JAK inhibitors: What your dermatologist wants you to know
The JAK inhibitor is a newer type of medication that’s changing patients’ lives. It’s helping some patients with alopecia areata regrow their hair and some patients with vitiligo regain lost skin color. One JAK inhibitor can stop the itch of eczema – sometimes within a few days.
JAK inhibitors also offer patients these benefits:
The medication tends to work quickly.
Some patients who haven’t been helped by other treatments are seeing results.
A JAK-inhibitor doesn’t have to be injected.
Dermatologists ran the research studies that led the U.S. Food and Drug Administration (FDA) to approve JAK inhibitors for conditions that dermatologists treat
Thanks to this breakthrough research, JAK inhibitors are FDA approved to treat conditions ranging from eczema to vitiligo.
What makes this medication unique is the way it works. A JAK inhibitor interferes with signals in the body that are thought to cause inflammation. This, in turn, reduces the inflammation that fuels diseases like eczema, psoriatic arthritis, and vitiligo.
With less inflammation, the immune system calms down. For someone with vitiligo, this may give the skin a chance to re-pigment. A child who has eczema can have noticeably less itch and clearer skin.
Several JAK inhibitors approved for conditions that dermatologists treat
In September 2021, the U.S. Food and Drug Administration (FDA) approved the first JAK inhibitor, ruxolitinib, to treat a skin condition. Since then, the FDA has approved several more for conditions that dermatologists treat.
The dermatologic conditions for which the FDA has approved a JAK inhibitor include:
Atopic dermatitis/eczema (mild to moderate)
Ruxolitinib (Opzelura™)
A cream
It can be applied continuously for up to 8 weeks or longer when applied occasionally.
In clinical trials:
More than 50% of the patients had clear or almost clear skin and/or significantly less itch after applying this cream twice a day for 8 weeks.
After applying the first dose, some patients had noticeably less itch in 12 hours.
Atopic dermatitis/eczema (moderate to severe)
Upadacitinib (Rinvoq®)
A once-daily tablet
In clinical trials:
Some patients had less itch as early as 2 days after starting the medication.
Some patients saw clearer skin in as little as 2 weeks.
Abrocitinib (Cibinqo™)
A once-daily tablet
In clinical trials:
Patients were given different doses of this medication. After 12 weeks of taking this medication, 24% of patients taking the lower dose and 38% of those taking the higher dose had clear or almost clear skin and 35% (lower dose) to 55% (higher dose) had noticeably less itch.
Some patients had less itch within a day of starting abrocitinib.
Alopecia areata (severe)
Baricitinib (Olumiant®)
A once-daily tablet
In clinical trials:
About one-third of patients with severe alopecia areata regrew some of their hair, often with about 80% or more of their scalp being covered.
This JAK inhibitor also helped some patients regrow eyebrows and eyelashes.
Psoriatic arthritis (causing symptoms)
Tofacitinib (Xeljanz®)
Available as a tablet or liquid
In clinical trials:
More than 20% of patients taking tofacitinib had noticeably less joint pain and swelling two weeks after starting the medication.
As patients continued to take this medication, more had reduced pain and swelling – 50% of patients at 3 months and 68% of patients at one year.
Vitiligo (non-segmental)
Ruxolitinib (Opzelura™)
A cream applied to the skin
In the clinical trials:
Patients applied this cream twice a day. At 24 weeks, 30% of the patients had a 75% or greater re-pigmentation (return of skin color) on their face and 20% had 75% or greater re-pigmentation on other parts of their body.
Ruxolitinib is less effective on the hands and feet.
What you should know about the possible side effects of JAK inhibitors
JAK inhibitors are considered safe, but like all medications, they have possible side effects.
In clinical trials, the most common side effects seen in patients using a JAK inhibitor to treat a skin condition were less serious and included:
Common cold
Bronchitis
Ear infection
Urinary tract infection
Headache
Nausea
Other more serious side effects have occurred in patients taking a JAK inhibitor for a skin condition. A few patients have developed a serious side effect like pneumonia or tuberculosis.
Hearing about possible side effects may make you hesitant to try a new medication. If you feel this way, here’s what you should know about possible side effects:
Some of the side effects that you see listed for a particular JAK inhibitor did not occur in the safety studies run for that JAK inhibitor. If that seems confusing, you’re right.
Here’s what happened. When a side effect occurred in a study for one type of JAK inhibitor, the FDA required that side effect to be listed on all JAK inhibitors that work in a similar way.
