Safety Monitoring Strategies for Oral JAK Inhibitors in Dermatology

Victoria Garcia Albea, NP, a dermatology nurse practitioner at Lahey Clinic outside Boston, discussed safety monitoring for oral JAK inhibitors during a recent JAK Institute session. Garcia Albea directs the dermatology nurse practitioner training program at Lahey and serves on the Elevate Derm leadership board. She said oral JAK inhibitors remain among the fastest-acting systemic therapies available in dermatology, and although boxed warnings continue to play an important role in patient counseling, growing long-term safety data have increased clinician confidence in prescribing these agents for appropriately selected patients.

Lab Monitoring Trends Over Time

Garcia-Albea said clinicians should expect certain laboratory abnormalities early in treatment, as some values may fluctuate initially before returning toward baseline. Rather than discontinuing therapy immediately, she recommended monitoring trends and reassessing abnormalities that persist beyond approximately 12 weeks. She added that lifestyle modifications, including dietary changes, may help address mild lipid elevations without requiring treatment discontinuation.

We're going to keep an eye on it and see if we can maybe add some dietary changes so patients bring their lipids down a little more naturally, said Garcia Albea.

Screening for Blood Clot and Malignancy Risk

Before initiating therapy, Garcia-Albea reviews each patient's history for unprovoked venous thromboembolism, which she said warrants additional evaluation before prescribing a JAK inhibitor. She also collaborates with oncology when patients have a history of malignancy to determine whether treatment remains appropriate.

"If they have a history of malignancy, you want to collaborate with oncology and see if they're still a potential candidate for a JAK inhibitor," said Garcia Albea.

Baseline Infection and Laboratory Screening

Baseline screening typically includes annual tuberculosis testing with a Quantiferon Gold blood test, hepatitis B and C screening, and baseline complete blood count with differential, comprehensive metabolic panel, and lipid testing. Garcia Albea said HIV testing is performed when patients have risk factors or request screening. Follow-up laboratory monitoring generally occurs about 12 weeks after treatment initiation.

"We still have to screen for tuberculosis annually," said Garcia Albea.

Looking Beyond Skin Clearance

Although much of the discussion focused on laboratory monitoring and risk assessment, Garcia Albea said treatment success extends beyond objective clinical findings. Reflecting on the early biologic era beginning around 2006, she said clinicians once viewed visible skin clearance as the primary measure of success. Today, she said, dermatology care increasingly incorporates patient-reported symptoms and quality of life into treatment decisions.

"So much actually is beyond what we can just see on the skin," — Victoria Garcia Albea, NP

Garcia Albea said conversations about itch, pain, disease control, and overall quality of life now play a much larger role in assessing treatment response than they did earlier in her career. As oral JAK inhibitor use continues to expand across dermatologic diseases, she said careful patient selection, routine monitoring, and ongoing conversations about patient experience can help clinicians use these therapies safely while maximizing patient benefit.

References:

1. Elevate-Derm. JAK Institute Summer 2026. Elevate-Derm; 2026. Accessed July 30, 2026. https://elevate-derm.com/
2. Garcia Albea V. Victoria Garcia Albea, NP. Beth Israel Lahey Health. Accessed July 30, 2026. https://physicians.lahey.org/details/3990/victoria-garcia-albea-dermatology-burlington
3. US Food and Drug Administration. FDA requires warnings about increased risk of serious heart-related events, cancer, blood clots, and death for JAK inhibitors that treat certain chronic inflammatory conditions. Published September 1, 2021. Accessed July 30, 2026. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-warnings-about-increased-risk-serious-heart-related-events-cancer-blood-clots-and
4. European Alliance of Associations for Rheumatology (EULAR). Points to consider on the initiation of Janus kinase inhibitors in immune-mediated inflammatory diseases. Ann Rheum Dis. 2023;82(1):35-44. doi:10.1136/ard-2022-222979.