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Dermbits

MD, MPH

How do you decide whether to use a JAK first line vs monoclonal antibody?

Atopic Dermatitis

Both classes of medications, be it jack inhibitor or monoclonal antibodies or biologics, really will play a big role in our management of patients with moderate to severe atopic dermatitis. This is not a quick question to answer, because the different jack inhibitors or the different biologics that are emerging for atopic dermatitis all have different efficacy profiles, different safety profile, and different dosing profiles. So the decision on which one to use for our individual patient really needs to be customized or individualized based on the patient's disease severity, their experience with past therapies, and possibly their comorbidities as well. So the key, when we look at these different data that's coming out is really also looking at the subpopulations that are responsive to the different therapies. So, let me give you a few example. For example, for those who have done really well on dupilumab, there would be really no reason to switch, in my opinion, if they haven't responded optimally, then we want to look at the head to head trial data that they may have with another agent, and also the switch data that there may be available of looking at dupilumab failures and how they would do, let's say, on another il 13 inhibitor or on a jack inhibitor. Some jack inhibitors have shown really robust efficacy, and this is very promising in terms of the use of jack inhibitors for long term control of atopic dermatitis. However, they will likely need to be monitored in terms of laboratory monitoring at some frequency. And so when we think about that, in addition to using JAX as a long term control therapy for atopic dermatitis, I think they can also be very helpful in terms of controlling flares, in that some jacks have a really fast onset of action, and they can be used more on and off because they're small molecules. So we don't really have to worry about things like antidrug antibodies. So they can be used like how we currently use cyclosporin, but with a greater safety profile. So I can see scenarios where jack inhibitors can be used, for example, in combination with biologics with regards to controlling flares that may happen when a patient is not well controlled on the biologic. And then finally, the clinical data for the emerging IL 13 inhibitors show that they have good safety data and will likely remain really an excellent choice for long term control for AD patients. And then, very importantly, patient preference need to take their preference into account whether they would prefer an oral medication or injectable medication. And that will be another key factor in terms of ultimately deciding what may be a good therapeutic option for them.