What’s Next for Topical JAK Inhibitors?

Matthew Zirwas, MD, a board-certified dermatologist specializing in atopic dermatitis discussed advancements in topical Janus kinase (JAK) inhibitors, particularly ruxolitinib (Opzelura; Incyte), in a recent interview with Dermatology Times ahead of South Beach Symposium 2025. With extensive experience conducting trials on topical JAK inhibitors, Zirwas highlights key aspects of ruxolitinib’s effectiveness, long-term benefits, pediatric applications, and upcoming developments in the field.

One of the central topics Zirwas addressed is how ruxolitinib compares to traditional topical steroids. He raises the question, “Is it worth going to an expensive drug whenever we've got topical steroids?” and explores its benefits over conventional treatments. While topical steroids have been the standard treatment for atopic dermatitis, ruxolitinib offers an alternative mechanism of action with potentially fewer adverse effects and a different safety profile. He notes that while topical steroids are effective, there is still a need for alternative treatments for patients who may not tolerate or respond well to steroids.

Another critical point Zirwas discussed is ruxolitinib’s long-term efficacy. He stated, “You probably heard that it works really fast. But how does it work long term?” Zirwas explains that while many clinicians and patients are aware of the drug’s rapid onset of action, its long-term performance remains an essential factor in clinical decision-making. Understanding how it sustains improvement over extended use is crucial for determining its role in the treatment landscape.

The conversation also touched on pediatric use, as ruxolitinib is expected to receive approval for children soon. Zirwas inquires, “Does it work as well for kids? Better for kids, not as well for kids? What's the safety like in kids?” He emphasizes the importance of safety studies, particularly regarding maximum-use trials, to ensure that the medication is both effective and safe for younger patients. Pediatric atopic dermatitis can be particularly challenging to treat, making the expansion of ruxolitinib’s indication a significant development for dermatologists and patients alike.

In addition to ruxolitinib, Zirwas previewed an upcoming topical JAK inhibitor, delgocitinib, which is expected to receive FDA approval specifically for hand eczema. He explains that assessing hand eczema requires different metrics than atopic dermatitis, such as the Hand Eczema Severity Index rather than the Eczema Area and Severity Index. He highlights the need to understand how this new treatment compares to existing options and how it may benefit patients with chronic hand eczema.

Zirwas will be presenting on these topics at the 2025 South Beach Symposium. He describes it as “a great meeting, and it is really the kind of meeting that can be super helpful, because of the wide spectrum of coverage.” He encourages attendees to participate, emphasizing that even those familiar with topical JAK inhibitors will gain new, valuable knowledge from the presentation.

Zirwas’s discussion provides a thorough overview of the current landscape and future developments in JAK inhibitors for dermatological conditions. His insights help clinicians understand how these novel treatments compare to existing therapies, their long-term utility, and their potential expansion to new patient populations.

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