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JAK inhibitor risk assessment — SCE Rheumatology MCQ

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HardRheumatoid arthritisJAK inhibitor risk assessmentSCE Rheumatology

A 68-year-old smoker with rheumatoid arthritis, previous myocardial infarction and prior pulmonary embolism is considering advanced treatment. Which option requires the greatest regulatory caution?

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Correct answer: B — Upadacitinib because its class warnings align with this risk profile

MHRA advises JAK inhibitors in people aged 65 or older, current or long-term former smokers, or those with cardiovascular, malignancy or thrombotic risk only when no suitable alternatives exist. This patient has several overlapping risk factors.

Reference: MHRA: JAK inhibitors — measures to reduce cardiovascular, malignancy, VTE, infection and mortality risks (Published April 2023): https://www.gov.uk/drug-safety-update/janus-kinase-jak-inhibitors-new-measures-to-reduce-risks-of-major-cardiovascular-events-malignancy-venous-thromboembolism-serious-infections-and-increased-mortality; NICE NG100: rheumatoid arthritis in adults — recommendations (Updated October 2020): https://www.nice.org.uk/guidance/ng100/chapter/Recommendations