JAK inhibitors for AD in the real world

JAK inhibitors performed well in a real-world, Asian cohort of patients with atopic dermatitis (AD). Although most patients had received prior immunosuppressant therapies, JAK inhibitors delivered encouraging efficacy rates, in particular with respect to itch response.

“JAK inhibitors are used in a variety of diseases, including myeloproliferative neoplasms, rheumatoid arthritis, and inflammatory bowel disease,” said Dr Yik Weng (National Skin Centre, Singapore) [1]. “Recently, selective JAK inhibitors have been approved for the treatment of AD.” Dr Weng and colleagues analysed the efficacy and safety of baricitinib, abrocitinib, and upadacitinib in a real-world cohort of Asian patients with AD (n=53) [2]. The study mainly looked at safety and efficacy measures like itch response and Investigator Global Assessment (IGA) after 12 weeks of treatment.

Baricitinib was used by 66% of the participants, 21% used abrocitinib, and 13% used upadacitinib. Cyclosporin (62.3%), methotrexate (47.2%), azathioprine (39.6%), and dupilumab (35.8%) were prior systemic therapies that were most used in this study population. In total, 54% of the participants on baricitinib achieved an IGA response, defined as a score of 0 or 1, and an improvement of at least 2 points. For upadacitinib users and abrocitinib users, the corresponding rates were 67% and 70%. An itch score reduction of at least 4 points was reached by 100% of the abrocitinib and upadacitinib users and by 71% of the baricitinib users. Furthermore, a self-reported improvement in their skin condition was reported by 100% of the participants on upadacitinib, 90% of the participants on abrocitinib, and 69% of the baricitinib users.

Adverse events: 11.3% of the participants had raised creatine kinase levels, 9.4% had herpes zoster, and 9.4% had raised lipid levels. Headache, transaminitis, and acne were observed in 5.7% of the participants.

“Patients receiving JAK inhibitors for AD usually had received previous other immunosuppressant agents,” summarised Dr Weng. “Nonetheless, a good treatment response was observed for all 3 investigated JAK inhibitors in this cohort, especially with regard to itch response. Abrocitinib and upadacitinib appeared to have a slight advantage over baricitinib with respect to efficacy.” However, the sample size and follow-up duration of this study were limited. These limitations need to be addressed to validate the current findings. “Finally, we need to understand the profile of patients who failed on dupilumab,” Dr Weng concluded his talk.

1. Chovatiya R, Paller AS. J Allergy Clin Immunol. 2021;148(4):927–940.
2. Weng YY, et al. Efficacy and adverse effects of oral JAK inhibitors in the treatment of atopic dermatitis: an initial real-world experience in an Asian clinical cohort. Late-breaker Session 5, WCD 2023, 3–8 July, Singapore, Singapore.