Atopic Dermatitis

Key clinical point: The binary outcomes of atopic dermatitis (AD) were most effectively improved up to week 16 by 30 mg upadacitinib daily and 200 mg abrocitinib daily, followed by 15 mg upadacitinib daily, and 600 mg dupilumab and subsequently 300 mg dupilumab every 2 weeks.

Major finding: The odds of achieving 50% improvement in the Eczema Area and Severity Index scores were higher with daily doses of 200 mg abrocitinib (odds ratio [OR] 1.5, 95% credible interval [CrI] 1.1-2.2), 30 mg upadacitinib (OR 2.5, 95% CrI 1.3-5.0), and 15 mg upadacitinib (OR 1.7; 95% CrI 0.9-3.3) and lower with 100 mg abrocitinib daily (OR 0.7; 95% CrI 0.5-1.0) and 4 mg baricitinib daily (OR 0.5; 95% CrI 0.3-0.7) compared with dupilumab every 2 weeks.

Study details: This network meta-analysis of 83 trials included 22,122 patients with moderate-to-severe AD receiving systemic immunomodulatory treatment for ≥8 weeks.

Disclosures: This study was sponsored by a UK National Institute for Health Research Career Development Fellowship held by C Flohr and other funds. Seven authors declared ties with various sources.

Source: Drucker AM et al. Comparing binary efficacy outcomes for systemic immunomodulatory treatments for atopic dermatitis in a living systematic review and network meta-analysis. Br J Dermatol. 2023 (Oct 13). doi: 10.1093/bjd/ljad393

Key clinical point: The binary outcomes of atopic dermatitis (AD) were most effectively improved up to week 16 by 30 mg upadacitinib daily and 200 mg abrocitinib daily, followed by 15 mg upadacitinib daily, and 600 mg dupilumab and subsequently 300 mg dupilumab every 2 weeks.

Major finding: The odds of achieving 50% improvement in the Eczema Area and Severity Index scores were higher with daily doses of 200 mg abrocitinib (odds ratio [OR] 1.5, 95% credible interval [CrI] 1.1-2.2), 30 mg upadacitinib (OR 2.5, 95% CrI 1.3-5.0), and 15 mg upadacitinib (OR 1.7; 95% CrI 0.9-3.3) and lower with 100 mg abrocitinib daily (OR 0.7; 95% CrI 0.5-1.0) and 4 mg baricitinib daily (OR 0.5; 95% CrI 0.3-0.7) compared with dupilumab every 2 weeks.

Study details: This network meta-analysis of 83 trials included 22,122 patients with moderate-to-severe AD receiving systemic immunomodulatory treatment for ≥8 weeks.

Disclosures: This study was sponsored by a UK National Institute for Health Research Career Development Fellowship held by C Flohr and other funds. Seven authors declared ties with various sources.

Source: Drucker AM et al. Comparing binary efficacy outcomes for systemic immunomodulatory treatments for atopic dermatitis in a living systematic review and network meta-analysis. Br J Dermatol. 2023 (Oct 13). doi: 10.1093/bjd/ljad393

Key clinical point: The binary outcomes of atopic dermatitis (AD) were most effectively improved up to week 16 by 30 mg upadacitinib daily and 200 mg abrocitinib daily, followed by 15 mg upadacitinib daily, and 600 mg dupilumab and subsequently 300 mg dupilumab every 2 weeks.

Major finding: The odds of achieving 50% improvement in the Eczema Area and Severity Index scores were higher with daily doses of 200 mg abrocitinib (odds ratio [OR] 1.5, 95% credible interval [CrI] 1.1-2.2), 30 mg upadacitinib (OR 2.5, 95% CrI 1.3-5.0), and 15 mg upadacitinib (OR 1.7; 95% CrI 0.9-3.3) and lower with 100 mg abrocitinib daily (OR 0.7; 95% CrI 0.5-1.0) and 4 mg baricitinib daily (OR 0.5; 95% CrI 0.3-0.7) compared with dupilumab every 2 weeks.

Study details: This network meta-analysis of 83 trials included 22,122 patients with moderate-to-severe AD receiving systemic immunomodulatory treatment for ≥8 weeks.

Disclosures: This study was sponsored by a UK National Institute for Health Research Career Development Fellowship held by C Flohr and other funds. Seven authors declared ties with various sources.

Source: Drucker AM et al. Comparing binary efficacy outcomes for systemic immunomodulatory treatments for atopic dermatitis in a living systematic review and network meta-analysis. Br J Dermatol. 2023 (Oct 13). doi: 10.1093/bjd/ljad393

Key clinical point: Atopic dermatitis (AD) significantly increases the risk for cognitive dysfunction, particularly that of all-cause dementia and Alzheimer’s disease-related dementia, in middle-aged adults (age 45-59 years) and older adults (age ≥60 years).

Major finding: Patients with AD vs control individuals had a significantly higher risk of developing all-cause dementia (pooled hazard ratio [HR] 1.16; 95% CI 1.10-1.23) and Alzheimer’s disease-related dementia (pooled HR 1.28; 95% CI 1.01-1.63). However, no significant association was observed between AD and vascular dementia (pooled HR 1.42; 95% CI 0.99-2.04).

