Best of Dermatology 2021: JAK Inhibitors

In the session, “Editors Focus - Best of 2021 Dermatology, Gastroenterology & Rheumatology” presented at IAS 2022, Joel Gelfand, MD MSCE, joined his colleagues Leonard Calabrese, DO, and Stephen Hanauer, MD, FACG, to share some exciting news on the use of JAKs in dermatology.

“Really what I think we should be struck by is how many of these drugs are under development,” he stated, “we felt we had a lot of targeted biologics and now we have an unbelievable amount of JAKs that have come in the market.”

For his presentation Dr Gelfand highlighted 3 major JAKs that are in development for dermatologic conditions, including:

• Tofacitinib
• Upadacitinib
• Abrocitinib

Starting with tofacitinib, Dr Gelfand shared old data prior to the FDA approval for psoriasis; however, as of now it has been proven to treat many dermatologic conditions, including dermatomyositis, atopic dermatitis (as a topical), psoriasis, alopecia areata, and psoriatic arthritis.

“The important teaching point here is dose matters,” he shared, “the higher dose gives the better efficacy and maybe a trade-off with a little more side effects.”

He also noted that tofacitinib has not been FDA approved as of yet for the treatment of alopecia areata.

Next, he introduced upadacitinib, a targeted JAK1 that has been FDA approved for atopic dermatitis and active psoriatic arthritis. One major study he shared showcased upadacitinib being highly effective when treating psoriatic arthritis in the higher dose by achieving PASI 75 in 62% of participants compared with adalimumab 53%.

Finally, the last JAK Dr Gelfand addressed was abrocitinib, which has been FDA approved for atopic dermatitis. He presented a study that highlighted the higher dose of abrocitinib was much more effective when treating atopic dermatitis compared with dupilumab. He added that the lower dose did not outdo dupilumab so that, with the higher dosage, it was more of safety trade-off with adverse effects being more common.

To conclude in summary on JAKs in dermatology, Dr Gelfand shared that many were already approved both topically and orally for treating atopic dermatitis. Additionally, they have a role to play in patients with psoriasis and active psoriatic arthritis. There are new indications for alopecia areata and vitiligo that may be on the horizon. Also, some conditions may need long-term JAK inhibitors whereas others could be managed with intermittent treatment. He also added that lower incidence of adverse events was likely driven by patients of a younger age, smaller sample sizes, shorter follow-ups, and the use of monotherapy. Finally, Dr Gelfand stressed that safety concerns remain dose related and are considered during second-line treatments.

Reference
Gelfand J, Calabrese L, Hanauer S. Editors focus—best of 2021 dermatology, gastroenterology & rheumatology. Presented at: Interdisciplinary Autoimmune Summit; April 21-24, 2022; Virtual.