The following is the summary of “JAK Inhibitor Safety Compared to Traditional Systemic Immunosuppressive Therapies” published in the December 2022 issue of Dermatology by Daniele, et al.

After receiving boxed safety warnings, dermatologists treating atopic dermatitis are curious about the safety profile of the newly available JAK inhibitors, upadacitinib and abrocitinib. Clinical trial data involving the use of these JAK inhibitors for the treatment of atopic dermatitis over long periods of time suggests that they are associated with very low incidence rates of malignancy, significant adverse cardiac events, and thromboembolic events. However, there is a lack of data on the relative risk of side events for JAK inhibitors and more conventional systemic therapy for poorly controlled atopic dermatitis, as well as baseline rates in atopic dermatitis and reference control populations. 

To fill this void, researchers compiled information on methotrexate, cyclosporine, and systemic corticosteroids and determined the incidence of adverse events per 100 patient-years. Further, investigators compared the occurrence of adverse events in patients with atopic dermatitis and healthy controls based on data from the beginning of their treatment. We showed that the incidence rates of malignancy (excluding non-melanoma skin cancer), non-melanoma skin cancer, significant adverse cardiac events, and venous thromboembolism were the same or greater for standard systemic treatments for atopic dermatitis compared to upadacitinib and abrocitinib. 

Also, as compared to rates in individuals with atopic dermatitis or controls, those on upadacitinib or baricitinib had a lower incidence of malignancy (excluding non-melanoma skin cancer), significant adverse cardiac events, and venous thromboembolism, but higher rates of non-melanoma skin cancer. These results suggest that JAK inhibitors should be prioritized above conventional systemic medications for the treatment of atopic dermatitis, at least in terms of safety.