Advancements in Managing Thrombotic Risks in High-Risk Polycythemia Vera

Recent clinical studies have shed light on the management of thrombotic events in high-risk patients with polycythemia vera (PV), a blood disorder characterized by elevated red blood cell counts. During a Community Case Forum held on July 2, 2025, in Santa Monica, California, Dr. Mojtaba Akhtari, a distinguished professor of medicine at Loma Linda University, presented findings from several key trials that aim to enhance patient outcomes and reduce the risk of thrombosis, a leading cause of morbidity and mortality in this population.

Polycythemia vera is a myeloproliferative neoplasm that often requires treatment to lower hematocrit levels and improve quality of life. According to Dr. Akhtari, recent trials have provided promising data regarding the effectiveness of targeted therapies in reducing thrombotic events, which are critical to the survival of PV patients.

The MAJIC-PV study, conducted in the United Kingdom by Dr. Claire N. Harrison from St. Thomas’ Hospital in London, involved 190 patients with high-risk PV and compared the efficacy of ruxolitinib (Jakafi) against the best available treatment. The results indicated that patients treated with ruxolitinib not only achieved better overall responses but also demonstrated significantly improved event-free survival (EFS) rates, with a hazard ratio (HR) of 0.58, indicating a 42% reduction in the risk of adverse events. Notably, ruxolitinib administration led to fewer thrombotic events, marking a pivotal advancement in the management of PV.

Further supporting the potential of targeted therapies, the PROUD-PV and CONTINUATION-PV studies explored the long-term effects of ropeginterferon alfa-2b (Besremi) in patients who were either treatment-naïve or previously treated with hydroxyurea. These studies revealed that 81.4% of patients on ropeginterferon maintained hematocrit levels below 45% after six years, significantly better than the 60% in the control group. Dr. Akhtari emphasized that ropeginterferon is less toxic compared to hydroxyurea, which is considered an older chemotherapy option, and is well tolerated by patients.

The REVEAL study, the largest observational study of PV in the United States, further corroborated these findings. With over 2,500 patients enrolled, the study identified a cumulative incidence of 5.2% for thrombotic events in high-risk patients, compared to 2.78% in lower-risk patients. Elevated white blood cell counts and hematocrit levels were associated with worse outcomes, underscoring the importance of effective management strategies tailored to individual patient profiles.

Experts in the field highlight the significance of these findings for clinical practice. Dr. Akhtari noted that the data from these trials not only guide treatment decisions but also emphasize the necessity for ongoing monitoring of hematological parameters to mitigate thrombotic risks.

The implications of these advancements extend beyond individual patient care. With an increasing understanding of the relationship between hematologic values and thrombotic events, there is a growing consensus that personalized treatment approaches can significantly enhance the quality of life and survival rates in patients with polycythemia vera.

In conclusion, the emerging evidence from recent studies presents a promising outlook for managing thrombotic events in high-risk PV patients. As clinical practice continues to evolve, these findings will aid healthcare providers in making informed decisions and improving patient outcomes in this challenging disease landscape.