JAKs and TYKs - What You Need to Know
Director of Clinical Dermatology
Therapeutics Clinical Research
San Diego, CA
In the ever-expanding world of systemic dermatologic treatments, busy clinicians may struggle to keep up with all of the recent approvals. In this session, Neal Bhatia, MD, provides an in-depth look at the efficacy and safety data of several Janus Kinase (JAK) inhibitors for a variety of inflammatory diseases including psoriasis, atopic dermatitis, alopecia areata, and hidradenitis suppurativa. Dr. Bhatia begins with an overview of the mechanism of action of JAK inhibitors as well as their safety profile and how to address the dreaded black box warning. He also highlights the increasingly common side effect of acne, colloquially known as “JAKne”. For upadacitinib, 13% of patients on the 15 mg dose and 17% of patients on the 30 mg dose developed acne, which was mild in two-thirds of cases. For abrocitinib, 2.9% of patients on the 100 mg dose and 6.6% of patients on the 200 mg dose developed acne that was mild to moderate in all cases. For baricitinib, 2.9% of patients developed acne across all doses.
Next, Dr. Bhatia reviews efficacy data from several pivotal trials. He starts with upadacitinib and its quick onset. By week 2 of the Measure Up 1 and 2 phase 3 trials, 38% of patients experienced EASI-75 by week 2. With regard to itch, 16% of patients experienced a numerical rating score (NRS) improvement of at least 4 points by day 2. This is important because breaking the itch-scratch cycle earlier than biologics leads to improved quality of life much quicker. In the abrocitinib phase 3 pivotal trials, 62.7% of patients on the 200 mg dose and 39.7% of patients on the 100 mg dose achieved EASI-75 at 12 weeks, compared with just 11.8% of patients on placebo.
Dr. Bhatia wraps up the session highlighting several medications that are in the pipeline as well as off label uses. This includes Jaktinib for atopic dermatitis, rilzabrutinib for atopic dermatitis and pemphigus, ritlecitinib and brepocitinib for alopecia areata, and deucravacitinib for lupus.