Dr Hunter on the Role of Momelotinib as First-Line Therapy in Myelofibrosis

“Momelotinib is really emerging in this space now, and [it] was FDA approved specifically for patients with [myelofibrosis] and anemia. [It] does have the potential for similar spleen and symptom reductions that we may see in ruxolitinib, but also the potential to improve anemia over time, and could lead to transfusion independence in some patients who are transfusion dependent.”

Anthony M. Hunter, MD, an assistant professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine, discussed the role of momelotinib (Ojjaara) for the first-line treatment of patients with myelofibrosis and anemia.

Historically, ruxolitinib (Jakafi) has been the standard of care in the myelofibrosis landscape, which has demonstrated its efficacy in the first-line setting, Hunter began. For patients who exhibit anemia, he noted that reduced dosing strategies could help; however, momelotinib has emerged as another option in the landscape following its September 2023 FDA approval for the treatment of adult patients with intermediate or high-risk myelofibrosis, which included primary or secondary myelofibrosis, and anemia. Hunter emphasized that momelotinib has demonstrated similar spleen and symptom reductions compared with ruxolitinib, along with its potential to improve anemia over time. Of note, momelotinib is also associated with transfusion independence in patients who are transfusion dependent, he added.

Still, there are some challenges that need to be addressed regarding anemia, Hunter said. Specifically, knowing when the cut off is for anemia and identifying when momelotinib should potentially be used over ruxolotinib, as it relates to their respective safety profiles, he explained. Notably, the measurement of hemoglobin could also help determine which treatment could be best in the first-line setting for a given patient, he continued. Hunter noted that if a patient’s hemoglobin levels are at 9 g/dL or below, then he would consider selecting treatment differently. Some patients can tolerate anemia well, whereas others may not, and therefore, treatment approaches should be tailored to each individual, he said. A reasonable option could be ruxolitinib for many patients, but for those with moderate to severe anemia, momelotinib could offer another treatment option, he concluded.