Author + information
- Dave L. Dixon,
- Gary Simmons,
- Lindsey Rodriguez and
- Antonio Abbate
Ruxolitinib is a janus kinase inhibitor used to treat steroid refractory acute graft versus host disease (GVHD). Hyperlipidemia can occur with ruxolitinib. We describe a case of severe hyperlipidemia occurring after ruxolitinib initiation managed by a collaboration between hematology, cardiology, and pharmacy.
A 63-year-old white male presented to stem cell transplant (SCT) clinic with a history of myelodysplastic syndrome (2007) treated with matched unrelated allogeneic SCT in 2008. He relapsed in 2018 and received donor lymphocyte infused T cells which caused steroid refractory acute GVHD of skin and liver; maximum alanine aminotransferase (ALT) was 1,515 U/L and bilirubin 8.3mg/dL. His pravastatin was stopped and four days later, the patient was admitted and started on ruxolitinib. Six weeks after discharge, the ALT improved (356 U/L) and bilirubin normalized; however, his TC increased 188% and low-density lipoprotein cholesterol (LDL-C) increased 259% from baseline (Figure 1).
Cardiology was consulted and discussed the case with a clinical pharmacist who recommended evolocumab, since it is not hepatically metabolized and significantly lowers LDL-C. Ezetimibe was not considered due to its modest potency and concern for increased risk of cholestasis.
In collaboration with specialty pharmacy, a prior authorization was obtained, and the patient was successfully treated with evolocumab.
Posters Hall_Hall A
Saturday, March 28, 2020, 12:30 p.m.-1:15 p.m.
Session Title: Cardiovascular Team Cases 2
Presentation Number: 1171-265
- 2020 American College of Cardiology Foundation