JAK Inhibitor Monitoring — SCE Rheumatology MCQ
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Correct answer: A — Interrupt baricitinib until zoster resolves; thereafter perform periodic skin examinations and periodically reassess VTE risk
Explanation lettering: E = shown as A · D = shown as B · A = shown as D · B = shown as E
E is correct. Herpes zoster is a recognised viral reactivation complication of baricitinib, and the UK SmPC directs temporary interruption until the episode has resolved; a single uncomplicated episode does not mandate permanent withdrawal. JAK-inhibitor safety surveillance is not confined to blood tests or liver monitoring. Periodic skin examination is recommended for all treated patients because of the skin-malignancy signal, and VTE risk should be reassessed periodically, with prompt evaluation of suggestive symptoms. Cardiovascular and malignancy risk factors also influence ongoing benefit–risk assessment. Options A and C incorrectly continue baricitinib during zoster and omit important class-specific surveillance. Option B appropriately interrupts treatment but makes monitoring too narrow. Option D overstates the consequence of zoster by requiring permanent discontinuation.
Reference: Electronic Medicines Compendium. Baricitinib Lilly 2 mg and 4 mg film-coated tablets, Summary of Product Characteristics, sections 4.4 (Viral reactivation, Malignancy and Venous thromboembolism), updated 3 June 2026. https://www.medicines.org.uk/emc/product/16006/smpc