First-Line Cytoreductive Selection: Hydroxyurea Vs Interferon Considerations
Panelists discuss how the choice between hydroxyurea (HU) and interferon (IFN) for cytoreductive therapy in polycythemia vera (PV) depends on factors such as patient age, long-term safety, tolerability, comorbidities, response to previous treatments, and patient preferences, with HU often preferred in older patients and IFN favored for younger patients, those intolerant to HU, or those seeking potential disease-modifying effects.
Summary for Physicians: Choosing Between Hydroxyurea and Interferon in PV
The decision between hydroxyurea (HU) and interferon (IFN) for cytoreductive therapy in polycythemia vera (PV) is influenced by several clinical and patient-specific factors. Both agents are effective, but each has distinct profiles that guide individualized treatment selection.
Key Considerations Influencing Treatment Choice:
- Age and Long-Term Safety:
- Hydroxyurea is typically preferred in older patients due to its rapid efficacy, ease of administration, and established safety profile in this population.
- Interferon is often favored in younger patients, particularly those of childbearing potential, due to its nonmutagenic nature and potential disease-modifying effects.
- Tolerability and Comorbidities:
- HU may be avoided in patients with baseline cytopenias or concerns about long-term leukemogenic potential (though this remains debated).
- IFN can be limited by flu-like symptoms, mood disturbances, or autoimmune conditions, though pegylated forms are generally better tolerated.
- Response and Resistance:
- IFN may be preferred in patients who are intolerant or resistant to HU, or those with progressive disease features (eg, rising counts, splenomegaly, symptoms).
- IFN has also shown potential for molecular remission in some patients, making it attractive for those with a goal of long-term disease control beyond symptom management.
Patient Preference and Lifestyle Factors:
Mode of administration (oral vs injectable), adverse effect profile, and patient priorities (eg, pregnancy planning, quality of life) also play a key role in treatment selection.
