Ruxolitinib and the risk of infection

Dr Chris Hillis is an assistant professor in the Division of Oncology at McMaster University and hematologist at the Juravinski Hospital and Cancer Centre.

How do you reduce the risk of infection in patients treated with ruxolitinib?

Chris Hillis, MD, MSc: We are just starting to understand that there is a risk of atypical infections in patients on long-term ruxolitinib therapy. However, there is no great evidence to support how to prevent them with suppressive [agents] or antibiotics.

What we do in clinic is we do tuberculin (TB) skin testing in patients who would be at high risk for having latent TB and then provide a pill-in-the-pocket approach to zoster, or shingles, because we know that the risk of shingles is increased in these patients.

Now that we have a new nonlive shingles vaccine, we are recommending patients to get that prior to starting ruxolitinib therapy. But I will still provide patients with a prescription to begin as soon as they start to get any symptoms of a shingles infection because it would be very important to suppress that to prevent postherpetic neuralgia.