JAK inhibitors for the Management of Atopic Dermatitis (AD) - Episode 7

Patient Selection of JAK Inhibitors in Atopic Dermatitis

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Alexandra K. Golant, MD, highlights factors to consider when recommending the use of JAK inhibitors to manage atopic dermatitis for various patient populations.

Linda Stein Gold, MD: Ale, when we think about our range of treatment options and specifically about JAK inhibitors, there are particular patients that would be potentially good candidates for an oral or potentially a topical [Janus kinase] JAK inhibitor because we have both. I'll turn to Eric later to talk about some of the data, but how do you pick a patient? How do you know that when somebody walks into a room, I'm going start to think that maybe a JAK inhibitor might be an appropriate treatment option for that particular atopic patient?

Alexandra Golant, MD: That's a great question and one that many health care providers are asking themselves right now because they're kind of new on the scene in dermatology, but like I've been saying, and we all feel that they’re here to stay, so it's time to get comfortable with them. The answer is a little bit different for a topical or a systemic JAK inhibitor. Topical JAK inhibitors, like other nonsteroidal topicals, work really well for that nonsteroidal maintenance therapy that these patients, as a chronic inflammatory skin disease, need in-between the management of those acute flares. On the topical end, these can be incorporated into that artistry of the management plan for your atopic dermatitis. With that said, more of a topical patient or potentially combined with systemic treatments to get a patient that's pretty well controlled to be much better controlled. From the standpoint of a systemic JAK inhibitor based on the approved indications when the labels were granted from the United States Food and Drug Administration] FDA, this is going to be more for your refractory, moderate-to-severe patients. The majority of these individuals are patients that have tried and failed other systemic therapies, be they biologics, the traditional systemic immunosuppressants, and repeated courses of systemic corticosteroids. There are many ways to kind of view a patient failed by systemic treatment who have not been well controlled, be that from an itch perspective or a skin clearance perspective. They are placed really nicely for those patients. The order in which we use them after biologics, before biologics, how we offer them to patients, differs from all of us and is a question of appropriate patient identification. That's where the nuance and artistry of medicine comes in and you want to make sure that the patient you're talking about this with would be an appropriate candidate. I like to equip my patients with that menu of treatment options so I will mention to them very early on along with my conversation about biologics because I like patients to know that there is innovation, that there are new therapies in this space, and to help guide them to the option that feels right for them.

Linda Stein Gold, MD: If we have a pediatric patient and we know that we have some indications topically and orally for that adolescent population, are you comfortable prescribing either a topical or an oral JAK for that adolescent population at this point? Do you think it's okay?

Alexandra Golant, MD: I do because there are data in both topical and oral. One of our orals right now is 12 and up for that adolescent population, so I have a conversation with the patient and caregivers just like I do with adults and I'm willing to do a deep dive into safety when the questions come up, but I don't think it's something we should withhold from our adolescents. There are other special populations for whom I'm certainly not using a JAK like pregnant women, or breastfeeding women, or patients with multiple comorbidities tend to be more associated in the 65 to 75 years and up population. Those can kind of self-exclude sometimes, but that gets to kind of knowing your patient, knowing their history, and making that decision together in the office is so important.

Linda Stein Gold, MD: Thanks for that.

Transcript Edited for Clarity