Regulators advise that JAK inhibitors be used in patients aged 65 or over, current or long-term former smokers, and those with cardiovascular risk factors or other malignancy risk only when no suitable alternative exists. Venous thromboembolism risk should also be considered.
A short checklist before starting — age, smoking, previous cardiovascular event, diabetes, hypertension, lipids, previous VTE, cancer history — documents the decision and makes the conversation with the patient explicit. Herpes zoster vaccination before starting, where available, is also standard advice.
- Record age, smoking status, cardiovascular history and VTE history before starting a JAK inhibitor.
- Check blood pressure and lipids at baseline and during treatment.
- Prefer an alternative where possible in patients over 65 or with major cardiovascular risk factors.
- Offer recombinant zoster vaccination before starting where available.
Why it matters
The decision is only defensible if the risk review behind it is written down.
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