March 14, 2012
Volume 7 - Issue 11             

DynaMed Weekly Update

For the week ending March 9, 2012  

Last week 305 articles were evaluated via DynaMed's Systematic Literature Surveillance and 191 were added to DynaMed content. 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Ruxolitinib May Improve Survival in Patients with Myelofibrosis


There are few treatment options for myelofibrosis, a myeloproliferative neoplasm causing splenomegaly and an array of symptoms including fatigue, weakness, abdominal pain, weight loss, itching, night sweats, and bone pain. Mean survival has been estimated at 4-7 years (Blood 2009 Mar 26;113(13):2895). Ruxolitinib, a selective inhibitor of Janus kinase 1 and 2, has been associated with clinical benefit in a previous case series of patients with myelofibrosis (N Engl J Med 2010 Sep 16;363(12):1117). Now, ruxolitinib has been evaluated in a large randomized trial with 309 adult patients with intermediate to high-risk myelofibrosis. Patients were randomized to ruxolitinib vs. placebo orally twice daily. The starting ruxolitinib dose was determined by baseline platelet count and adjusted for lack of efficacy or excess toxicity. Crossover from placebo to ruxolitinib was permitted for protocol-defined worsening of splenomegaly.


At median follow-up of 51 weeks, mortality was 8.4% for ruxolitinib vs. 15.6% for placebo (p = 0.05, NNT 14) (level 2 [mid-level] evidence). At planned analyses at 24 weeks, ruxolitinib was associated with significantly greater rates of patients with ≥ 50% reduction in total myelofibrosis-related symptoms (45.9% vs. 5.3%, p < 0.001, NNT 3), and patients with ≥ 35% reduction in spleen volume (41.9% vs. 0.7%, p < 0.001, NNT 3). The rate of crossover from the placebo to ruxolitinib was 23.4% (N Engl J Med 2012 Mar 1;366(9):799).


For more information, see the Myeloid Metaplasia with Myelofibrosis (MMM) topic in DynaMed.

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: March 14, 2012 
Expiration Date: March 14, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
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AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.


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Program ID 1102072B.

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