Dr. King: “JAK inhibitors will be a very important — maybe the most important — drug class in dermatology.”
Meeting attendees had the opportunity to glean groundbreaking information on the use of Janus kinase (JAK) inhibitors in dermatology when session director Brett A. King, MD, PhD, presented “Treating Alopecia Areata, Vitiligo, and Atopic Dermatitis: JAK Inhibitors, Something New for Dermatology” (U032). He outlined the new class of medications, including potential dermatologic treatment options, their safety, and future developments.
A novel approach
Historically, effective treatments for alopecia areata, vitiligo, and atopic dermatitis (AD) have been limited. Now, with increasing understanding of the mechanisms of these diseases, together with the emergence of a new class of medicines, JAK inhibitors, dermatologists will soon have reliably effective therapies for these and other patients.
“JAK inhibitors target the pathologic processes that drive these diseases and, therefore, effectively interrupt those processes to reverse the diseases or make them better,” said Dr. King. “The other treatments that we have been using for these conditions are blunt, non-specific instruments and, thus, are frequently less effective.”
Dr. King touched on the three oral JAK inhibitors that are currently commercially available, and discussed how they have been used in recent trials and studies to treat alopecia areata, vitiligo, and AD.
- Xeljanz (tofacitinib): FDA-approved for rheumatoid and psoriatic arthritis. Dose: 5 to 10 mg twice a day.
- Jakafi (ruxolitinib): FDA-approved for myelofibrosis and polycythemia vera. Dose: 10 to 25 mg twice a day. This medication is used less often because of its high cost.
- Olumiant (baricitinib): FDA-approved (in June) for rheumatoid arthritis. Dose: likely to be 2 to 4 mg once a day.
Safety first
There are certain precautions to take when prescribing JAK inhibitors in order to ensure patient safety and help prevent adverse effects. Prior to starting treatment, dermatologists should screen patients for HIV, hepatitis B, hepatitis C, and tuberculosis. Patients should also be evaluated with complete blood count, complete metabolic panel, and fasting lipids. After treatment begins, the latter tests should be repeated at four weeks and then every three months.
Dr. King also said it’s important to evaluate initial progress around three months into treatment and then every three to six months thereafter. A physical exam and review of symptoms should be performed at each visit, he said. This will help to understand how the patient is tolerating the therapy and guide medication adjustments, if needed.
Looking ahead
Because JAK inhibitors are bringing reliably effective treatments within reach, Dr. King predicts a bright future for patients who have alopecia areata, vitiligo, or AD. As different JAK inhibitors become available, dermatologists will have the ability to address the specific mechanisms that drive these and other diseases.
“JAK inhibitors will be a very important — maybe the most important — drug class in dermatology because of their broad applicability across numerous conditions that patients commonly, and uncommonly, present within our clinics,” said Dr. King.
For more information on the recent trials and studies that Dr. King presented on, see the resources below.
- “JAK inhibitors in dermatology: The promise of a new drug class”(Journal of the American Academy of Dermatology)
- “Rapid repigmentation of vitiligo using Tofacitinib plus low-dose, narrowband UV-B phototherapy”(JAMA Dermatology)
- “Treatment of recalcitrant atopic dermatitis with the oral Janus kinase inhibitor tofacitinib citrate”(Journal of the American Academy of Dermatology)
- “Tofacitinib for the treatment of severe alopecia areata and variants: A study of 90 patients”(Journal of the American Academy of Dermatology)
