Indications and Efficacy of JAK Inhibitors for AD

Opinion
Video

Lisa Swanson, MD, PhD, reviews the indications for ruxolitinib, abrocitinib, and upadacitinib, as well as the clinical trial data on efficacy of these JAK inhibitors when treating AD.

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.

Lisa Swanson, MD, PhD, discusses FDA-approved topical and systemic Janus kinase (JAK) inhibitors for atopic dermatitis, addressing their indications and clinical trial data. Topically, ruxolitinib is approved for patients aged 12 and older with nonsegmental vitiligo or mild to moderate atopic dermatitis, demonstrating significant efficacy at 8 weeks. Orally, abrocitinib and upadacitinib are daily pills for patients aged 12 and older, with flexible dosing based on response.

Clinical trial data, including the TRuE-AD1 and TRuE-AD2 trials for ruxolitinib and studies comparing upadacitinib and abrocitinib to dupilumab, is reviewed. Ruxolitinib shows rapid efficacy, with about half of the patients achieving IGA (investigator lobal assessment scale) clear or almost clear at 8 weeks. Comparisons with dupilumab reveal that upadacitinib at 100mg is as effective, while the 200mg dose appears slightly more effective. In head-to-head studies, upadacitinib at 30mg outperforms dupilumab.

Dr Swanson also mentions the ongoing Level Up study comparing upadacitinib 15mg to dupilumab and discusses network meta-analyses evaluating advanced therapies. Despite challenges in indirect comparisons, these analyses suggest that upadacitinib at 30mg is superior to upadacitinib at 15mg, which is superior to abrocitinib at 200mg, and abrocitinib at 200mg is superior to dupilumab at 300mg every two weeks.

The discussion concludes with the analogy of treating atopic dermatitis as the Olympics, where JAK inhibitors, specifically abrocitinib and upadacitinib at certain doses, take gold, silver, and bronze, reflecting the revolutionary efficacy and impact on itch in the field.

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

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