Role of JAK Inhibitors in Skin Lesions

Primary Indications and Efficacy

The American Academy of Dermatology recommends upadacitinib (15 mg and 30 mg daily) and abrocitinib (200 mg daily) for the treatment of moderate-to-severe atopic dermatitis, demonstrating superior efficacy to dupilumab in head-to-head trials 1
Baricitinib shows efficacy in the treatment of moderate-to-severe atopic dermatitis, although network meta-analysis suggests it is less efficacious than upadacitinib and abrocitinib 1
JAK inhibitors offer rapid reduction in disease burden and itch in patients with atopic dermatitis, with the convenience of oral administration and flexible dosing 2
Tofacitinib (5 mg and 10 mg twice daily) showed superiority over placebo for all efficacy endpoints at week 16 in the treatment of psoriasis, with maintained response for 52 weeks 3, 4
The European League of Dermatological Societies notes that tofacitinib 10 mg twice daily demonstrated greater efficacy than 5 mg twice daily in the treatment of psoriasis 3

The FDA recommends upadacitinib 15 mg or 30 mg once daily for the treatment of moderate-to-severe atopic dermatitis 5
The FDA recommends abrocitinib 100 mg or 200 mg once daily for the treatment of moderate-to-severe atopic dermatitis 5
The British Association of Dermatologists suggests that baricitinib is not recommended with severe renal impairment (eGFR <30 mL/min) and requires dose adjustment for mild-to-moderate impairment 6

The American Academy of Dermatology recommends complete blood count with differential, liver enzymes, renal function tests, lipid panel, tuberculosis screening, hepatitis B and C testing, HIV testing in high-risk populations, and pregnancy testing before initiating JAK inhibitors 5
The British Association of Dermatologists suggests that recombinant zoster vaccine (Shingrix) should be completed 3-4 weeks before JAK inhibitor initiation in adults ≥50 years or immunocompromised adults ≥19 years 2, 6

The American Academy of Dermatology recommends monitoring for infections, particularly herpes zoster, which occurs more frequently with JAK inhibitors 5
The British Association of Dermatologists suggests that patients on JAK inhibitors should be monitored for thrombotic events, especially in patients with cardiovascular risk factors 5

The FDA warns of increased risk of major adverse cardiovascular events, venous thromboembolism (VTE), cancer, and death based on tofacitinib data in rheumatoid arthritis patients ≥50 years with cardiovascular risk factors 1, 6
The European League of Dermatological Societies notes that JAK inhibitors carry boxed warnings for increased malignancy risk 6
The American Academy of Dermatology recommends avoiding JAK inhibitors during active serious infections 5

The British Association of Dermatologists suggests that JAK inhibitors should be considered first-line for moderate-to-severe atopic dermatitis in patients without cardiovascular risk factors, age <50 years, no malignancy history, and no active infections 2, 1
The European League of Dermatological Societies recommends considering JAK inhibitors as an alternative for psoriasis patients who are inadequate responders to conventional therapy, recognizing lower efficacy than IL-17/IL-23 inhibitors 3