{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:02:17Z","timestamp":1790395337931,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Ruxolitinib remains first\u2010line standard of care for symptomatic myelofibrosis, but resistance\/intolerance develops in most patients. Three Janus kinase inhibitors (JAKis) have entered the post\u2010ruxolitinib space via distinct pivotal trials. We systematically searched prospective trials evaluating JAKi in refractory adults with myelofibrosis. Efficacy was assessed across phase 3 trials, with safety integrating phase 2 and real\u2010world data. Pooled \u226535% spleen volume reduction at week 24 was 32.7% (95% confidence intervals 27.3\u201338.6) for fedratinib, 15.8% (11.7\u201321.0) for momelotinib and 21.6% (13.8\u201332.3) for pacritinib 200\u2009mg bis in die; pooled \u226550% Total Symptom Score reduction rates were 32.8% (27.4\u201338.7), 25.3% (20.2\u201331.3) and 32.4% (22.9\u201343.7) respectively. Across safety datasets (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091004 trial;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009790 real\u2010world), fedratinib showed the highest grade \u22653 anaemia (34.3%) and any\u2010grade diarrhoea (56.6%), whereas momelotinib the lowest (8.0%). Pacritinib carried the greatest risk of grade \u22653 bleeding (11.2%). Discontinuation due to adverse events was comparable across agents (~16%\u201317%). Real\u2010world evidence from five momelotinib cohorts (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009580) identified nephrotoxicity (glomerular filtration rate\u00a0decline 17%\u201329%) and peripheral neuropathy (4%\u201320%) as monitoring targets. Despite limitations from differing study designs, each post\u2010ruxolitinib JAKi shows a distinct efficacy\/safety fingerprint mapping onto a phenotype, guiding second\u2010line choice by clinical factors and prior adverse events.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70754","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T06:30:13Z","timestamp":1786775413000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Janus kinase inhibitors after ruxolitinib failure in myelofibrosis: A systematic review and pooled analysis of phase 3 efficacy and integrated safety across clinical trials and real\u2010world evidence"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9510-4755","authenticated-orcid":false,"given":"Andrea","family":"Duminuco","sequence":"first","affiliation":[{"name":"Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate \u201cG.F. Ingrassia\u201d, University of Catania  Catania Italy"},{"name":"Hematology With BMT Unit A.O.U. \u201cG. Rodolico\u2010San Marco\u201d  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5704-466X","authenticated-orcid":false,"given":"Patrick","family":"Harrington","sequence":"additional","affiliation":[{"name":"Department of Haematology Guy's and St Thomas' Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Torre","sequence":"additional","affiliation":[{"name":"Department of Haematology Guy's and St Thomas' Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Catellani","sequence":"additional","affiliation":[{"name":"Department of Hematology Azienda USL, IRCCS di Reggio Emilia  Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2714-5109","authenticated-orcid":false,"given":"Novella","family":"Pugliese","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia e Trapianti di Midollo Osseo, Azienda Ospedaliera Universitaria Federico II, Universit\u00e0 degli Studi Federico II  Napoli Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pacilli","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia Grande Ospedale Metropolitano Bianchi\u2010Melacrino\u2010Morelli Reggio Calabria  Reggio Calabria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Santisi","sequence":"additional","affiliation":[{"name":"Hematology With BMT Unit A.O.U. \u201cG. Rodolico\u2010San Marco\u201d  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Sbriglione","sequence":"additional","affiliation":[{"name":"Hematology With BMT Unit A.O.U. \u201cG. Rodolico\u2010San Marco\u201d  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1859-6319","authenticated-orcid":false,"given":"Giuseppe A.","family":"Palumbo","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate \u201cG.F. Ingrassia\u201d, University of Catania  Catania Italy"},{"name":"Hematology With BMT Unit A.O.U. \u201cG. 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