TNF and cancer: Following this, the US Food and Drug Administration changed the labeling of JAK inhibitors across all indications, restricting their use in patients who experienced prior treatment failure with or intolerance to TNF antagonists.3 The European Medicines Agency recommended that for patients aged 65 years or older with a history of smoking or risk factors for cardiovascular disease or malignant neoplasms, tofacitinib should be used only if no suitable alternatives exist.4