Talking To My Doctor About JAK Inhibitors

In my previous update, I shared some backstory critical to understanding my next few treatment options. So if you haven’t read that one yet, be sure to go back and read it now!

Having a history of blood clots and a couple of pulmonary embolisms, and now being on blood thinners, my options for treating hives are a bit more complicated. Not that treating hives is easy, to begin with, I just like to give my doctor a good challenge when it comes to treating me. After many long discussions, my doctor and I have come up with the following options.

Considering JAK inhibitors

One option is a class of medications called JAK inhibitors (Janus-Kinase or JAK). JAK inhibitors block pathways in the body that can lead to inflammation, specifically interleukins and IFN signals if you want to get technical. JAK inhibitors are now being used to treat disorders like rheumatoid arthritis, atopic dermatitis, dermatitis—-all the “itis-es”!¹

The suffix “-itis” means inflammation. And since chronic urticaria is a type of dermatITIS, which is inflammation of the skin, it makes sense that JAK inhibitors can also be used to treat hives.

One of the unfortunate side effects of JAK inhibitors is that they can lead to blood clots. The FDA and EMA both have warnings declaring an increased risk of cardiovascular issues and blood clots for people taking this class of medication.^2,3

Weighing risks and benefits

So, as someone who is already at an increased risk of blood clots given my history, does the benefit of using a JAK inhibitor to prevent hives outweigh the risk of another blood clot? That's a good question, and while the literature is actually controversial about the increased incidence of blood clots, my doctor and I both feel like I would likely benefit from being on one of these medications.⁴

I am already on a medication that makes it harder for my blood to clot, aka a blood thinner. Although I am at a greater risk than the average person for getting a blood clot, the chance of me actually developing a blood clot while on a blood thinner, even with the addition of a JAK inhibitor, is relatively low. It may even be lower than the average person who doesn’t have a history of blood clots.

Don’t get me wrong, there is still a risk, but after weighing all the pros and cons my doctor and I have left JAK inhibitors on the table as a possible option for the future if and when my hives do return. Honestly, a JAK inhibitor is not on the top of the list of things I do want to try, but my options are becoming more and more limited. That’s just the reality of it.

Author's disclaimer: This is not medical advice. My doctor and I have discussed the risk and benefits of JAK inhibitors as it relates to my medical history and risk factors. If you are considering JAK inhibitors, please talk to your doctor about whether this class of medication might be suitable for you.