TY - JOUR
T1 - A practical guide to using oral Janus kinase inhibitors for atopic dermatitis from the International Eczema Council
AU - Haag, Carter
AU - Alexis, Andrew
AU - Aoki, Valeria
AU - Bissonnette, Robert
AU - Blauvelt, Andrew
AU - Chovatiya, Raj
AU - Cork, Michael J.
AU - Danby, Simon G.
AU - Eichenfield, Lawrence F.
AU - Eyerich, Kilian
AU - Gooderham, Melinda
AU - Guttman-Yassky, Emma
AU - Hijnen, Dirk Jan
AU - Irvine, Alan D.
AU - Katoh, Norito
AU - Murrell, Dedee F.
AU - Leshem, Yael A.
AU - Levin, Adriane A.
AU - Vittrup, Ida
AU - Olydam, Jill I.
AU - Orfali, Raquel L.
AU - Paller, Amy S.
AU - Renert-Yuval, Yael
AU - Rosmarin, David
AU - Silverberg, Jonathan I.
AU - Thyssen, Jacob P.
AU - Ständer, Sonja
AU - Stefanovic, Nicholas
AU - Todd, Gail
AU - Yu, Jia De
AU - Simpson, Eric L.
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.
PY - 2024/12/23
Y1 - 2024/12/23
N2 - BACKGROUND: Janus kinase inhibitors (JAKi) have the potential to alter the landscape of atopic dermatitis (AD) management dramatically, owing to promising efficacy results from phase III trials and their rapid onset of action. However, JAKi are not without risk, and their use is not appropriate for all patients with AD, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD. OBJECTIVES: To provide a consensus expert opinion statement from the International Eczema Council (IEC) that provides a pragmatic approach to prescribing JAKi, including choosing appropriate patients and dosing, clinical and laboratory monitoring and advice about long-term use. METHODS: An international cohort of authors from the IEC with expertise in JAKi selected topics of interest were placed 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 that JAKi be considered for patients with moderate-to-severe AD seeking the benefits of a rapid reduction in disease burden and itch, oral administration and the potential for flexible dosing. Baseline risk factors should be assessed prior to prescribing JAKi, including increasing age, venous thromboembolisms, malignancy, cardiovascular health, kidney/liver function, pregnancy and lactation, and immunocompetence. Patients being considered for JAKi treatment should be current on vaccinations and we provide a generalized framework for laboratory monitoring, although clinicians should consult individual product labels for recommendations as there are variations among the different JAKi. 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 patients with AD to assess the durability and safety of continuous long-term JAKi use, combination medication regimens and the effects of flexible, episodic treatment over time. CONCLUSIONS: The decision to initiate JAKi treatment should be shared between the patient and provider, accounting for AD severity and personal risk-benefit assessment, including consideration of baseline health risk factors, monitoring requirements and treatment costs.
AB - BACKGROUND: Janus kinase inhibitors (JAKi) have the potential to alter the landscape of atopic dermatitis (AD) management dramatically, owing to promising efficacy results from phase III trials and their rapid onset of action. However, JAKi are not without risk, and their use is not appropriate for all patients with AD, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD. OBJECTIVES: To provide a consensus expert opinion statement from the International Eczema Council (IEC) that provides a pragmatic approach to prescribing JAKi, including choosing appropriate patients and dosing, clinical and laboratory monitoring and advice about long-term use. METHODS: An international cohort of authors from the IEC with expertise in JAKi selected topics of interest were placed 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 that JAKi be considered for patients with moderate-to-severe AD seeking the benefits of a rapid reduction in disease burden and itch, oral administration and the potential for flexible dosing. Baseline risk factors should be assessed prior to prescribing JAKi, including increasing age, venous thromboembolisms, malignancy, cardiovascular health, kidney/liver function, pregnancy and lactation, and immunocompetence. Patients being considered for JAKi treatment should be current on vaccinations and we provide a generalized framework for laboratory monitoring, although clinicians should consult individual product labels for recommendations as there are variations among the different JAKi. 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 patients with AD to assess the durability and safety of continuous long-term JAKi use, combination medication regimens and the effects of flexible, episodic treatment over time. CONCLUSIONS: The decision to initiate JAKi treatment should be shared between the patient and provider, accounting for AD severity and personal risk-benefit assessment, including consideration of baseline health risk factors, monitoring requirements and treatment costs.
UR - http://www.scopus.com/inward/record.url?scp=85210417423&partnerID=8YFLogxK
U2 - 10.1093/bjd/ljae342
DO - 10.1093/bjd/ljae342
M3 - Article
C2 - 39250758
AN - SCOPUS:85210417423
SN - 0007-0963
VL - 192
SP - 135
EP - 143
JO - British Journal of Dermatology
JF - British Journal of Dermatology
IS - 1
ER -