JAK Inhibitors for the Management of Atopic Dermatitis

At the 2022 Fall Clinical Dermatology Conference in Las Vegas, Nevada, Lisa Swanson, MD, FAAD, pediatric dermatologist from Boise, Idaho, started the morning session by discussing topical ruxolitnib for the management of atopic dermatitis (AD)¹. Ruxolitnib (Opzelura; Incyte Dermatology) was approved by the US Food and Drug Administration in late October 2022. Ruxolitnib is indicated for the topical short-term and non-continuous chronic treatment of mild-to-moderate AD in non-immunocompromised adult and pediatric patients, aged 12 years or older, whose AD is not well-controlled with other topical treatments.

Swanson mentions that ruxolitnib is an ideal topical therapy option because it is safe on all body areas, including sensitive areas such as the face or eyelids. Another positive aspect of ruxolitinibi s its efficacy and speed of improvement are comparable to topical steroids, but without the adverse effects of steroids.

A common question regarding AD and topical ruxolitnib is whether dermatologists can pair ruxolitinib with systemic medications. According to Swanson, “Officially, no. There’s a limitation on the use of topical ruxolitinib saying that it should not be used in combination with therapeutic biologics, systemic immunosuppressants, or systemic JAK inhibitors.”

The ideal patient for topical ruxolitnib will:

• Be 12 years old or older
• Have <20% of body surface area affected
• Have AD in sensitive skin areas
• Have previously failed topical steroids or want to avoid topical steroids

Beginning his portion of the presentation, James Q. Del Rosso, DO, FAOCD, FAAD, dermatologist from Las Vegas, Nevada, analyzed JAK inhibitors and where they fit in for treating patients with AD. Del Rosso states that it’s very easy for clinicians and their staff to fall into management patterns and habits, and that new topical therapy options must be discussed responsibly and in-depth. Dermatologists have the responsibility of understanding what the new drug information is telling them and what is clinically relevant to have the correct conversations with patients.

Del Rosso presented information on an atopic dermatitis assessment tool that he learned about from Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. The Atopic Dermatitis Control Tool (ADCT) helps to take the subjectivity out of determining whether or not patients with AD are improving. The ADCT can be given to patients before the start of their appointments to gather more information prior to assessment and treatment.

To begin prescribing oral JAK inhibitors like ruxolitnib, dermatologists need to have a shared discussion with patients regarding the benefit/risk assessment. The overall goal is to find a reasonable management option for AD. Patient-related factors should be considered when deciding on the dosing and regimen selection. Before recommending oral JAK inhibitors, hepatitis B and C testing should be performed, as well as tuberculosis screening and HIV testing. Annual skin exams will be needed, as well as skin cancer detection screenings.

“The companies that are working on these [JAK inhibitors] can give you more specifics on the number of patient years to look at to see what the actual risk factors are and looking at specific risk factors,” said Del Rosso.

Reference

Swanson L, Del Rosso, JQ. Atopic dermatitis management – getting the inside track on JAKs. 2022 Fall Clinical Dermatology Conference. October 20, 2022. Las Vegas, Nevada.