Are Janus Kinase Inhibitors Effective for Treating Atopic Dermatitis?
The quality of life for patients with severe atopic dermatitis (AD) is comparable to patients suffering from chronic pain. AD, which affects 10% to 30% of the pediatric population and 1% to 3% of the adult population can cause debilitating and severe itching. Unlike other chronic conditions, such as psoriasis, where great advances in treatment have been made, there is a lack of targeted and effective treatments and most treatments for AD include nonpharmacologic emollients and topical corticosteroids.
Research has established that an exaggerated type 2 helper T-cell (Th2) immune response is part of the pathogenesis of AD. Disrupting the cytokines that are required for Th2 immune responses, has demonstrated reductions in eczema severity. The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway in Th2 immunity plays a role in activating eosinophils, and suppressing regulatory T cells. Tofacitinib citrate (sold under the names Xeljanz and Jakvinus) is an oral JAK 1/3 inhibitor approved for the treatment of moderate to severe rheumatoid arthritis. In this study it was evaluated for its effectiveness in patients with refractory moderate to severe AD.
In this small study, tofacitinib treatment resulted in marked reductions in signs and symptoms of disease. There was improvement in both objective and subjective measures of pruritus, a particularly bothersome aspect of the disease. Though the study is limited by the small sample size, the results indicated that treatment with tofacitinib and/or other Janus kinase inhibitors merits further investigation. A larger randomized controlled study to further assess the safety and efficacy of tofacitinib in moderate to severe AD is needed and a topical formulation of tofacitinib or another Janus kinase inhibitor would be particularly useful.
Byline: Martha L. Sikes, MS, RPh, PA-C and Wendy Meltzer, MPH
Adapted from the original article.
[image by Care SMC]