Ep. 3: Managing Hematocrit and Symptoms in PV: Dose-Titration Strategies for Rusfertide
Key Points
-
Rusfertide dosing is titrated weekly based on hematocrit response, with most patients stabilizing between 20 and 40 mg.
-
Injection site reactions and mild thrombocytosis are the most common adverse events, manageable with supportive care and symptom-based monitoring.
-
Continuous therapy is necessary to maintain hematocrit control; rusfertide can complement phlebotomy or cytoreductive therapy in patients with persistent symptoms or frequent phlebotomy requirements.
Clinical Use and Dose Management of Rusfertide in Polycythemia Vera
During a Clinical Insights session, Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, discussed practical considerations for integrating rusfertide into the polycythemia vera (PV) treatment paradigm. Panelists Talha Badar, MBBS, MD, of Mayo Clinic; Aaron Gerds, MD, of Cleveland Clinic; and Andrew Kuykendall, MD, of Moffitt Cancer Center, reviewed the clinical implications of VERIFY trial data, focusing on dose management, safety, and real-world patient selection.
Dose Titration, Safety, and Practical Integration
Rusfertide is administered subcutaneously weekly, typically starting at 20 mg and titrated based on hematocrit response, with most patients stabilizing between 20 and 40 mg. Dose adjustments are guided primarily by hematocrit control rather than adverse events. The most common adverse effect is injection site reactions, which are generally low grade and manageable with topical corticosteroids or antihistamines. Mild thrombocytosis may occur in 15% to 20% of patients, but the panelists emphasized that intervention should be based on symptoms such as microvascular disturbances, bleeding, or bruising, rather than platelet count alone.
Continuous therapy is supported by data from the phase 2 REVIVE study, where temporary discontinuation of rusfertide led to rapid hematocrit spikes, which normalized upon reinitiation. Panelists highlighted that in clinical practice, rusfertide could be used in conjunction with cytoreductive therapy or phlebotomy to optimize hematocrit control, particularly for patients experiencing frequent phlebotomies or persistent fatigue.