Study details: Findings are from a meta-analysis of five studies including 8,595,252 patients with AD and a corresponding number of control individuals without AD.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Zhou Q et al. Atopic dermatitis and cognitive dysfunction in middle-aged and older adults: A systematic review and meta-analysis. PLoS One. 2023;18(10):e0292987 (Oct 25). doi: 10.1371/journal.pone.0292987

Key clinical point: Atopic dermatitis (AD) significantly increases the risk for cognitive dysfunction, particularly that of all-cause dementia and Alzheimer’s disease-related dementia, in middle-aged adults (age 45-59 years) and older adults (age ≥60 years).

Major finding: Patients with AD vs control individuals had a significantly higher risk of developing all-cause dementia (pooled hazard ratio [HR] 1.16; 95% CI 1.10-1.23) and Alzheimer’s disease-related dementia (pooled HR 1.28; 95% CI 1.01-1.63). However, no significant association was observed between AD and vascular dementia (pooled HR 1.42; 95% CI 0.99-2.04).

Study details: Findings are from a meta-analysis of five studies including 8,595,252 patients with AD and a corresponding number of control individuals without AD.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Zhou Q et al. Atopic dermatitis and cognitive dysfunction in middle-aged and older adults: A systematic review and meta-analysis. PLoS One. 2023;18(10):e0292987 (Oct 25). doi: 10.1371/journal.pone.0292987

Key clinical point: Atopic dermatitis (AD) significantly increases the risk for cognitive dysfunction, particularly that of all-cause dementia and Alzheimer’s disease-related dementia, in middle-aged adults (age 45-59 years) and older adults (age ≥60 years).

Major finding: Patients with AD vs control individuals had a significantly higher risk of developing all-cause dementia (pooled hazard ratio [HR] 1.16; 95% CI 1.10-1.23) and Alzheimer’s disease-related dementia (pooled HR 1.28; 95% CI 1.01-1.63). However, no significant association was observed between AD and vascular dementia (pooled HR 1.42; 95% CI 0.99-2.04).

Study details: Findings are from a meta-analysis of five studies including 8,595,252 patients with AD and a corresponding number of control individuals without AD.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Zhou Q et al. Atopic dermatitis and cognitive dysfunction in middle-aged and older adults: A systematic review and meta-analysis. PLoS One. 2023;18(10):e0292987 (Oct 25). doi: 10.1371/journal.pone.0292987

Key clinical point: Children with atopic dermatitis (AD) have an increased risk for multiple comorbidities, even beyond atopic disorders, with a positive association between AD severity and the risk for comorbidity onset.

Major finding: In children with vs without AD, the risk for hypersensitivity and allergic disorders was the highest (hazard ratio [HR] 3.87; 95% CI 3.77-3.97), followed by that for malignancies (HR 2.53; 95% CI 1.96-3.26) and immunological and inflammatory disorders (HR 2.36; 95% CI 2.22-2.50). Hypersensitivity onset risk increased in children with mild-to-moderate (adjusted HR 2.71; 95% CI 2.41-3.05) and severe (adjusted HR 3.56; 95% CI 3.10-4.09) AD compared with those in remission.

Study details: This observational, retrospective cohort study included 165,145 children with AD (age < 18 years) who were matched with 165,145 children without AD.

Disclosures: This study was sponsored by Pfizer Inc. Some authors declared receiving research grants or consultancy fees from or serving as advisors, investigators, etc., for Pfizer and others. Six authors declared being employees of or holding stock or stock options in Pfizer.

Source: von Kobyletzki L et al. Comorbidities in childhood atopic dermatitis: A population-based study. J Eur Acad Dermatol Venereol. 2023 (Oct 12). doi: 10.1111/jdv.19569

Key clinical point: Children with atopic dermatitis (AD) have an increased risk for multiple comorbidities, even beyond atopic disorders, with a positive association between AD severity and the risk for comorbidity onset.

Major finding: In children with vs without AD, the risk for hypersensitivity and allergic disorders was the highest (hazard ratio [HR] 3.87; 95% CI 3.77-3.97), followed by that for malignancies (HR 2.53; 95% CI 1.96-3.26) and immunological and inflammatory disorders (HR 2.36; 95% CI 2.22-2.50). Hypersensitivity onset risk increased in children with mild-to-moderate (adjusted HR 2.71; 95% CI 2.41-3.05) and severe (adjusted HR 3.56; 95% CI 3.10-4.09) AD compared with those in remission.

Study details: This observational, retrospective cohort study included 165,145 children with AD (age < 18 years) who were matched with 165,145 children without AD.

Disclosures: This study was sponsored by Pfizer Inc. Some authors declared receiving research grants or consultancy fees from or serving as advisors, investigators, etc., for Pfizer and others. Six authors declared being employees of or holding stock or stock options in Pfizer.

