After a large safety trial of tofacitinib in older patients with cardiovascular risk, regulators restricted JAK inhibitors in rheumatoid arthritis. The European Medicines Agency advises using them in people aged 65 or over, current or long-term past smokers, and those at raised cardiovascular or cancer risk only when no suitable alternative exists, and with caution in those at risk of blood clots.
The practical consequence is a structured check before starting, and a documented reason when a higher-risk patient is started anyway.
- Record age, smoking history, cardiovascular disease, cancer history and previous venous thrombosis before starting.
- Screen for latent tuberculosis and hepatitis B, especially relevant in India.
- Consider herpes zoster vaccination before treatment where available.
- Check lipids and blood counts after starting and at intervals.
Why it matters
The restrictions only protect patients if the risk check happens before the first prescription.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for rheumatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free