Interferon Therapy Evolution: Clinical Applications and Paradigm Shifts in Polycythemia Vera Management
Panelists discuss how interferon therapy (particularly ropeginterferon) can provide better hematologic control over time and potentially modify disease progression in polycythemia vera patients.
In this segment, Dr. Vachhani and Dr. Rampal discuss interferon therapy for polycythemia vera (PV), from early daily interferons to pegylated interferon alfa-2a (Pegasys) and the newer ropeginterferon alfa-2b, a monopegylated interferon. Dr. Rampal reviews the head-to-head trials comparing interferons with hydroxyurea, noting that the MPN-RC 112 trial comparing Pegasys to hydroxyurea showed no significant differences at 1 year, though interferons typically take longer to work.
The PROUD-PV study comparing ropeginterferon to hydroxyurea showed similar results at 1 year, but significant differences emerged in years 3 through 5, with ropeginterferon demonstrating better hematologic control and reduced JAK2 allele burden. Importantly, longer follow-up (approximately 6 years) showed an event-free survival benefit with ropeginterferon. This suggests disease-modifying potential with interferon therapy. Dr Rampal also references an Italian study where low-risk PV patients (typically managed with phlebotomy and aspirin) showed better hematocrit control and fewer progression events when treated with ropeginterferon.
Dr. Rampal concludes that there’s emerging evidence supporting earlier interferon treatment, with potential for disease modification. In his practice, he uses interferon for younger patients needing cytoreductive therapy and as a second-line agent after hydroxyurea. Dr. Vachhani agrees with this approach, noting that ropeginterferon is the only FDA-approved interferon for PV. He adds that ruxolitinib is an excellent second-line option, particularly for symptom improvement, reduced allele burden, and decreased phlebotomy requirements.
