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The JAK inhibitor for myelofibrosis patients whose platelet counts are too low for ruxolitinib.
Pacritinib inhibits JAK2 and FLT3 while sparing JAK1, and also blocks IRAK1 and ACVR1, the receptor that drives hepcidin production; because it spares JAK1 it causes less myelosuppression and can be used when platelet counts are too low for ruxolitinib. In PERSIST-2 it produced spleen and symptom responses in myelofibrosis patients with platelets below 100 x 10^9/L, including those below 50, and it received accelerated approval in 2022 for intermediate or high-risk myelofibrosis with platelets below 50 x 10^9/L. ACVR1 inhibition lowers hepcidin and may improve anaemia. Diarrhoea is the main adverse event. PACIFICA is the confirmatory trial needed to convert accelerated approval into full approval, and its role in patients with higher platelet counts is unsettled. For a newcomer: the myelofibrosis JAK inhibitor for people whose platelets are dangerously low.
Inhibits JAK2 and FLT3 while sparing JAK1, plus IRAK1 and ACVR1 (hepcidin pathway), allowing use with very low platelets. Connects to JAK2, FLT3 and ACVR1 (ALK2).
1.Pacritinib slips into a pocket on JAK2.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy. Platelet count below 50,000 documented, per the label.
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE search: pacritinib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
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| Region | Year | Indication |
|---|---|---|
| US | 2022 | Intermediate/high-risk myelofibrosis with platelets <50×10⁹/L |
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MOMENTUM addressed the biggest gap left by ruxolitinib: patients whose anaemia makes standard JAK inhibition hard to give. Momelotinib is now the preferred option for anaemic, previously treated myelofibrosis and is being adopted in first line for anaemic patients. The absolute symptom benefit is modest and durable disease modification has not been shown.
COMFORT-I turned the 2005 discovery of the JAK2 V617F mutation into the first effective medicine for myelofibrosis, transforming symptom control for a disease with no prior standard. Ruxolitinib is still the reference first-line therapy, with fedratinib, pacritinib and momelotinib as alternatives for cytopenic patients. It does not eliminate the malignant clone or reverse fibrosis in most patients.
Query for this drug: (TITLE:"Pacritinib" OR ABSTRACT:"Pacritinib" OR TITLE:"Vonjo" OR ABSTRACT:"Vonjo") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Pacritinib, not a curated reading list.
Shares ACVR1 (ALK2), DIPSS, DIPSS-plus and MIPSS70 (myelofibrosis risk scores), MOMENTUM: momelotinib versus danazol for myelofibrosis patients with anaemia after a prior JAK inhibitor, JAK1.
Shares DIPSS, DIPSS-plus and MIPSS70 (myelofibrosis risk scores), COMFORT-I: ruxolitinib, the first JAK inhibitor, versus placebo for myelofibrosis, FLT3, JAK2.
Shares MOMENTUM: momelotinib versus danazol for myelofibrosis patients with anaemia after a prior JAK inhibitor, COMFORT-I: ruxolitinib, the first JAK inhibitor, versus placebo for myelofibrosis, Myeloproliferative neoplasms (PV, ET, myelofibrosis), Small-molecule kinase inhibitors.
Shares COMFORT-I: ruxolitinib, the first JAK inhibitor, versus placebo for myelofibrosis, Primary myelofibrosis, Myeloproliferative neoplasms (PV, ET, myelofibrosis), Small-molecule kinase inhibitors.
Shares DIPSS, DIPSS-plus and MIPSS70 (myelofibrosis risk scores), JAK2, Primary myelofibrosis.
Shares JAK2, Primary myelofibrosis, Myeloproliferative neoplasms (PV, ET, myelofibrosis).
Shares DIPSS, DIPSS-plus and MIPSS70 (myelofibrosis risk scores), MOMENTUM: momelotinib versus danazol for myelofibrosis patients with anaemia after a prior JAK inhibitor, JAK1, COMFORT-I: ruxolitinib, the first JAK inhibitor, versus placebo for myelofibrosis.
Shares Primary myelofibrosis, Myeloproliferative neoplasms (PV, ET, myelofibrosis), Small-molecule kinase inhibitors.