Dear Editor,
I read with interest the article, “Lose Your Inhibitions: Expanding Use of JAK Inhibitors,” published in the May issue of Practical Dermatology. I applaud the positive tone of the headline. Having served as faculty for many years now for the Dermatology Education Foundation (DEF) Biologic and Small Molecule NP/PA CME Bootcamp Series, I and fellow faculty have focused on educating dermatology health care team members—from administrators and support staff to PAs, NPs, and physicians—about JAKs and other innovative systemic and topical therapies. We firmly believe that these agents have a role in patient care and encourage their appropriate use in the clinical setting.
This article highlighted some of the known and theoretical risks associated with the use of JAK inhibitors in a very specific population of patients with rheumatoid arthritis who were taking concomitant methotrexate. Despite the headline, however, the article leaves the impression that JAK inhibitors are associated with significant safety concerns and potentially off-putting practical and administrative burdens. Readers must be aware that there are practical and efficient strategies they can employ to facilitate the use of JAK inhibitors and ensure patient access. There is no need for fear or trepidation among prescribers or patients specifically with respect to access.
The article would have benefited from a clearer presentation of information and selected data. For example, all JAKs have a boxed warning (the FDA has encouraged this terminology in lieu of “black box warning”), as this is a class warning. The article suggests only certain JAKs have a boxed warning. Additionally, the author of the article failed to indicate that some of the referenced data compared different therapeutic doses, making the stated incidence rates of adverse events difficult to comprehend. As noted above, this patient population was also taking concomitant methotrexate. The differences in the patient population of the ORAL surveillance study versus the patient populations of the Atopic Dermatitis and Alopecia Areata trials is a salient fact, especially if we are to infer safety of these agents in diverse patient populations.
The article provides safety data comparisons of JAKs to “traditional” systemic therapies extracted from review articles. This data provides context, but we encourage readers to become familiar with the efficacy and safety data for the approved and emerging JAKs, particularly the phase 3 trial data. Prescribers and potential prescribers of JAK inhibitors must be aware of all baseline and ongoing monitoring requirements in the product labels, as well as current expert consensus and best practices.
The landscape for dermatology therapeutics is advancing rapidly, and we who treat patients with inflammatory skin diseases have access to treatments that provide remarkable efficacy with a high degree of safety; risks are generally manageable and predictable. Given the substantial negative impact on quality of life and function that diseases like atopic dermatitis, vitiligo, and alopecia areata can have on affected individuals, it is imperative that dermatology care providers understand the potential benefits and risks of available treatments and be prepared to offer patients the best treatments to meet their needs. We know many inflammatory skin diseases, left unmanaged, are associated with dangerous long-term comorbidities and detrimental health effects.
Education is key. We encourage any dermatology prescriber interested in the use of JAK inhibitors to clearly understand the nature of the boxed warning so we can become fully informed about these agents and their use.
Sincerely,
