A Practical Guide to Using Oral JAK Inhibitors for Atopic Dermatitis from the International Eczema Council

Carter Haag, Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.
Andrew Alexis, Department of Dermatology, Weill Cornell Medical College, New York, NY, USA.
Valeria Aoki, Department of Dermatology, University of São Paulo, São Paulo, Brazil.
Robert Bissonnette, Innovaderm Research, Montreal, Canada.
Andrew Blauvelt, Oregon Medical Research Center, Portland, OR, USA.
Raj Chovatiya, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Michael J. Cork, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England.
Simon G. Danby, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England.
Lawrence Eichenfield, Department of Dermatology and Pediatrics, University of California San Diego, San Diego, CA, USA.
Kilian Eyerich, Department of Dermatology, University of Freiburg, Freiburg im Breisgau, Germany.
Melinda Gooderham, Department of Medicine, Queen's University, Kingston, ON, Canada.
Emma Guttman-Yassky, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Dirk-Jan Hijnen, Department of Dermatology, Erasmus University MC, Rotterdam, Netherlands.
Alan Irvine, Clinical Medicine, Trinity College, Dublin, Ireland.
Norito Katoh, Department of Dermatology, Kyoto Prefecture University of Medicine, Kyoto, Japan.
Dedee F. Murrell, Department of Dermatology, St. George Hospital, University of NSW, Sydney, Australia.
Yael A. Leshem, Division of Dermatology, Rabin Medical Center, Petach Tikva, and the Faculty of Medicine, Tel Aviv University, Israel.
Adriane Levin, Massachusetts Dermatology Associates, Beverly, MA, USA.
Ida Vittrup, Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Jill I. Olydam, Department of Dermatology, Erasmus University MC, Rotterdam, Netherlands.
Raquel L. Orfali, Department of Dermatology, University of São Paulo, São Paulo, Brazil.
Amy Paller, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Yael Renert-Yuval, Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikya, and the Faculty of Medicine, Tel Aviv University, Israel.
David Rosmarin, Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Jonathan Silverberg, Department of Dermatology, George Washington University School of Medicine, Washington DC, USA.
Jacob Thyssen, Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Sonja Ständer, Center for Chronic Pruritus, Department of Dermatology, University of Münster, Münster, Germany.
Nick Stefanovic, Clinical Medicine, Trinity College, Dublin, Ireland.
Gail Todd, Department of Dermatology, University of Cape Town, Cape Town, South Africa.
JiaDe Yu, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Eric Simpson, Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.

Document Type

Journal Article

Publication Date

9-10-2024

Journal

The British journal of dermatology

DOI

10.1093/bjd/ljae342

Abstract

BACKGROUND: Janus kinase inhibitors (JAKinibs) have the potential to dramatically alter the landscape of atopic dermatitis (AD) management due to their promising efficacy results from phase 3 trials and rapid onset of action. However, JAKinibs are not without risk, and their use is not appropriate for all AD patients, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD. OBJECTIVE: This consensus expert opinion statement from the International Eczema Council (IEC) provides a pragmatic approach to prescribing JAKinibs, including choosing appropriate patients, dosing, clinical and lab monitoring, as well as long-term use. METHODS: An international cohort of authors from the IEC with expertise in JAKinibs selected topics of interest and were formed into authorship groups covering 10 subsections. The groups performed topic-specific literature reviews, consulted up-to-date adverse event (AE) data, referred to product labels and provided analysis and expert opinion. The manuscript guidance and recommendations were reviewed by all authors as well as the IEC Research Committee. RESULTS: We recommend JAKinibs be considered for patients with moderate to severe AD seeking the benefits of rapid reduction in disease burden and itch, oral administration, and the potential for flexible dosing. Baseline risk factors should be assessed prior to prescribing JAKinibs, including increasing age, venous thromboembolisms, malignancy, cardiovascular health, kidney/liver function, pregnancy and lactation, and immunocompetence. Patients being considered for JAKinib therapy should be current on vaccinations and we provide a generalized framework for laboratory monitoring, though clinicians should consult individual product labels for recommendations as there are variations among the JAKinib class. Patients who achieve disease control should be maintained on the lowest possible dose, as many of the observed AEs occurred in a dose-dependent manner. Future studies are needed in AD patients to assess the durability and safety of continuous long-term use of JAKinibs, combination medication regimens, and the effects of flexible, episodic treatment over time. CONCLUSIONS: The decision to initiate a JAKinib should be shared among patient and provider, accounting for AD severity and personal risk/benefit assessment, including consideration of baseline health risk factors, monitoring requirements and treatment costs.

Department

Dermatology

Link to Full Text

Share

COinS