Source: von Kobyletzki L et al. Comorbidities in childhood atopic dermatitis: A population-based study. J Eur Acad Dermatol Venereol. 2023 (Oct 12). doi: 10.1111/jdv.19569

Key clinical point: Children with atopic dermatitis (AD) have an increased risk for multiple comorbidities, even beyond atopic disorders, with a positive association between AD severity and the risk for comorbidity onset.

Major finding: In children with vs without AD, the risk for hypersensitivity and allergic disorders was the highest (hazard ratio [HR] 3.87; 95% CI 3.77-3.97), followed by that for malignancies (HR 2.53; 95% CI 1.96-3.26) and immunological and inflammatory disorders (HR 2.36; 95% CI 2.22-2.50). Hypersensitivity onset risk increased in children with mild-to-moderate (adjusted HR 2.71; 95% CI 2.41-3.05) and severe (adjusted HR 3.56; 95% CI 3.10-4.09) AD compared with those in remission.

Study details: This observational, retrospective cohort study included 165,145 children with AD (age < 18 years) who were matched with 165,145 children without AD.

Disclosures: This study was sponsored by Pfizer Inc. Some authors declared receiving research grants or consultancy fees from or serving as advisors, investigators, etc., for Pfizer and others. Six authors declared being employees of or holding stock or stock options in Pfizer.

Source: von Kobyletzki L et al. Comorbidities in childhood atopic dermatitis: A population-based study. J Eur Acad Dermatol Venereol. 2023 (Oct 12). doi: 10.1111/jdv.19569

Key clinical point: Compared with dupilumab, lebrikizumab in less frequent doses shows equal or improved long-term maintenance of efficacy and overall adverse event rates in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: Between weeks 16 and 52, patients receiving lebrikizumab every 4 weeks (Q4W) vs dupilumab weekly or biweekly (QW/Q2W) were more likely to maintain Investigator’s Global Assessment scores of 0 or 1 (risk ratio [RR] 1.334; P  =  .035). Lebrikizumab and dupilumab were comparable in terms of adverse event rates (RR 1.052; P  =  .526) and maintenance of 75% improvement in Eczema Area and Severity Index scores (RR 0.937; P  =  .490).

Study details: This matching-adjusted indirect comparison study analyzed the data of adult patients with moderate-to-severe AD who received lebrikizumab Q4W (n = 101) in ADvocate1 and ADvocate2 or dupilumab QW/Q2W (n = 169) in SOLO-CONTINUE and achieved a treatment response at week 16.

Disclosures: This study was funded by Almirall S.A., Spain. Two authors declared being employees of Almirall S.A. The other authors declared ties with various sources, including Almirall.

Source: Rand K et al. Matching-adjusted indirect comparison of the long-term efficacy maintenance and adverse event rates of lebrikizumab versus dupilumab in moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Oct 28). doi: 10.1007/s13555-023-01058-z

Key clinical point: Compared with dupilumab, lebrikizumab in less frequent doses shows equal or improved long-term maintenance of efficacy and overall adverse event rates in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: Between weeks 16 and 52, patients receiving lebrikizumab every 4 weeks (Q4W) vs dupilumab weekly or biweekly (QW/Q2W) were more likely to maintain Investigator’s Global Assessment scores of 0 or 1 (risk ratio [RR] 1.334; P  =  .035). Lebrikizumab and dupilumab were comparable in terms of adverse event rates (RR 1.052; P  =  .526) and maintenance of 75% improvement in Eczema Area and Severity Index scores (RR 0.937; P  =  .490).

Study details: This matching-adjusted indirect comparison study analyzed the data of adult patients with moderate-to-severe AD who received lebrikizumab Q4W (n = 101) in ADvocate1 and ADvocate2 or dupilumab QW/Q2W (n = 169) in SOLO-CONTINUE and achieved a treatment response at week 16.

Disclosures: This study was funded by Almirall S.A., Spain. Two authors declared being employees of Almirall S.A. The other authors declared ties with various sources, including Almirall.

Source: Rand K et al. Matching-adjusted indirect comparison of the long-term efficacy maintenance and adverse event rates of lebrikizumab versus dupilumab in moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Oct 28). doi: 10.1007/s13555-023-01058-z

Key clinical point: Compared with dupilumab, lebrikizumab in less frequent doses shows equal or improved long-term maintenance of efficacy and overall adverse event rates in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: Between weeks 16 and 52, patients receiving lebrikizumab every 4 weeks (Q4W) vs dupilumab weekly or biweekly (QW/Q2W) were more likely to maintain Investigator’s Global Assessment scores of 0 or 1 (risk ratio [RR] 1.334; P  =  .035). Lebrikizumab and dupilumab were comparable in terms of adverse event rates (RR 1.052; P  =  .526) and maintenance of 75% improvement in Eczema Area and Severity Index scores (RR 0.937; P  =  .490).

Study details: This matching-adjusted indirect comparison study analyzed the data of adult patients with moderate-to-severe AD who received lebrikizumab Q4W (n = 101) in ADvocate1 and ADvocate2 or dupilumab QW/Q2W (n = 169) in SOLO-CONTINUE and achieved a treatment response at week 16.

