needs to be completely discontinued, a 1–2 week observation period is usually still given to see if the patient's symptoms worsen, and follow-up alternative treatments are prepared in a timely manner, such as JAK inhibitor replacement regimen or combined with other supportive treatments.

During the entire process of reducing or discontinuing medication, patients need to pay attention to several key points: first, closely monitor blood, especially hemoglobin, white blood cells and platelets; second, pay attention to whether symptoms such as spleen enlargement, fever, weight loss, bone pain, etc. reappear; third, if signs of infection appear (fever, chills, obvious fatigue), they need to seek medical treatment immediately; fourth, follow the doctor's advice and do not stop medication or adjust the dose on your own. Generally speaking, the discontinuation and dosage reduction of molotinib must be based on the core principles of "step-by-step, close monitoring, and full participation of doctors" in order to maximize safety and maintain disease stability.

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