Increased use of ruxolitinib in patients with myelofibrosis appears to be occurring mostly at the expense of thalidomide and erythropoiesis-stimulating agents (ESAs), according to a retrospective analysis involving 309 individuals. It has not had a major effect on first-line use of hydroxyurea. Participants had myelofibrosis and were treated at a single center either before (n=174) or after (n=135) ruxolitinib’s approval. Among the results:

• Patients treated after ruxolitinib’s approval were less likely to receive ESAs and thalidomide than those treated before approval.
• In patients with myelofibrosis-related symptoms and/or splenomegaly, increased ruxolitinib use was linked with decreased first-line ESA or thalidomide use.
• Increased use of first-line ruxolitinib was linked with decreased thalidomide use in patients with anemia.
• Hydroxyurea was the preferred first-line treatment in those with severe leukocytosis.