Disclosures: This study was funded by Almirall S.A., Spain. Two authors declared being employees of Almirall S.A. The other authors declared ties with various sources, including Almirall.

Source: Rand K et al. Matching-adjusted indirect comparison of the long-term efficacy maintenance and adverse event rates of lebrikizumab versus dupilumab in moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Oct 28). doi: 10.1007/s13555-023-01058-z

Key clinical point: Patients with alopecia areata (AA) have an increased risk for atopic dermatitis (AD) and vice versa.

Major finding: Patients with AA vs control individuals had a significantly higher risk of developing AD (adjusted odds ratio [aOR] 4.42; P < .001). Reciprocally, patients with AD vs control individuals also had a significantly higher risk of developing AA (aOR 5.08; P < .001).

Study details: Findings are from a nested case-control study including 984 patients with AA from the All of Us database (USA), who were matched with 3936 control individuals without AA using nearest neighbor propensity-score matching.

Disclosures: This study did not disclose any funding source. E Guttman-Yassky and B Ungar declared receiving institutional grants from, serving as consultants for, or having other ties with various sources. The other authors declared no conflicts of interest.

Source: Diaz MJ et al. Association between alopecia areata and atopic dermatitis: A nested case-control study of the All of Us database. J Am Acad Dermatol. 2023 (Oct 21). doi: 10.1016/j.jaad.2023.10.031

Key clinical point: Patients with alopecia areata (AA) have an increased risk for atopic dermatitis (AD) and vice versa.

Major finding: Patients with AA vs control individuals had a significantly higher risk of developing AD (adjusted odds ratio [aOR] 4.42; P < .001). Reciprocally, patients with AD vs control individuals also had a significantly higher risk of developing AA (aOR 5.08; P < .001).

Study details: Findings are from a nested case-control study including 984 patients with AA from the All of Us database (USA), who were matched with 3936 control individuals without AA using nearest neighbor propensity-score matching.

Disclosures: This study did not disclose any funding source. E Guttman-Yassky and B Ungar declared receiving institutional grants from, serving as consultants for, or having other ties with various sources. The other authors declared no conflicts of interest.

Source: Diaz MJ et al. Association between alopecia areata and atopic dermatitis: A nested case-control study of the All of Us database. J Am Acad Dermatol. 2023 (Oct 21). doi: 10.1016/j.jaad.2023.10.031

Key clinical point: Patients with alopecia areata (AA) have an increased risk for atopic dermatitis (AD) and vice versa.

Major finding: Patients with AA vs control individuals had a significantly higher risk of developing AD (adjusted odds ratio [aOR] 4.42; P < .001). Reciprocally, patients with AD vs control individuals also had a significantly higher risk of developing AA (aOR 5.08; P < .001).

Study details: Findings are from a nested case-control study including 984 patients with AA from the All of Us database (USA), who were matched with 3936 control individuals without AA using nearest neighbor propensity-score matching.

Disclosures: This study did not disclose any funding source. E Guttman-Yassky and B Ungar declared receiving institutional grants from, serving as consultants for, or having other ties with various sources. The other authors declared no conflicts of interest.

Source: Diaz MJ et al. Association between alopecia areata and atopic dermatitis: A nested case-control study of the All of Us database. J Am Acad Dermatol. 2023 (Oct 21). doi: 10.1016/j.jaad.2023.10.031

Key clinical point: In real-world settings, dupilumab is safe and effective in children with moderate-to-severe atopic dermatitis (AD) who are age > 2 to < 12 years.

Major finding: Dupilumab led to significant improvements in the Eczema Area and Severity Index scores and Body Surface Area scores in children age > 2 to < 6 years (both P < .001) and ≥ 6 to < 12 years (both P < .001) but not in those age ≤ 2 years (P  =  .191 and P  =  .092, respectively). No serious adverse events were reported.

Study details: This multicenter retrospective study included 63 children with moderate-to-severe AD who were classified relative to age: ≤ 2 years (n = 4), > 2 to < 6 years (n = 25), and ≥ 6 to < 12 years (n = 34), with most having received prior systemic immunosuppressive therapies and all being treated with dupilumab.

Disclosures: This study did not disclose any funding source. Several authors declared receiving grants or honoraria from or serving as investigators, advisors, consultants, or speakers for various sources.

Source: Martinez-Cabriales S et al. Multicenter Canadian case series of pediatric patients less than 12 years of age with moderate-to-severe atopic dermatitis treated with dupilumab. Pediatr Dermatol. 2023 (Oct 31). doi: 10.1111/pde.15418

Key clinical point: In real-world settings, dupilumab is safe and effective in children with moderate-to-severe atopic dermatitis (AD) who are age > 2 to < 12 years.

Major finding: Dupilumab led to significant improvements in the Eczema Area and Severity Index scores and Body Surface Area scores in children age > 2 to < 6 years (both P < .001) and ≥ 6 to < 12 years (both P < .001) but not in those age ≤ 2 years (P  =  .191 and P  =  .092, respectively). No serious adverse events were reported.

