The Food and Drug Administration (FDA) recently approved two oral JAK-1 inhibitors for people with moderate to severe atopic dermatitis (eczema):
- abrocitinib (Cibinqo)
- upadacitinib (Rinvoq)
The topical JAK inhibitor ruxolitinib (Opzelura) was approved in 2021, as well.
These are potentially helpful treatments for eczema as they block the overactive pathway that leads to inflammation. This can help reduce eczema symptoms, such as itching and inflammation.
These are exciting times for some neglected conditions like atopic dermatitis. JAK inhibitors show promise as a new class of treatment by more precisely blocking the overactive immune pathway that contributes to symptoms of eczema.
JAK inhibitors are associated with rare yet serious side effects, including blood clots and cancer. Due to this finding, the FDA requires a black box warning on these treatments.
Topical JAK inhibitors are less likely to be a potential issue or concern because they have less absorption into the body than the oral versions. Healthcare professionals may try to decrease the risk by monitoring treatments closely and giving patients breaks between treatments.
So far, no serious side effects have been reported for the two oral JAK inhibitors approved to treat atopic dermatitis. But since other JAK inhibitors have shown some of those serious side effects, patients should still be monitored closely for 12 weeks, then every 3 months. Monitoring includes lab work and clinical assessments.
Black box warnings are not listed for all biologics. This warning is required by the FDA when serious or life threatening risks are detected from a medication.
If a treatment you’re considering comes with a black box warning, it’s important to talk with your doctor about the potential risks.
All medications come with some risks. The level of risk for side effects listed on black box warnings can vary from person to person.
Healthcare professionals need to take into account each patient’s own risk factors. Not every person will have the same side effects or risk factors for treatments. People with certain health histories or conditions, such as a compromised immune system, could be at higher risk of side effects from these treatments.
Dosing can also play a role in the risk factor. Higher dosages and more frequent treatments may increase someone’s risk of side effects.
It’s important that your doctor is aware of your personal and family medical history to help understand the risks you may face. There needs to be a conversation about the risks versus benefits of your treatment.
JAK inhibitors can alter your immune system’s ability to react to pathogens, which can put you at risk for bacterial, fungal, or viral infections. Herpes viruses can reactivate, as well.
Another potential side effect is headaches, which people with migraine should be aware of. This could potentially make their migraine episodes worse.
Before starting treatment, patients should be screened and have their health history reviewed to see whether the medication is likely to be safe for them.
Often baseline lab work is required for certain medications, as well as for ongoing monitoring to ensure the treatment continues to be safe and well-tolerated.
Inflammation at a molecular level is very complex. There are different pathways that trigger and cause people with eczema to experience inflammation, irritation, and itching.
Corticosteroids and JAK inhibitors target that inflammation in different ways.
Steroid treatments are human-made medications that reduce inflammation in the skin. They interact to block the chemical necessary for inflammation, which can help reduce eczema symptoms.
JAK inhibitors can block more specific pathways that are involved with atopic dermatitis.
You and a healthcare professional should work together to determine whether to treat your eczema with a JAK inhibitor. The factors to consider include:
- how well your eczema is managed
- your quality of life
- cost of treatments
- potential risks versus benefits
As you discuss eczema treatment options with a healthcare professional, it’s important to consider any potential side effects.
Before switching treatments, you’ll need to undergo a screening with a healthcare professional to assess those risks. This includes providing an up-to-date medical history and undergoing lab work.
If you experience a minor, unpleasant side effect from the drug, get in touch with your doctor right away. If you think you’re experiencing a serious allergic reaction or side effect, call local emergency services or go to the hospital immediately.
Side effects and signs of an allergic reaction can include:
- upper respiratory tract infection
- difficulty swallowing
- shortness of breath
It’s important to have a conversation with your doctor before starting treatment to understand the specific potential risks and side effects you should watch out for.
Amanda Caldwell is a nurse practitioner in dermatology. She is certified by the American Academy of Nurse Practitioners (AANP) as a family nurse practitioner. She currently practices at KMC Dermatology in Kansas. She has diverse experience in family medicine, neurology, and dermatology. Caldwell strives to provide compassionate and patient-centered care in all aspects of both general and cosmetic dermatology.
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