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JAK inhibitor risk — SCE Rheumatology MCQ

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HardRheumatological pharmacologyJAK inhibitor riskSCE Rheumatology

A patient with rheumatoid arthritis is likely to start a JAK inhibitor and has no previous shingles vaccination. What preventive step should be considered before treatment?

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Correct answer: B — Offer recombinant zoster vaccine before JAK inhibition when eligible

The best answer is “Offer recombinant zoster vaccine before JAK inhibition when eligible”. JAK inhibitors increase herpes-zoster risk, and the non-live recombinant vaccine can be used in immunosuppressed people, ideally planned before treatment when feasible. Live vaccination during significant immunosuppression is unsafe, universal antiviral prophylaxis is not routine, inactivated vaccines cannot cause infection, and prevention should not wait for disease.

Reference: UK Green Book shingles chapter: https://www.gov.uk/government/publications/shingles-herpes-zoster-the-green-book-chapter-28a