For example, you’ll find tuberculosis (TB), which occurred in patients taking tofacitinib (a pill approved to treat psoriatic and rheumatoid arthritis), within the possible side effects listed for ruxolitinib (a cream approved to treat eczema and vitiligo). If you read the details, you’ll see that no cases of active TB were reported in the clinical trials for ruxolitinib cream. The TB occurred in patients taking tofacitinib to treat rheumatoid arthritis. Although the side effect was not reported in patients using ruxolitinib, the FDA requires that TB be listed as a possible side effect because these medications work in a similar way.Medications affect people differently. Some people have a greater risk of developing certain side effects. For example, a man who’s over 50, has high blood pressure and unhealthy cholesterol levels, and is overweight will have a higher risk for developing a heart problem than a teenager who has eczema and no other medical conditions.
You have a lower risk of developing side effects when you apply medication to your skin. When you take a pill, the medication gets inside your body. However, when you apply medication to your skin, very little of the medication gets inside your body. This means you have less risk of the side effects when you apply the medication to your skin.
Dermatologists weight the risks and benefits carefully
Be sure to tell your dermatologist if you have (or had):
Smoked (now or in the past)
A heart attack, stroke, blood clot, or any type of heart disease
High blood pressure
Unhealthy cholesterol levels
Diabetes
Cancer
Shingles
Swelling in your neck, armpits, or groin
A feeling of constantly being tired
A fever, night sweats, cough, difficulty breathing, hoarseness, wheezing, or unexplained weight loss
It’s also important that you tell your dermatologist about all medications (prescription and non-prescription) and supplements that you take. Some can interact with a JAK inhibitor.
Your dermatologist will consider all of this information before prescribing a JAK inhibitor medication. Your dermatologist will also think about your health, age, treatments you’ve used to manage your condition, and other considerations. This allows them to figure out if the benefits outweigh the risks.
Dermatologists carefully monitor their patients
If a JAK inhibitor is right for you, your dermatologist will watch you closely. By watching you, your dermatologist will be able to tell if the medication is working for you and whether you should continue taking it.
Wondering if a JAK inhibitor is right for you?
While there is plenty of information available that can help you understand the benefits and possible side effects, this information cannot tell you whether a JAK inhibitor is right for you. A dermatologist can tell you this. No one understands your skin better than a board-certified dermatologist.
Image
Getty Images
References
Blauvelt A, Silverberg JI, et al. “Abrocitinib induction, randomized withdrawal, and retreatment in patients with moderate-to-severe atopic dermatitis: Results from the JAK1 Atopic Dermatitis Efficacy and Safety (JADE) REGIMEN phase 3 trial.” J Am Acad Dermatol. 2022;86(1):104-12.
Damsky W, King BA.” JAK inhibitors in dermatology: The promise of a new drug class.” J Am Acad Dermatol. 2017;76(4):736-44.
King B, Ohyama M, et al. “BRAVE-AA Investigators. Two phase 3 trials of baricitinib for alopecia areata.” N Engl J Med. 2022;386(18):1687-99.
Mease P, Charles-Schoeman C, et al. “Incidence of venous and arterial thromboembolic events reported in the tofacitinib rheumatoid arthritis, psoriasis, and psoriatic arthritis development programmes and from real-world data.” Ann Rheum Dis. 2020;79(11):1400-13.
Papp K, Szepietowski JC, et al. “Efficacy and safety of Opzelura for the treatment of atopic dermatitis: Results from two phase 3, randomized, double-blind studies.” J Am Acad Dermatol. 202185(4):863-72.
Scoviak M. “How to explain JAK inhibitor warnings to patients.” Dermatol. Times, 2022;43(2):18.
Simpson EL, Papp KA, et al. “Efficacy and safety of upadacitinib in patients with moderate to severe atopic dermatitis: Analysis of follow-up data from the Measure Up 1 and Measure Up 2 randomized clinical trials. JAMA Dermatol. 2022;158(4):404-13.
Winthrop KL, Park SH, et al. “Tuberculosis and other opportunistic infections in tofacitinib-treated patients with rheumatoid arthritis.” Ann Rheum Dis. 2016 Jun;75(6):1133-8.
Written by:
Paula Ludmann, MS
Reviewed by:
Laurel Geraghty, MD, FAAD
William Warren Kwan, MD, FAAD
Shari Lipner, MD, PhD, FAAD
Bassel Hamdy Mahmoud, MD, PhD, FAAD
Omolara Olowoyeye, MD, FAAD
Sanna Ronkainen, MD, FAAD
Mario J. Sequeira, MD, FAAD
Last updated: 5/19/23