Ritlecitinib Disease Interactions

In a major safety study of a Janus kinase (JAK) inhibitor, tofacitinib, in rheumatoid arthritis patients 50 years and older with at least 1 cardiovascular risk factor, higher rates of all-cause mortality (including sudden cardiovascular death) and major adverse cardiovascular events (MACE) (defined as cardiovascular death, myocardial infarction, and stroke) were observed with the JAK inhibitor when compared with tumor necrosis factor (TNF) blockers. Patients who were current or past smokers had an additional increased risk. Based on a shared mechanism of action, this risk should be considered for other JAK inhibitors, including baricitinib, upadacitinib, ruxolitinib, fedratinib, ritlecitinib, deuruxolitinib, and pacritinib. Consider the benefits and risks for each individual patient prior and during treatment with JAK inhibitors, especially in patients with other cardiovascular risk factors, history of cardiovascular events, and patients who are current or past smokers. Patients should be informed about the symptoms of serious cardiovascular events and what to do if they occur.

Avoid the use of ritlecitinib in patients with an active, serious infection. Consider the risks and benefits of treatment in patients with chronic or recurrent infection, exposed to tuberculosis (TB), with a history of serious infection or an opportunistic infection, who have resided or traveled in areas of endemic TB or mycoses, or with underlying conditions that may predispose them to infection. Patients should be screened for TB before treatment initiation. This drug should not be given to patients with active TB or untreated latent TB; anti-TB therapy should be started prior to initiating treatment. Screening for viral hepatitis should be performed in accordance with clinical guidelines before starting therapy. Treatment interruption should be considered in patients with viral reactivation (e.g., herpes zoster).

Ritlecitinib is not recommended in patients with severe (Child Pugh C) hepatic impairment.