PracticalDermatology

Janus kinase (JAK) inhibitors are changing the playing field for patients with skin diseases and the doctors charged with their treatment. Recent research presented at the American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting in Anaheim, CA, showed that as-needed monotherapy with the topical JAK inhibitor ruxolitinib cream (Opzelura, Incyte) produced long-term disease control over 44 weeks in adults and adolescents with atopic dermatitis (AD), potentially reducing the need for therapy escalation.

Study author Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital-San Diego, and distinguished professor of dermatology and pediatrics and vice-chair of the department of dermatology at UC San Diego School of Medicine, discussed the findings and how they may impact practice with Practical Dermatology® magazine.

Tell us about the study.

Lawrence Eichenfield, MD: Ruxolitinib cream is the first topical JAK inhibitor and has been studied in 8-week, vehicle-controlled trials used twice-daily and in an extension study where it was utilized on an as-needed basis. In the extension study, patients were using either 1.5% ruxolitinib cream (the now-approved dosage of the medication) or 0.75% ruxolitinib cream. Patients would stop use of the drug when clear for several days and could restart with recurrence of lesions. The study showed the rapid control seen with the twice-daily application in the 8-week study continued showing long-term control maintenance during the rest of the year of observation and treatment.

What did the pooled analyses of these data show?

Dr. Eichenfield: Patients using ruxolitinib cream “as needed” had a substantial amount of time off medication regardless of disease severity at baseline or body surface area (BSA) involved, while showing that milder disease (Investigator Global Assessment [IGA]=2 mild, BSA<10%) at baseline had more time “off drug” (60.7% of the days and 57% of the days, respectively during the 48-week period). The study also showed that if patients were clear and held off on the use of the medication, the median time to reach mild or worse disease was 36.1 days, and recapturing skin clearance was rapid when ruxolitinib cream was restarted. In addition, the drug was well tolerated, with a safety profile similar to the 8-week study, with no new safety signals.

How may these findings change practice?

Dr. Eichenfield: This study and analysis supports longer-term use of topical ruxolitinib cream and helps establish expectations of long-term disease control with intermittent use as needed with good safety and tolerance and may empower patients to adopt a non-steroid based approach to long-term disease control.

Disclosures
Dr. Eichenfield has served as a consultant, speaker, advisory board member or investigator for AbbVie, Amgen, Arcutis, Aslan, Bristol-Myers Squibb, Castle Biosciences, Dermavant, Eli Lilly, Forte, Galderma, Incyte, Janssen, Johnson & Johnson, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi-Genzyme, Target RWE and UCB.