Potential JAK Inhibitor Combination Regimens in Dermatology

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Matthew Zirwas, MD, discusses the prospect of pairing JAK inhibitors like ruxolitinib cream with other disease-targeting options for conditions including vitiligo and alopecia areata.

If the last 5 years of dermatology drug development have delivered on new standards for treatment efficacy, what may the next 5 years bring?

For one, dermatologists may begin to optimize combination therapy regimens for chronic diseases with these highly efficacious treatments.

In the final segment of an interview with HCPLive during the Society for Dermatology Physician Assistants (SDPA) 2024 Summer Meeting, Matthew Zirwas, MD, director of the clinical trials and dermatitis center at Dermatologists of Greater Columbus, shared his perspective on how Janus kinase (JAK) inhibitors will be utilized in the overall treatment strategies to treat common skin diseases in the coming years. He believes early evidence suggests they will be only more beneficial when used in a refined regimen.

“So for example, for vitiligo: topical ruxolitinib, very good drug. Slow, but it works,” Zirwas said. “I think we can speed it up dramatically if we combine ruxolitinib together with topical bimatoprost. So, there's a study showing that topical bimatoprost eye drops, when you use it on facial vitiligo, it leads to significant repigmentation. So, now it makes perfect sense to me. You suppress the autoimmune attack on the melanocytes with your JAK inhibitor, and then you stimulate the melanocytes with the bimatoprost.”

Zirwas also highlighted combination JAK inhibitors with antibiotic therapy for patients with hidradenitis suppurativa (HS) as another viable combination treatment, as well as JAK inhibitors with minoxidil for alopecia areata.

While such pursuits are ideal for most dermatologic conditions JAK inhibitors are currently indicated for, there still remains a missing complementary treatment for atopic dermatitis, he noted.

“I really wish we did,” Zirwas said. “I really wish that we had, 'You target the inflammation with the JAK, and then you target the skin barrier with this.' But we don't have anything, because the key with the multi-therapy, with using a JAK and an antibiotic in HS, is you're targeting 2 different parts of the disease.”


Kanokrungsee S, Pruettivorawongse D, Rajatanavin N. Clinical outcomes of topical bimatoprost for nonsegmental facial vitiligo: A preliminary study. J Cosmet Dermatol. 2021;20(3):812-818. doi:10.1111/jocd.13648