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Dermbits

What are the recommendations on how to monitor patients on oral JAK inhibitors?

JAK Inhibitors

You. A very common question is what are the recommendations on how to monitor patients that are on oral Janus kinase inhibitors, specifically with laboratory testing? I want to refer you to an article by Nash in the Annals of Rheumatic Diseases in 2020. And you can go to PubMed, it's open access and you can actually print the article. And there are recommendations from clinicians that utilize a lot of Janus kinase inhibitors because these agents, although they're not yet approved in the United States for dermatologic disorders, there are many of them that are used for other conditions in other specialties, like in rheumatology, for example. So patient selection is important. So in the history we want to get the vaccination status of the patients, if they have any history of severe infections or malignancies, if they have any history of thromboembolic disease. And then as far as pretreatment screening, we look at obviously getting the history and physical exam, as I mentioned, but looking at complete blood cell counts, liver function tests, hepatitis B and hepatitis C testing, TB screening and HIV testing in patients at high risk. Those are important as far as baseline evaluation because, remember, these agents, depending on what Janus kinases they're inhibiting, can impact on a variety of different organ systems in terms of potential adverse events, even though they may be uncommon in many cases. Then as far as follow up monitoring, complete blood cell counts and liver function tests at month one and three, and then periodically there after around every three months, lipid levels at about three months and maybe periodically thereafter. And don't forget, skin examination, annual skin exams and skin cancer detection are recommended. So this article really gives you a good framework until we get further direction as we see approvals and recommendations in package inserts and from further information from studies.