JAK Inhibitor Safety for Atopic Dermatitis

On the first day of the 2023 Interdisciplinary Autoimmune Summit, Peter Lio, MD, FAAD, presented his session, “JAK Inhibitor Safety in the Treatment of Atopic Dermatitis (AD): Evaluating the Long-Term Data.” He kicked off the session by highlighting the unmet needs in AD, “Most adults with moderate to severe AD continue to report inadequate disease control despite recent advances in treatment.”

Next, Dr Lio discussed the pathophysiology of AD, with skin and epithelial barriers as the hypothesis. He also reviewed current treatments and presented an algorithm for step-up care.  “Targeted treatments are important because, ideally, we will do less collateral damage. If we suppress the whole immune system, yes, the patient is going to be better, but at what cost? If we do targeted treatment, we can do less damage and be safer and, sometimes, it is even more effective or comparably effective,” he said.

Dr Lio reviewed dupilumab, which has been a revolutionary therapy in the treatment of AD that can have a remittive effect; tralokinumab, which was approved in 2021 in the United States; and abrocitinib and upadacitinib, which “did a great job in blasting over the placebo effect.”

He also discussed a network meta-analysis to compare therapies and quoted the study authors, “Our finding that abrocitinib, 200 mg daily, and upadacitinib, 30 mg daily, may be associated with slightly better index scores than dupilumab, 600 mg then 300 mg every 2 weeks, is supported by head-to-head trials.”

Regarding monitoring JAK inhibitors, Dr Lio shared his personal approach:

• Baseline and annually: complete blood cell (CBC) count, comprehensive metabolic panel (CMP), lipids, hepatitis screen, TB test, HIV screen
• First month: CBC count, CMP, lipids
• Third month: CBC count, CMP, lipids
• Every 2 to 3 months thereafter if reassuring: CBC count, CMP, lipids

Lastly, Dr Lio concluded with a case study and stated, “This is an example of how the new tools are coming just in time, and together we can work with our patients and try to get what they need as safely as possible.” 

Reference
Lio P. JAK inhibitor safety in the treatment of atopic dermatitis: evaluating the long-term data. Presented at: Interdisciplinary Autoimmune Summit; April 26–28, 2023; Virtual.