Safety of JAK Inhibitors Approved for AD Treatment

This is a video synopsis/summary of a panel discussion involving Christopher Bunick, MD, PhD; Peter Lio, MD; Lisa Swanson, MD, PhD; and Alexandra Golant, MD.

In this discussion about the treatment considerations in atopic dermatitis, the focus shifts from efficacy to safety, particularly regarding Janus kinase (JAK) inhibitors. Dr Lio acknowledges the initial apprehension clinicians and patients might feel due to the black box warning associated with all JAK inhibitors. The warning highlights concerns such as major adverse cardiovascular events, increased mortality, potential clot risks, and malignancy.

Dr Lio emphasizes the need to address these concerns transparently with patients while providing perspective. He notes that the black box warning originated from a study on a specific JAK inhibitor, tofacitinib, in a different population (rheumatoid arthritis patients over 50 with cardiovascular risk factors), making it somewhat less directly applicable to atopic dermatitis patients.

Despite the warning, the conversation shifts to the actual safety profile observed in trials. Dr BunicK discusses common treatment-emergent adverse events, including JAK inhibitor-related acne and the necessity of lab monitoring. Overall, the class has been well-tolerated, and adverse events are mostly theoretical or mild.

The dialogue extends to long-term safety data, with a focus on upadacitinib and abrocitinib. The physicians find the data reassuring, highlighting low rates of severe side effects. They stress the importance of contextualizing the risks, mentioning that the adverse event of highest frequency is shingles, which could potentially be mitigated by vaccination.

The conversation concludes with insights into counseling patients using long-term safety data. Dr Lio and Dr Bunick emphasize the need to understand the patient's individual health context, referencing factors such as oral contraceptives and smoking. They also stress the importance of comparing event rates to baseline rates in the overall population and the rate of the disease without therapy, providing a comprehensive understanding of the risks and benefits associated with JAK inhibitors.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.