SOHO 2024 Insights: Examining the Use and Cost of Interferon Therapy for MPNs

In this interview, Abdulraheem Yacoub, MD discusses myeloproliferative neoplasms, as presented at the SOHO annual conference. Explore the interview to gain key insights into interferon therapies and important considerations for payers regarding coverage decisions.

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Abdulraheem Yacoub, MD: Hello, my name is Abdulraheem Yacoub. I'm a professor of medicine at the University of Kansas and I specialize in myeloproliferative neoplasms and myeloid cancer.

How have recent advances in the treatment of myeloproliferative neoplasms (MPNs) influenced the current standard of care, and what are the most notable emerging therapies?

Yacoub, MD: Thank you very much for this question. Myeloproliferative neoplasms are old cancers, but a lot of the science that we are applying and a lot of the therapeutics are actually very recent. So, there has been a dramatic increase in attention and in therapeutics for MPN. I think a big paradigm shift is the recognition of MPN. There has been increased testing, reporting, and diagnoses of MPN, so it is likely that in a few years we'll notice an epidemiological change in the incidence and prevalence of MPNs just by the increased attention and recognition of these diseases.

We also have multiple approved agents. We have 4 oral JAK inhibitors that are approved for different aspects of myelofibrosis. We have JAK inhibitors approved for polycythemia vera. We also have interferon approvals for polycythemia vera, and we have a robust international clinical portfolio of clinical trials that are investigating multiple novel and unique agents with unique mechanisms of actions for all aspects of MPNs. Hopefully, as this momentum continues, we are going to have more tools and more options to better understand the disease, better understand the biology, and provide better therapeutics for our patients.

How are treatment guidelines for MPNs evolving in response to new evidence and therapies, and what impact does this evolution have on payer policies and reimbursement strategies?

Yacoub, MD: There has been multiple approvals in MPNs, particularly for polycythemia vera and myelofibrosis, in the last few years. These agents come in with enhanced and improved activity, also probably with additional safety over older agents. And they are agents that are applicable for use immediately for a large portion of our patients. In fact, there are many patients who had no viable therapeutic options waiting for those approvals. So, there was a backlog of patients who needed this therapy and were waiting for the approval.

Of course, pharmacoeconomics have been a challenge in all cancer care, and MPNs are not spared from that dilemma and that challenge. We do stumble upon all these barriers as we try to provide the state-of-the-art therapeutics for our patients. Fortunately, based on the teamwork of physicians, patient advocates, and the participation of pharmaceutical companies that provide these drugs, we can deliver those options to most patients or the majority of patients who need it. And all the barriers that we have to deal with globally can be managed through a team approach to involving physicians, patients advocate social workers, and participating pharmaceutical companies to make those agents available to the patients who need it.

What should payers consider when establishing coverage for interferon therapies?

Yacoub, MD: Interferons have been a therapeutic option with reliable activity for multiple decades, and the recent approvals provide related interferons that are more stable, effective, and safe for patients. And that does come with an increased price tag for patients and their insurers.

I would like to emphasize that the data for activity is really applicable across all interferons, and we extrapolate the efficacy data from one preparation to the other and accept that as a reasonable extrapolation because these are all biological agents that work relatively in the same context and they differ by certain degree efficacy and deliverability. But, they fundamentally work in the same mechanism. So, there is a very large body of data to support the use of interferons in patients with MPN.

Interferons are agents that are disease modifying. They might prevent disease progression and transformation, and, potentially, can result in changing patients’ outcomes in the long run, including improving their lives and lives expectancy, and lives and risk of transformation to higher risk cancers.

It's a very important investment in patients' futures. Patients with MPNs are young and they will be on their therapy for many decades. Choosing an appropriate therapy that is more effective and safer is a high priority for patients who will undergo this therapy for decades to come. In addition, these are agents that are safe in individuals who are young, who are childbearing, who expect fertility preservation, and they are associated with lesser risk of second cancers. So, in general, they are the superior therapy that is safer or more effective on the long run. And based on the needs of these patients who have orphan/rare diseases, I think that the medical community should collaborate to make sure those patients get the best care, and that should include being able to financially provide these medicines in an affordable way for these patients.

What are positive outcomes, if any, for the use of interferon therapy when treating patients with MPNs?

Yacoub, MD: Interferons have shown that sustained and long-term use has been associated with actual reduction in the cancer burden and change in the cancer behavior in a favorable way, which patients are at lower risk of cancer progression into more serious cancers or death from this cancer. This has been presented through multiple efforts and it has been accepted by the medical community as disease modifying in the nature that therapy with this disease will actually change the outlook of the cancer on the long run. They are associated with lesser long-term complications and risks such as skin cancers and other complications of other agents that are immunosuppressive, or agents that can cause of cancer. They are also effective and safe in young individuals throughout phases of their lives, including pregnancy and fertility. And they are appropriate for all patients of all ages. So, it's really an applicable therapy to the majority of MPN patients. If anything, the indications for MPNS are increasing over the years and the clinical trial portfolio is expanding in indications. This is a therapy that is here to stay. It is a therapy for the future, and we all need to learn how to use it, how to apply it, and to be able to make it available for our patients and all the barriers that circumvent that should be addressed systematically.