JAK Inhibitors Ended the Novel Atopic Dermatitis Treatment "Drought"

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Peter Lio, MD, explains firsthand how abrocitinib and upadacitinib became the latest options for his most difficult-to-treat patients.

After a boom of biologic therapies for moderate-to-severe atopic dermatitis in the mid-2010s, dermatologists like Peter Lio, MD, awaited the next great options to benefit difficult-to-clear patients who still could not benefit from the latest and greatest.

It wasn’t until only recently that their hopes were answered by a new drug class.

In an interview with HCPLive during the 2022 Fall Clinical Dermatology Meeting this week, Lio, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine, discussed the latest surge of viable systemic therapies indicated for treating moderate-to-severe eczema in the US.

“We’re very lucky after a very long drought of having almost no new systemic medicines in the past 5-6 years, it’s been kind of a bonanza,” he said. “We have some biologics, and most recently we had 2 of the systemic JAK inhibitors approved in the US.”

The pair of upadacitinib and abrocitinib should be classified as “game changers,” Lio opined—comparing their clinical tradeoffs and disease breakthrough capability to that observed with initial biologic options in 2017.

Lio recalled how, 5 years ago, his practice had a biologics treatment waiting list of approximately 50 patients—predominately those who had “run the course” of available therapies and had sought care with multiple specialists already.

“Now we have (JAK inhibitors), and I have the same kind of scenario: a big, pent-up list of people who really had tried everything available, waiting for the next big thing, and I’m happy to say that by and large the JAK inhibitors have delivered,” he said.

Along with upadacitinib and abrocitinib, Lio highlighted the promising, potentially more simplistic option of ruxolitinib cream contributing to the space as well in the future.

On the subject of advancing systemic therapy options for atopic dermatitis, Lio discussed the heterogeneity of the common chronic disease. “Just because somebody is severe, it doesn’t mean they look the same,” he said. “They really can be different. And one of the areas I think we have to understand better is, what are the subtypes of differences?”

He added that none of the differences in individual patient presentation, disease tolerance, nor quality of life may do justice to the fact that “there’s a huge amount of suffering, there’s a temporal aspect to the disease, and there’s the whole concept of treatment refractoriness: some people look hard but are easy, and some people look easy but are hard to clear.”

Lastly, Lio highlighted the benefit of free, online validated diagnostic tools such as Sanofi and Regeneron’s supported Atopic Dermatitis Control Tool (ADCT): a simplistic, 6-item questionnaire that he uses to objective gauge atopic dermatitis burden and severity in new patients.