Do patient co-morbidities impact when you prescribe oral jak inhibitors?
Great and pertinent question in our field. Autoimmunity doesn’t make me less likely to prescribe, actually more likely as there is plenty of case report and case series data on JAKi being used in a variety of autoimmune conditions. Certainly, dyslipidemia (think MACE), VTE risk, and malignancy risk do factor into the decision. If you review the phase 3 long-term extension data + the Bunick paper in the JDD comparing AD treatments you see that the risk of these is very low with the selective JAK1 inhibitors so as long as a patient doesn’t have active internal malignancy, severe dyslipidemia with imminent or recent MACE or recent VTE I don’t block them from this drug class. Also, benefit-risk analysis is helpful too. I have used JAKi in some folks in the above category that I typically wouldn’t have recommended but the patients said they’d rather die than be as itchy as they are so severity definitely plays a role.
Not exactly the question you asked, but relevant recent study:
Yes