Study details: This multicenter retrospective study included 63 children with moderate-to-severe AD who were classified relative to age: ≤ 2 years (n = 4), > 2 to < 6 years (n = 25), and ≥ 6 to < 12 years (n = 34), with most having received prior systemic immunosuppressive therapies and all being treated with dupilumab.

Disclosures: This study did not disclose any funding source. Several authors declared receiving grants or honoraria from or serving as investigators, advisors, consultants, or speakers for various sources.

Source: Martinez-Cabriales S et al. Multicenter Canadian case series of pediatric patients less than 12 years of age with moderate-to-severe atopic dermatitis treated with dupilumab. Pediatr Dermatol. 2023 (Oct 31). doi: 10.1111/pde.15418

Key clinical point: In real-world settings, dupilumab is safe and effective in children with moderate-to-severe atopic dermatitis (AD) who are age > 2 to < 12 years.

Major finding: Dupilumab led to significant improvements in the Eczema Area and Severity Index scores and Body Surface Area scores in children age > 2 to < 6 years (both P < .001) and ≥ 6 to < 12 years (both P < .001) but not in those age ≤ 2 years (P  =  .191 and P  =  .092, respectively). No serious adverse events were reported.

Study details: This multicenter retrospective study included 63 children with moderate-to-severe AD who were classified relative to age: ≤ 2 years (n = 4), > 2 to < 6 years (n = 25), and ≥ 6 to < 12 years (n = 34), with most having received prior systemic immunosuppressive therapies and all being treated with dupilumab.

Disclosures: This study did not disclose any funding source. Several authors declared receiving grants or honoraria from or serving as investigators, advisors, consultants, or speakers for various sources.

Source: Martinez-Cabriales S et al. Multicenter Canadian case series of pediatric patients less than 12 years of age with moderate-to-severe atopic dermatitis treated with dupilumab. Pediatr Dermatol. 2023 (Oct 31). doi: 10.1111/pde.15418

Key clinical point: Upadacitinib is effective and well-tolerated in patients with moderate-to-severe atopic dermatitis (AD) and prior failure to multiple systemic immunosuppressive and biologic therapies.

Major finding: At a median follow-up of 37.5 weeks, the median Investigator’s Global Assessment scores and Numerical Rating Scale itch scores reduced significantly from 3.00 to 1.50 and from 7.00 to 2.25, respectively (both P < .001). The adverse events reported were mostly mild in severity, with acne-like eruptions (25%) and nausea (13%) being the most common.

Study details: This prospective observational single-center study included 48 patients with moderate-to-severe AD receiving 15 mg or 30 mg upadacitinib daily, most of whom (n = 39) had failed other targeted therapies, including other Janus kinase inhibitors and biologics.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator and consultant for various sources. The other authors declared no conflicts of interest.

Source: Schlösser AR et al. Upadacitinib treatment in a real-world difficult-to-treat atopic dermatitis patient cohort. J Eur Acad Dermatol Venereol. 2023 (Oct 21). doi: 10.1111/jdv.19581

Key clinical point: Upadacitinib is effective and well-tolerated in patients with moderate-to-severe atopic dermatitis (AD) and prior failure to multiple systemic immunosuppressive and biologic therapies.

Major finding: At a median follow-up of 37.5 weeks, the median Investigator’s Global Assessment scores and Numerical Rating Scale itch scores reduced significantly from 3.00 to 1.50 and from 7.00 to 2.25, respectively (both P < .001). The adverse events reported were mostly mild in severity, with acne-like eruptions (25%) and nausea (13%) being the most common.

Study details: This prospective observational single-center study included 48 patients with moderate-to-severe AD receiving 15 mg or 30 mg upadacitinib daily, most of whom (n = 39) had failed other targeted therapies, including other Janus kinase inhibitors and biologics.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator and consultant for various sources. The other authors declared no conflicts of interest.

Source: Schlösser AR et al. Upadacitinib treatment in a real-world difficult-to-treat atopic dermatitis patient cohort. J Eur Acad Dermatol Venereol. 2023 (Oct 21). doi: 10.1111/jdv.19581

Key clinical point: Upadacitinib is effective and well-tolerated in patients with moderate-to-severe atopic dermatitis (AD) and prior failure to multiple systemic immunosuppressive and biologic therapies.

Major finding: At a median follow-up of 37.5 weeks, the median Investigator’s Global Assessment scores and Numerical Rating Scale itch scores reduced significantly from 3.00 to 1.50 and from 7.00 to 2.25, respectively (both P < .001). The adverse events reported were mostly mild in severity, with acne-like eruptions (25%) and nausea (13%) being the most common.

Study details: This prospective observational single-center study included 48 patients with moderate-to-severe AD receiving 15 mg or 30 mg upadacitinib daily, most of whom (n = 39) had failed other targeted therapies, including other Janus kinase inhibitors and biologics.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator and consultant for various sources. The other authors declared no conflicts of interest.

