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Dermbits

Lilly Olumiant AA October 2023

What kind of monitoring is suggested for patients taking baricitinib?

Alopecia

You. So those of us who have been paying any type of attention in dermatology could not help but avoid discussions on the safety and the monitoring with oral Janus kinase inhibitors. If they inhibit Janus kinase one, two, three, any collection of those. There are some laboratory monitoring recommendations and they're well founded based on the fact that you could get into some changes in blood counts. You have patients that may be at greater risk of venous thromboembolism. There may be some cardiac events or serious infections. Those are all listed in the box warnings. But the fact of the matter is a good clinician is going to get the history, is going to find out what's in the background of the patient. In women, you're going to want to know if they're on oral contraceptives, if they're heavy smokers. That puts them at increased risk of venous thromboembolism. It doesn't mean you absolutely would not do it, but that's a discussion that you would need to have. And you look at other risk factors in their history. If they've had a recent malignancy or something significant like that, then you have to take that under consideration. But many of these patients are in a younger category and they don't often have some of those significant comorbidity conditions that increase their risk. That being said, once you get a good history, get a good skin exam, because you're going to want to monitor for risk of skin malignancy over time in these patients like you would with anyone else, but a baseline complete blood cell count and chemical profile which looks at hepatic enzymes and renal function. You're going to want to monitor lipids because some patients may have some increases in their lipids and baseline TB testing, something like a quantiferon gold and also hepatitis screen. So I do hepatitis B, certainly, and I include hepatitis C. If you feel there's any risk factors for HIV, you should certainly test for that. And this is something that you would carry out over time, depending on the situation and the history of the patient based on what you feel is clinically recommended. But if you do that, you'll have a pretty good handle at being able to evaluate the patients with the cbcs and the chemical profile. I will do that at one month, at three months, and then periodically thereafter package inserts for the different Janus kinase inhibitors may have some variations on that, but I think this works very well in general and talking to the patient. So these patients have a significant problem with alopecia, severe disease, not many other options that are available to them, so they are going to be an integral part of that decision process. When you discuss the risk versus the benefit.

What kind of monitoring is suggested for patients taking baricitinib?

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