JAK inhibitors, including ruxolitinib, momelotinib, pacritinib, and fedratinib, are key in myelofibrosis treatment, each with unique benefits and side effects. Momelotinib, approved in 2023, is notable for addressing anemia, spleen size, and symptoms. Combination therapies and new agents like CALR-directed antibodies are under investigation, offering potential for improved disease management. Prognostic models consider genetic and clinical features to guide treatment decisions.