Source: Schlösser AR et al. Upadacitinib treatment in a real-world difficult-to-treat atopic dermatitis patient cohort. J Eur Acad Dermatol Venereol. 2023 (Oct 21). doi: 10.1111/jdv.19581

Key clinical point: Lebrikizumab monotherapy for 16 weeks significantly reduced itch and itch-associated sleep loss in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At 16 weeks, a significantly higher number of patients from the ADvocate1 and ADvocate2 trials treated with lebrikizumab vs placebo achieved a ≥ 3-point improvement in the Pruritus Numeric Rating Scale scores (ADvocate1 54.6% vs 19.2%; ADvocate2 49.4% vs 14.0%; both P < .001) and ≥ 1-point improvement in Sleep-Loss Scale scores (ADvocate1 64.1% vs 27.2%; ADvocate2 58.1% vs 21.7%; both P < .001).

Study details: Findings are from a study including patients from the ADvocate1 (n = 424) and ADvocate2 (n = 427) trials who had moderate-to-severe AD and were randomized to receive subcutaneous lebrikizumab or placebo every 2 weeks.

Disclosures: This study was sponsored by Dermira, a wholly owned subsidiary of Eli Lilly and Company. Several authors declared receiving research grants or honoraria from, serving as employees and shareholders of, or having other ties with various sources, including Eli Lilly and Dermira.

Source: Yosipovitch G et al. Lebrikizumab improved itch and reduced the extent of itch interference on sleep in patients with moderate-to-severe atopic dermatitis: Two randomized, placebo-controlled, phase III trials. Br J Dermatol. 2023 (Nov 6). doi: 10.1093/bjd/ljad435

Key clinical point: Lebrikizumab monotherapy for 16 weeks significantly reduced itch and itch-associated sleep loss in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At 16 weeks, a significantly higher number of patients from the ADvocate1 and ADvocate2 trials treated with lebrikizumab vs placebo achieved a ≥ 3-point improvement in the Pruritus Numeric Rating Scale scores (ADvocate1 54.6% vs 19.2%; ADvocate2 49.4% vs 14.0%; both P < .001) and ≥ 1-point improvement in Sleep-Loss Scale scores (ADvocate1 64.1% vs 27.2%; ADvocate2 58.1% vs 21.7%; both P < .001).

Study details: Findings are from a study including patients from the ADvocate1 (n = 424) and ADvocate2 (n = 427) trials who had moderate-to-severe AD and were randomized to receive subcutaneous lebrikizumab or placebo every 2 weeks.

Disclosures: This study was sponsored by Dermira, a wholly owned subsidiary of Eli Lilly and Company. Several authors declared receiving research grants or honoraria from, serving as employees and shareholders of, or having other ties with various sources, including Eli Lilly and Dermira.

Source: Yosipovitch G et al. Lebrikizumab improved itch and reduced the extent of itch interference on sleep in patients with moderate-to-severe atopic dermatitis: Two randomized, placebo-controlled, phase III trials. Br J Dermatol. 2023 (Nov 6). doi: 10.1093/bjd/ljad435

Key clinical point: Lebrikizumab monotherapy for 16 weeks significantly reduced itch and itch-associated sleep loss in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At 16 weeks, a significantly higher number of patients from the ADvocate1 and ADvocate2 trials treated with lebrikizumab vs placebo achieved a ≥ 3-point improvement in the Pruritus Numeric Rating Scale scores (ADvocate1 54.6% vs 19.2%; ADvocate2 49.4% vs 14.0%; both P < .001) and ≥ 1-point improvement in Sleep-Loss Scale scores (ADvocate1 64.1% vs 27.2%; ADvocate2 58.1% vs 21.7%; both P < .001).

Study details: Findings are from a study including patients from the ADvocate1 (n = 424) and ADvocate2 (n = 427) trials who had moderate-to-severe AD and were randomized to receive subcutaneous lebrikizumab or placebo every 2 weeks.

Disclosures: This study was sponsored by Dermira, a wholly owned subsidiary of Eli Lilly and Company. Several authors declared receiving research grants or honoraria from, serving as employees and shareholders of, or having other ties with various sources, including Eli Lilly and Dermira.

Source: Yosipovitch G et al. Lebrikizumab improved itch and reduced the extent of itch interference on sleep in patients with moderate-to-severe atopic dermatitis: Two randomized, placebo-controlled, phase III trials. Br J Dermatol. 2023 (Nov 6). doi: 10.1093/bjd/ljad435

When topical treatment does not control atopic dermatitis (AD) in adults, a range of advanced treatments may improve outcomes and can be considered, according to new evidence-based guidelines from the American Academy of Dermatology (AAD)..

The guidelines cover approved and off-label uses of systemic therapies and phototherapy, including new treatments that have become available since the last guidelines were published almost a decade ago. These include biologics and oral Janus kinase (JAK) inhibitors, as well as older oral or injectable immunomodulators and antimetabolites, oral antibiotics, antihistamines, and phosphodiesterase-4 inhibitors. The guidelines rate the existing evidence as “strong” for dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. They also conditionally recommend phototherapy, as well as cyclosporine, methotrexate, azathioprine, and mycophenolate, but recommend against the use of systemic corticosteroids.

