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Meta-Analysis
. 2020 Jan 28;4(2):380-386.
doi: 10.1182/bloodadvances.2019001158.

Ruxolitinib for the prevention of thrombosis in polycythemia vera: a systematic review and meta-analysis

Arianna Masciulli, Alberto Ferrari  1 , Alessandra Carobbio  1 , Arianna Ghirardi  1 , Tiziano Barbui  1
Affiliations
Meta-Analysis

Ruxolitinib for the prevention of thrombosis in polycythemia vera: a systematic review and meta-analysis

Arianna Masciulli et al. Blood Adv. .

Abstract

Ruxolitinib is a recommended second-line treatment for the prevention of thrombosis in patients with polycythemia vera who become resistant or intolerant to hydroxyurea; however, evidence regarding its efficacy in terms of thrombosis reduction is uncertain. We searched Medline, Embase, and archives of abstracts from the European Hematology Association and the American Society of Hematology annual congresses from 2014 onward for randomized controlled trials comparing the treatment vs best available therapy (BAT). Our search retrieved 80 records; after screening of abstracts and full text, the total was reduced to 16. Evidence came from 4 randomized controlled trials, including 663 patients (1057 patients per year). We estimated a thrombosis risk ratio of 0.56 for ruxolitinib BAT, corresponding to an incidence of 3.09% and 5.51% patients per year, respectively. The number of thrombotic events reported with ruxolitinib was consistently lower than that with BAT in our sample, but, globally, the difference did not reach significance (P = .098). Hard evidence in favor of ruxolitinib is lacking; a clinical trial on selected patients at high risk of thrombosis would be warranted, but its feasibility is questionable.

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Conflict of interest statement

Conflict-of-interest disclosure: T.B. is a member of the advisory board and has received research grant funding from Novartis and AOP (Orphan Drug Company). The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Study selection process detail.
Figure 2.
Figure 2.
RCTs on ruxolitinib (Rux). Annual incidence of thrombosis per study per arm with binomial CIs and corresponding calculated RRs.
See this image and copyright information in PMC

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