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JAK Inhibitor VZV Risk — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostJAK Inhibitor VZV RiskSCE Infectious Diseases

A 45-year-old man with ulcerative colitis is about to start Tofacitinib (JAK inhibitor). His pre-treatment screening shows a positive IGRA. Chest X-ray is normal. He is asymptomatic. In addition to latent TB treatment, what specific viral reactivation risk is uniquely associated with JAK inhibitors?

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Correct answer: E — Herpes zoster — JAK inhibitors carry a significantly elevated risk of VZV reactivation compared to other immunosuppressants

JAK inhibitors (Tofacitinib, Baricitinib, Upadacitinib) are uniquely associated with a significantly elevated risk of herpes zoster compared to conventional DMARDs and biological therapies. The risk is 2–3 fold higher than with anti-TNF agents. This is likely due to JAK-STAT pathway disruption affecting IFN-gamma-mediated T-cell control of VZV. NICE and MHRA recommend considering Shingrix vaccination before starting JAK inhibitors. Latent TB must also be treated before immunosuppression (IGRA-positive in this case).

Reference: MHRA 2024 – JAK inhibitor safety; BSR 2024 – JAK inhibitor prescribing; NICE NG33 – TB