For patients living with atopic dermatitis (AD), oral Janus kinase (JAK) inhibitors have demonstrated superior efficacy in head-to-head trials with dupilumab.

For a paper published in Expert Review of Clinical Immunology, Jonathan Silverberg, MD, PhD, MPH, and Shanthi Narla, MD, examined the safety and efficacy of topical and oral JAK inhibitors for the treatment of AD.


Many Patients Prefer Oral Medications Over Injectable Therapies

“Janus inhibitors have demonstrated rapid onset of effect with some patients, who have experienced improvements in itch after their first dose,” Dr. Silverberg says. These medications “have also demonstrated unprecedented efficacy, particularly at the highest approved doses.  Many patients [also] prefer an oral option over injectable therapies.”

Although only FDA-approved for use in moderate-to-severe AD that is refractory to prior systemic therapy, JAK inhibitors may be considered in patients with moderate-to-severe AD in certain circumstances, noted Drs. Silverberg and Narla. These include induction treatment followed by an alternative therapy for long-term control, short or intermediate treatment, long-term continuous treatment, or as a second-line therapy in patients with a poor response or adverse events leading to discontinuation from prior systemic therapies.


Certain Patients Are Not Good Candidates

Dr. Silverberg notes that rare, but serious, AEs have been reported with JAK inhibitor therapy for AD, rheumatoid arthritis, and other immune-mediated disorders and warrant careful consideration. Therefore, prescribing JAK inhibitors should be limited in patients who may be at high risk for AEs, such as older patients, those with elevated malignancy risk at baseline, and “those with a strong family history of blood clots, heart attack, or stroke,” the authors added

Dr. Silverberg recommended that clinicians address these crucial features in shared decision-making discussions, when choosing appropriate therapies, patient counseling, and monitoring patients in clinical practice.