For adults with atopic dermatitis (AD), topical therapies alone or in combination with phototherapy can be effective in managing symptoms. However, for patients with moderate-to-severe AD, systemic therapies, such as Janus kinase (JAK) inhibitors, may be necessary for satisfactory disease control, especially if topical treatments are not helpful in relieving symptoms.
“Oral JAK inhibitors have shown great potential in improving the symptoms of AD,” wrote Farnam B. Sedeh, MD, Mattias A.S. Henning, MD, and colleagues in Acta Dermato-Venerealogica. “Whether they are better than other treatments in controlling AD remains uncertain, as only a few studies have directly compared them with other treatments,” they wrote. “Currently, three head-to-head studies have compared JAK inhibitors with monoclonal antibodies (dupilumab). The first study investigated abrocitinib versus dupilumab, the second study upadacitinib versus dupilumab, and the last study abrocitinib versus dupilumab. The conclusions of the studies were similar, suggesting that JAK inhibitors were significantly better at reducing the signs and symptoms of moderate-to-severe AD compared to dupilumab (regarding abrocitinib 200 mg).”
To evaluate the effectiveness of systemic therapies with JAK inhibitors and dupilumab, and with tralokinumab, for moderate-to-severe AD, Drs. Sedeh, Henning, and colleagues conducted a systematic literature review, examining randomized controlled trials (19 studies, N=6,444).
Upadacitinib Showed Highest Efficacy in Monotherapy Studies
The percentage of patients with AD achieving 90%, 75%, and 50% improvement in Eczema Area and Severity Index (EASI) score after dupilumab, tralokinumab, or JAK inhibitors was the primary outcome. Upadacitinib (30 mg once daily) demonstrated the highest numerical efficacy in monotherapy studies regarding EASI-90, EASI-75, and EASI-50.
Dupilumab (300 mg once every other week) had the highest efficacy regarding EASI-50, and abrocitinib (200 mg once daily) had the highest score regarding EASI-90 and EASI-75 in combination therapy studies with topical corticosteroids.
More Studies Needed to Understand the Long-term Effectiveness of JAK Inhibitors
JAK inhibitors, such as upadacitinib, abrocitinib, and baricitinib, may be beneficial to patients with moderate-to-severe AD who are unresponsive to topical treatments, the study team noted.
The treatment showed similar results in both combination with topic corticosteroids and as monotherapy. Treatment with tralokinumab, however, did not appear to be as efficacious as treatment with upadacitinib, abrocitinib, and dupilumab.