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Practical management of patients on Janus kinase inhibitor (JAKi) therapy: Practical fact sheets drawn up by the Rheumatism and Inflammation Club (CRI), a group endorsed by the French Society for Rheumatology (SFR) - 30/10/19

Doi : 10.1016/S1297-319X(19)30154-X 
Christophe RICHEZ, Prof a, Jacques MOREL, Prof b, Divi CORNEC, Dr c, Claire DAÏEN, Dr d, Philippe GOUPILLE, Prof e, Estibaliz LAZARO, Prof f, Thierry LEQUERRÉ, Prof q, Gaëtane NOCTURNE, Dr g, Victor de LÉDINGHEN, Prof h, Benoit Le GOFF, Prof i, Valérie POURCHER, Dr j, Clément PRATI, Prof k, Raphaèle SEROR, Prof l, Anne TOURNADRE, Prof m, Marie-Elise TRUCHETET, Dr n, Jean SIBILIA, Prof o, Thao PHAM, Prof p
a Service de Rhumatologie, CHU Pellegrin, Bordeaux 
b Service de Rhumatologie, CHU Montpellier 
c Service de Rhumatologie, CHRU Brest, Brest 
d Service de Rhumatologie, CHU Montpellier, Montpellier 
e Service de Rhumatologie, CHU Tours, Tours 
f Service de Médecine interne, CHU Haut-Lévêque, Pessac 
g Service de Rhumatologie, CHU Bicêtre, Le Kremlin-Bicêtre 
h Unité d’Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac 
i Service de Rhumatologie, CHU Hôtel-Dieu, Nantes 
j Service de Maladies Infectieuses et Tropicales, CHU Pitié-Salpétrière, Paris 
k Service de Rhumatologie, CHU Minjoz, Besançon 
l Service de Rhumatologie, CHU Bicêtre, Le Kremlin-Bicêtre 
m Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand 
n Service de Rhumatologie, CHU Pellegrin, Bordeaux 
o Service de Rhumatologie, CHU Hautepierre, Strasbourg 
p Service de Rhumatologie, CHU Sainte-Marguerite, Marseille 
q Service de Rhumatologie, CHU Rouen, Rouen 

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CONTRIBUTORS
CONTENTS
What should be done before starting Janus kinase inhibitor (JAKi) therapy?
How to monitor on JAKi therapy?
What dosing schedule should be used?
When should clinical efficacy be assessed?
Clinical and biological tolerance
How could JAKi therapy be optimised?
Partial response after starting treatment
Recurrence of symptoms despite a good initial response
Complete and stable response for several months
What should be done if there is a history of viral infections?
What is the risk of infection associated with JAKi therapy?
What should be done before starting JAKi therapy to minimise the risk of viral infection?
What are the warning signs for a viral infection in patients JAKi therapy?
What should be the course of action in the event of a viral infection while on JAKi therapy?
When should JAKi therapy be restarted?
What should be done if there is a present or past history of bacterial infection?
What are the risks of infection during JAKi therapy?
What should be done before starting JAKi therapy to minimise the risk of bacterial infection?
What are the warning signs for a bacterial infection in patients on JAKi therapy?
What should be the course of action in the event of bacterial infection while on JAKi therapy?
When should JAKi therapy be restarted?
Can JAKi therapy reduce the increased cardiovascular risk?
Can JAKi therapy be prescribed in patients with a history of myocardial infarction, heart failure and/or arrhythmia?
Can JAKi therapy be prescribed in patients with a history of hypertension?
Can JAKi therapy be prescribed in patients with a history of venous thromboembolism?
Are there interactions between JAKis and heart disease drugs or anticoagulants?
Management of cardiovascular risk factors in practice
What should be done if there is a present or past history of solid cancer?
Is there an increased risk of solid cancer while on JAKi therapy?
What should be done before starting JAKi therapy in patients with a history of solid cancer?
What should be the course of action if cancer is suspected or detected during JAKi therapy?
What should be done if there is a present or past history of blood disorders or lymphoma?
Is there a risk of blood cell count disturbances during JAKi therapy?
What factors contribute to the development of blood disorders?
In patients with an abnormal blood count, what should be done before starting JAKi therapy?
In practice, how should we monitor for abnormal changes in blood test results while on JAKi therapy and manage patients in the event that we detect an abnormal blood cell count?
What about lymphoma?
What should be done if there is a present or past history of gastrointestinal or liver disorders?
What should be done before starting JAKi therapy in patients with liver disorders?
What are the warning signs of liver disease in patients on JAKi therapy?
How and when should transaminase levels be monitored and what should be done if levels increase?
What about other gastrointestinal/liver disturbances?
What should be the course of action in the event of surgery or dental care?
Data available
Course of action in the event of surgery
How long should the wait time be between the last dose of baricitinib or tofacitinib and a scheduled operation?
What should be the course of action in the event of pregnancy?
The JAK-STAT pathway and embryo development
JAKis and pregnancy
Pregnancy while on JAKi therapy
If a patient desires pregnancy
In event of pregnancy while on JAKi therapy
In the event of conception when the man is on JAKi therapy
Breastfeeding
What should be the course of action in the event of vaccination?
General recommendations concerning vaccinations in patients on immunosuppressants
Vaccination of patients starting on JAKis after treatment with a synthetic or biologic DMARD or/and corticosteroids
Vaccination while on JAKi therapy
Vaccination and specific situations
What should be the course of action in the event of travel?
Are there travel restrictions?
What vaccinations should be suggested before starting JAKi therapy? (see “Vaccination” fact sheet)
May malaria prophylaxis be taken after treatment with JAKis?
What other precautions should be taken?
What should be the course of action in the event of drug combinations?
Non-steroidal anti-inflammatory drugs/corticosteroid therapy
Synthetic disease-modifying antirheumatic drugs
Targeted drugs
Other drugs
Template for an informative letter to the usual rheumatologist
Template for an informative letter to the primary care physician
How may JAKi therapy be used in connective tissue disease?
Rationale for using JAKis
Data from the literature
Who would be candidates for this treatment?
What precautions should be taken?
What dosing schedule should be used?
How may JAKi therapy be used in spondyloarthritis?
Rationale for using JAKis
Data from the literature
Who would be candidates for this treatment?
What precautions must be taken?
What dosing schedule should be used?
DISCLOSURE OF INTEREST

 The creation of CRI fact sheets and this issue thereof, in particular, is supported in part by institutional funding from Lilly.


© 2019  Published by Elsevier Masson SAS on behalf of Société française de rhumatologie.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 86 - N° S1

P. eS2-eS103 - octobre 2019 Retour au numéro
Article précédent Article précédent
  • Practical management of patients on Janus kinase inhibitor (JAKi) therapy - the CRI fact sheets
  • Christophe RICHEZ, Jacques MOREL, Jean SIBILIA, Thao PHAM, In the name of the CRI and the team of expert authors
| Article suivant Article suivant
  • Practical management of patients on Janus kinase inhibitor (JAKi) therapy: Practical fact sheets drawn up by the Rheumatism and Inflammation Club (CRI), a group endorsed by the French Society for Rheumatology (SFR)
  • Christophe RICHEZ, Jacques MOREL, Divi CORNEC, Claire DAÏEN, Philippe GOUPILLE, Estibaliz LAZARO, Thierry LEQUERRÉ, Gaëtane NOCTURNE, Victor de LÉDINGHEN, Benoit Le GOFF, Valérie POURCHER, Clément PRATI, Raphaèle SEROR, Anne TOURNADRE, Marie-Elise TRUCHETET, Jean SIBILIA, Thao PHAM

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