Is a history of Zoster ophthalmicus a contraindication to starting upadacitinib?

A history of HZO (herpes zoster ophthalmicus) or herpes zoster in any dermatome is a relative contraindication to the use of upadacitinib or any JAK inhibitor. HZO is often a very unpleasant disease with pain, ocular discomfort, and vision loss, so the chance of reactivation should be minimized.

The clinician should ask if there is an alternative medication. If the patient is on prednisone, that dosage should be minimized.

If a JAK inhibitor is the optimal and essential therapy, the chance of re...