The guidelines update the AAD’s 2014 recommendations for managing AD in adults with phototherapy and systemic therapies. “At that time, prednisone – universally agreed to be the least appropriate chronic therapy for AD – was the only Food and Drug Administration–approved agent,” Robert Sidbury, MD, MPH, who cochaired a 14-member multidisciplinary work group that assembled the guidelines, told this news organization. “This was the driver.”

The latest guidelines were published online in the Journal of the American Academy of Dermatology.
 

Broad evidence review

Dr. Sidbury, chief of the division of dermatology at Seattle Children’s Hospital, guidelines cochair Dawn M. R. Davis, MD, a dermatologist at the Mayo Clinic, Rochester, Minn., and colleagues conducted a systematic evidence review of phototherapy such as narrowband and broadband UVB and systemic therapies, including biologics such as dupilumab and tralokinumab, JAK inhibitors such as upadacitinib and abrocitinib, and immunosuppressants such as methotrexate and azathioprine.

Next, the work group applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach for assessing the certainty of the evidence and formulating and grading clinical recommendations based on relevant randomized trials in the medical literature.
 

Recommendations, future studies

Of the 11 evidence-based recommendations of therapies for adults with AD refractory to topical medications, the work group ranks 5 as “strong” based on the evidence and the rest as “conditional.” “Strong” implies the benefits clearly outweigh risks and burdens, they apply to most patients in most circumstances, and they fall under good clinical practice. “Conditional” means the benefits and risks are closely balanced for most patients, “but the appropriate action may different depending on the patient or other stakeholder values,” the authors wrote.

In their remarks about phototherapy, the work group noted that most published literature on the topic “reports on the efficacy and safety of narrow band UVB. Wherever possible, use a light source that minimizes the potential for harm under the supervision of a qualified clinician.”

In their remarks about cyclosporine, they noted that evidence suggests an initial dose of 3 mg/kg per day to 5 mg/kg per day is effective, but that the Food and Drug Administration has not approved cyclosporine for use in AD. “The FDA has approved limited-term use (up to 1 year) in psoriasis,” they wrote. “Comorbidities or drug interactions that may exacerbate toxicity make this intervention inappropriate for select patients.” The work group noted that significant research gaps remain in phototherapy, especially trials that compare different phototherapy modalities and those that compare phototherapy with other AD treatment strategies.

“Larger clinical trials would also be helpful for cyclosporine, methotrexate, azathioprine, and mycophenolate to improve the certainty of evidence for those medications,” they added. “Furthermore, formal cost-effectiveness analyses comparing older to newer treatments are needed.”

They recommended the inclusion of active comparator arms in randomized, controlled trials as new systemic therapies continue to be developed and tested.

The work group ranked the level of evidence they reviewed for the therapies from very low to moderate. No therapy was judged to have high evidence. They also cited the short duration of most randomized controlled trials of phototherapy.

Using the guidelines in clinical care

According to Dr. Davis, the topic of which agent if any should be considered “first line” generated robust discussion among the work group members.

“When there are not robust head-to-head trials – and there are not – it is often opinion that governs this decision, and opinion should not, when possible, govern a guideline,” Dr. Davis said. “Accordingly, we determined based upon the evidence agents – plural – that deserve to be considered ‘first line’ but not a single agent.”

In her opinion, the top three considerations regarding use of systemic therapy for AD relate to patient selection and shared decision making. One, standard therapy has failed. Two, diagnosis is assured. And three, “steroid phobia should be considered,” and patients should be “fully informed of risks and benefits of both treating and not treating,” she said.

Dr. Sidbury reported that he serves as an advisory board member for Pfizer, a principal investigator for Regeneron, an investigator for Brickell Biotech and Galderma USA, and a consultant for Galderma Global and Micreos. Dr. Davis reported having no relevant disclosures. Other work group members reported having financial disclosures with many pharmaceutical companies. The study was supported by internal funds from the American Academy of Dermatology.

When topical treatment does not control atopic dermatitis (AD) in adults, a range of advanced treatments may improve outcomes and can be considered, according to new evidence-based guidelines from the American Academy of Dermatology (AAD)..

The guidelines cover approved and off-label uses of systemic therapies and phototherapy, including new treatments that have become available since the last guidelines were published almost a decade ago. These include biologics and oral Janus kinase (JAK) inhibitors, as well as older oral or injectable immunomodulators and antimetabolites, oral antibiotics, antihistamines, and phosphodiesterase-4 inhibitors. The guidelines rate the existing evidence as “strong” for dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. They also conditionally recommend phototherapy, as well as cyclosporine, methotrexate, azathioprine, and mycophenolate, but recommend against the use of systemic corticosteroids.

The guidelines update the AAD’s 2014 recommendations for managing AD in adults with phototherapy and systemic therapies. “At that time, prednisone – universally agreed to be the least appropriate chronic therapy for AD – was the only Food and Drug Administration–approved agent,” Robert Sidbury, MD, MPH, who cochaired a 14-member multidisciplinary work group that assembled the guidelines, told this news organization. “This was the driver.”

