Possible reactions and treatment methods after discontinuation of momelotinib

Momelotinib is an oral JAK1/JAK2 inhibitor, mainly used to treat patients with myelofibrosis (MF), especially moderate to severe patients with anemia and myelofibrosis symptoms. The drug reduces the inflammatory response related to myelofibrosis and improves symptoms such as anemia and splenomegaly by inhibiting the Janus kinase (JAK) signaling pathway. Patients' blood cell levels and symptoms can usually be well controlled during long-term use of molotinib, but a series of reactions may occur after discontinuation of the drug, which requires clinical and patient attention.

First of all, the most common reaction after stopping the drug is the recurrence or worsening of symptoms, including the emergence of symptoms such as re-enlargement of the spleen, fatigue, worsening of anemia, night sweats, weight loss, and bone pain. This is because once the inhibitory effect of molotinib disappears, the JAK signaling pathway may become active again, leading to an increase in the level of inflammatory factors and a decrease in bone marrow hematopoietic function, thus causing a rebound in symptoms that were originally under control. Some patients may experience significant changes in clinical symptoms within a few days to a week after stopping the drug. Therefore, it is clinically recommended to conduct a full evaluation before stopping the drug and to closely monitor symptoms and blood indicators after stopping the drug.

Secondly, hematological indicators may also fluctuate after stopping the drug, especially hemoglobin, white blood cells, and platelets. Patients taking molotinib for a long time may experience worsening anemia or decreased platelets after stopping the drug, and some patients may even require short-term blood transfusions or supportive care to maintain stable blood indicators. In addition, due to the reactivation of the JAK pathway, patients may again experience increased inflammation-related indicators, such as increased levels of Creactive protein (CRP) or cytokines, which also prompts the need for timely adjustment of management strategies.

There are a variety of clinical treatments for reactions that may occur after discontinuation of medication. For patients whose symptoms relapse or whose blood indicators drop significantly, short-term resumption of medication or gradual reduction and discontinuation of medication can be considered instead of sudden discontinuation to reduce the risk of rebound. At the same time, supportive treatments such as blood transfusions, erythropoietin, or platelet production stimulating agents can alleviate hematological abnormalities and related symptoms. During the withdrawal process, doctors should follow up regularly to evaluate spleen size, anemia degree and systemic symptoms, and adjust treatment plans in a timely manner to ensure patient safety and quality of life.

In addition, patients need to pay close attention to changes in their symptoms during the withdrawal period. If fatigue worsens, bleeding, infection, or discomfort in the spleen area occurs, they should contact their doctor immediately. Educating patients about possible reactions after stopping medication and what to do about them is crucial to help patients prepare psychologically and avoid panic if symptoms suddenly worsen. Taken together, the management of reactions after molotinib discontinuation requires an individualized strategy that combines hematological monitoring, symptom assessment, and necessary supportive treatment to ensure a safe and smooth transition and minimize the occurrence of recurrence and adverse events.

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