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Hydroxychloroquine retinopathy — SCE Rheumatology MCQ

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HardRheumatological PharmacologyHydroxychloroquine retinopathySCE Rheumatology

A 61-year-old with rheumatoid arthritis takes baricitinib 4 mg once daily. Creatinine clearance is now 52 mL/min and probenecid is proposed for refractory gout. If baricitinib is continued, what dose does the current UK SmPC specify?

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Reveal the answer and explanation

Correct answer: D — Reduce baricitinib to 2 mg once daily; do not halve it twice for the two concurrent exposure risks

Explanation lettering: B = shown as A · A = shown as B

D is correct. In an adult with creatinine clearance 30–60 mL/min, baricitinib is reduced to 2 mg once daily. The same 2 mg adult dose applies with a strong OAT3 inhibitor such as probenecid; the SmPC does not direct two sequential halvings to 1 mg. A ignores two exposure-increasing factors. B invents alternate-day dosing. C double-counts the two indications for the same dose adjustment. E cannot prevent a transporter interaction by separating administration times.

Reference: Baricitinib Lilly tablets — UK SmPC: https://www.medicines.org.uk/emc/product/16006/smpc