Enhancing Quality of Life in Myeloproliferative Neoplasms: Insights from Janus Kinase Inhibitors-a Comprehensive Review and Meta-Analysis

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Background Patients with myeloproliferative neoplasms (MPN) are known to have a high symptomatic burden, impairing quality of life. While JAK inhibitors (JAKi) have been the therapeutic backbone for the treatment of MPN, only a few studies have focused on quality of life (QoL) aspects. This meta-analysis aims to explore the effects of JAKi on QOL in MPN. Methods Following PRISMA guidelines, PubMed, Cochrane Register of Controlled Trials, and Clinicaltrials.gov were searched using MeSH terms and keywords for “Myeloproliferative Disorder”, “Quality of Life”, and “Janus Kinase Inhibitors” from the date of inception to January 31, 2024. 17 out of 129 articles reporting QoL with the use of JAKi in MPN patients were included. The inter-study variance was calculated using the Der Simonian-Laird Estimator. Proportions along with a 95% confidence interval (CI) were extracted to compute pooled analysis using the “meta” package by Schwarzer et al. in the R programming language (version 4.16-2). Results A total of 2136 patients were included for analysis. The median age was 64.9 (26-90) years and 57.2% (1175-2055) were male. The median follow-up time was 6.5 (6-67) months. Most patients had MF 70.6%, followed by PV 17.6% (3/17), while ruxolitinib was the most commonly used JAKi 41.2%, followed by Momelotinib 23.5%, Pacritinib 11.7%, Fedratinib 17.6%, and Gandotinib 6%. The most commonly used questionnaire to assess for QoL was EORTC QLQ-C30, 41.2%. The mean percentage change in baseline score for fatigue, insomnia, and appetite loss was -8.2,-12.1, and -5.7, respectively. MPNSAF TSS was the most commonly used questionnaire to assess symptom score 88.2%. The pooled ≥50% symptoms improvement was 40.3% (95% CI 0.32-0.49, I2=85%, p< 0.01 n=960), while the pooled spleen response, defined as at least a 35% reduction in spleen volume, was 29.1% (95% CI 0.21-0.38, I2=92%,p< 0.01 n=1664). Anemia 31%, diarrhea 29.5%, thrombocytopenia 21.6%, and nausea 13.7% were the most commonly reported side effects, with a mortality rate of 10.7%. Conclusions This analysis shows symptomatic improvement as well as better QoL with JAKi in MPN patients. However, further randomized studies are needed to better delineate these findings and establish guidelines.

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