Momelotinib is recommended as an option for treating myelofibrosis-related splenomegaly or symptoms in adults with moderate to severe anaemia who have not had a JAK inhibitor or have had ruxolitinib, only if:
they have intermediate‑2 or high-risk myelofibrosis, and
the company provides momelotinib according to the commercial arrangement.
This recommendation is not intended to affect treatment with momelotinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Usual treatment for splenomegaly or symptoms of intermediate‑2 or high-risk myelofibrosis in adults with moderate to severe anaemia who have not had a JAK inhibitor is ruxolitinib. For people who have had ruxolitinib, usual treatment is best available therapy.
For this evaluation, the company asked for momelotinib to be considered only for people with intermediate‑2 or high-risk myelofibrosis. This does not include everyone who it is licensed for.
Momelotinib works in a similar way to ruxolitinib and would be offered to the same population. Clinical trial evidence shows that momelotinib is likely to work as well as ruxolitinib for people who have not had a JAK inhibitor. A cost comparison suggests momelotinib has similar costs to ruxolitinib in this population.
Clinical trial evidence suggests that momelotinib is likely to work as well as best available therapy for people who have had ruxolitinib. The cost-effectiveness estimates for momelotinib in this population are within the range that NICE considers an acceptable use of NHS resources.
So, momelotinib is recommended for adults with intermediate‑2 or high-risk myelofibrosis with moderate to severe anaemia who have not had a JAK inhibitor or have had ruxolitinib.