From SDPA: JAKs, Black Boxes, and What It All Means

Practitioners shouldn’t fear Janus kinase (JAK) inhibitors for their patients when appropriate, according to a wide-ranging expert chat at the 2024 SDPA Annual Summer Conference in San Diego.

The conversation featured Matthew Zirwas, MD, a dermatologist with DOCS Dermatology, and Amy Spizuoco, DO, FAOCD, a board-certified dermatologist/dermatopathologist with True Dermatology, who spent time going through both general question they said practitioners should always be asking themselves as well as submitted questions related to JAK inhibitors.

Differences Between Different JAK Inhibitors

The presenters went through the questions that practitioners should have when deciding whether to use JAK inhibitors. One such common concerned the differences between the different JAK inhibitors and whether there are substantial differences between them.

“The real question that I have been dancing around is are they different in real life? Does all of this matter?” asked Dr. Zirwas. “Unfortunately for us, the answers to all of these questions are that we really have no idea. For me, I do not think there is a whole lot of difference based on what I've seen so far in the literature.”

Black Box Warnings

Dr. Spizuoco focused particularly on safety talked about how to process the black box warnings that the JAK inhibitor family of drugs has, and how to interpret the warnings and the data behind them. Provided as a general warning, drugs in the JAK inhibitor class have a warning from the U.S. Food and Drug Administration (FDA) for a possible increase in the risk for some serious adverse events, including thrombotic events, cardiovascular events, and cancer.

“As a reminder, regarding that black box warning, the information for MACE and thrombotic events comes from patients who have rheumatoid arthritis. It wasn’t our dermatologic patients that were being treated.”

Dr. Spizuoco noted that remains paramount to be selective and aware of risk factors when deciding who to assign to JAK inhibitors.

“If you have someone who's a really high BMI who smokes, they might not be the best patient for this drug,” she cautioned. “However, you want to factor in risk versus benefits for your patients as well.”

Dr. Zirwas echoed the sentiment, adding that the important consideration for JAK inhibitors is generally using the correct dosage.

“I would never say to a patient ‘there is no risk.’ There is no evidence of risk, which is a different statement,” he said. “It’s entirely possible that at some point we’re going to get evidence of risk, but it is highly unlikely because the manufacturers have looked hard for it.”

Presentation: Let's Get JAK'd: Taking the Fear Out of JAK Inhibitors. June 6. Presented at: SDPA Annual Summer Conference. June 5-9, 2024; San Diego.