For adult patients with atopic dermatitis (AD) who have not responded to systemic medications, abrocitinib, an oral Janus kinase (JAK) 1 inhibitor recently approved by the Food and Drug Administration (FDA), proved efficacious in the treatment of moderate-to-severe AD.
Prior to FDA approval of abrocitinib, prednisone was the only FDA-approved oral medication for AD, according to Steven R. Feldman, MD, PhD. “Although biologics such as dupilumab have revolutionized care, some patients prefer oral medications,” Dr. Feldman wrote. “Compared with clinical trials of conventional AD treatments, abrocitinib appears more effective.” He added that most adverse events were self-limited and not severe.
For a study published in the Annals of Pharmacotherapy, Dr. Feldman and colleagues conducted a literature search for articles from inception through end-March 2022 using the search terms atopic dermatitis, abrocitinib, PF 04965842, methotrexate, cyclosporine, dupilumab, ruxolitinib, and JAK-STAT pathway.
Clinical Improvement Greater With 200 mg Dose
Across phase 2b and phase 3 clinical trials, abrocitinib was efficacious, with an average of 47.5% of patients on 200 mg abrocitinib and 32.0% on 100 mg abrocitinib achieving an Investigator’s Global Assessment (IGA) of 0 or 1 at 12 weeks.
The study team observed that patients on abrocitinib 200 mg once daily had improved disease severity and itch response compared with dupilumab 300 mg subcutaneously every other week. Abrocitinib was effective in improving AD signs and symptoms, such as pruritus, and disease severity at both 100 and 200 mg dosages once daily across multiple clinical trials. However, clinical improvement was greater with the 200 mg dose.
Adverse event (AE) frequency was similar between patients taking 100 and 200 mg doses and was mainly limited to nonserious AEs such as nausea, headaches, acne, and nasopharyngitis. Upon medication discontinuation, relapse rates in patients taking 200 mg abrocitinib was high (77.5%). Therefore, maintenance doses of 100 or 200 mg may be required to maintain disease control.