Addressing JAK Inhibitor Concerns in Atopic Dermatitis, with Leon H. Kircik, MD

Leon H. Kircik, MD, spoke with the HCPLive editorial team at the 2025 Revolutionizing Atopic Dermatitis (RAD) Meeting in Nashville, TN, about the contents of his talk ‘Janus Kinase (JAK) Inhibitors in Atopic Dermatitis Management.’

Kircik—known for his work as medical director at Skin Sciences, PLLC, in Louisville, Kentucky—was asked what he sees as the biggest clinical advantage of JAK inhibitors in atopic dermatitis. Specifically, he was asked about JAK inhibitors compared to traditional systemic therapies or biologics.

“For JAK inhibitors, we certainly know their efficacy and the early onset of action,” Kircik said. “Oral JAKs work really fast. However, we know that there is a concern with boxed warnings. So when you compare to the biologics, of course, there is a concern with the safety of the JAK inhibitors versus the biologics.”

Kircik was asked more about the boxed warnings on JAK inhibitors. Specifically, he was asked abour counseling patients about the boxed warnings, especially in light of the broader JAK class warnings issued by the US Food and Drug Administration (FDA).

“I think as healthcare providers, first, we have to understand ourselves, the history of it, where it came from, and then accordingly, explain to the patient,” Kircik explained. “So as you know, the boxed warning comes from a drug called tofacitinib, and that drug was studied actually on rheumatoid arthritis patients. The boxed warning safety issues was raised because of the inferiority of the safety of tofacitinib in rheumatoid arthritis patients older than 50 years of age and at least with one cardiovascular event.”

Kircik added that, when looking at the patient population, there are not the same safety concerns, especially with topical JAK inhibitors such as ruxolitinib.

“I always tell patients, unless you're eating the cream, you have nothing to be concerned about,” he explained. “Absorption is very minimal, very low with topical ruxolitinib, and it's certainly not a concern. But according to the agency, it's a class effect, and we see that class effect everywhere. Ironically, when you look at oral ruxolitinib, which has been approved years ago for myelofibrosis, it doesn't have the boxed warning. So it's quite ironic that the oral ruxolitinib doesn't have a boxed warning versus the topical which does have one, but that's because of the class effect. Thus, everything after tofacitinib for inflammatory disorders got the boxed warning.”

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The quotes used in this interview summary were edited for clarity.