The latest guidelines were published online in the Journal of the American Academy of Dermatology.
 

Broad evidence review

Dr. Sidbury, chief of the division of dermatology at Seattle Children’s Hospital, guidelines cochair Dawn M. R. Davis, MD, a dermatologist at the Mayo Clinic, Rochester, Minn., and colleagues conducted a systematic evidence review of phototherapy such as narrowband and broadband UVB and systemic therapies, including biologics such as dupilumab and tralokinumab, JAK inhibitors such as upadacitinib and abrocitinib, and immunosuppressants such as methotrexate and azathioprine.

Next, the work group applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach for assessing the certainty of the evidence and formulating and grading clinical recommendations based on relevant randomized trials in the medical literature.
 

Recommendations, future studies

Of the 11 evidence-based recommendations of therapies for adults with AD refractory to topical medications, the work group ranks 5 as “strong” based on the evidence and the rest as “conditional.” “Strong” implies the benefits clearly outweigh risks and burdens, they apply to most patients in most circumstances, and they fall under good clinical practice. “Conditional” means the benefits and risks are closely balanced for most patients, “but the appropriate action may different depending on the patient or other stakeholder values,” the authors wrote.

In their remarks about phototherapy, the work group noted that most published literature on the topic “reports on the efficacy and safety of narrow band UVB. Wherever possible, use a light source that minimizes the potential for harm under the supervision of a qualified clinician.”

In their remarks about cyclosporine, they noted that evidence suggests an initial dose of 3 mg/kg per day to 5 mg/kg per day is effective, but that the Food and Drug Administration has not approved cyclosporine for use in AD. “The FDA has approved limited-term use (up to 1 year) in psoriasis,” they wrote. “Comorbidities or drug interactions that may exacerbate toxicity make this intervention inappropriate for select patients.” The work group noted that significant research gaps remain in phototherapy, especially trials that compare different phototherapy modalities and those that compare phototherapy with other AD treatment strategies.

“Larger clinical trials would also be helpful for cyclosporine, methotrexate, azathioprine, and mycophenolate to improve the certainty of evidence for those medications,” they added. “Furthermore, formal cost-effectiveness analyses comparing older to newer treatments are needed.”

They recommended the inclusion of active comparator arms in randomized, controlled trials as new systemic therapies continue to be developed and tested.

The work group ranked the level of evidence they reviewed for the therapies from very low to moderate. No therapy was judged to have high evidence. They also cited the short duration of most randomized controlled trials of phototherapy.

Using the guidelines in clinical care

According to Dr. Davis, the topic of which agent if any should be considered “first line” generated robust discussion among the work group members.

“When there are not robust head-to-head trials – and there are not – it is often opinion that governs this decision, and opinion should not, when possible, govern a guideline,” Dr. Davis said. “Accordingly, we determined based upon the evidence agents – plural – that deserve to be considered ‘first line’ but not a single agent.”

In her opinion, the top three considerations regarding use of systemic therapy for AD relate to patient selection and shared decision making. One, standard therapy has failed. Two, diagnosis is assured. And three, “steroid phobia should be considered,” and patients should be “fully informed of risks and benefits of both treating and not treating,” she said.

Dr. Sidbury reported that he serves as an advisory board member for Pfizer, a principal investigator for Regeneron, an investigator for Brickell Biotech and Galderma USA, and a consultant for Galderma Global and Micreos. Dr. Davis reported having no relevant disclosures. Other work group members reported having financial disclosures with many pharmaceutical companies. The study was supported by internal funds from the American Academy of Dermatology.

When topical treatment does not control atopic dermatitis (AD) in adults, a range of advanced treatments may improve outcomes and can be considered, according to new evidence-based guidelines from the American Academy of Dermatology (AAD)..

The guidelines cover approved and off-label uses of systemic therapies and phototherapy, including new treatments that have become available since the last guidelines were published almost a decade ago. These include biologics and oral Janus kinase (JAK) inhibitors, as well as older oral or injectable immunomodulators and antimetabolites, oral antibiotics, antihistamines, and phosphodiesterase-4 inhibitors. The guidelines rate the existing evidence as “strong” for dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. They also conditionally recommend phototherapy, as well as cyclosporine, methotrexate, azathioprine, and mycophenolate, but recommend against the use of systemic corticosteroids.

The guidelines update the AAD’s 2014 recommendations for managing AD in adults with phototherapy and systemic therapies. “At that time, prednisone – universally agreed to be the least appropriate chronic therapy for AD – was the only Food and Drug Administration–approved agent,” Robert Sidbury, MD, MPH, who cochaired a 14-member multidisciplinary work group that assembled the guidelines, told this news organization. “This was the driver.”

The latest guidelines were published online in the Journal of the American Academy of Dermatology.
 

Broad evidence review

Dr. Sidbury, chief of the division of dermatology at Seattle Children’s Hospital, guidelines cochair Dawn M. R. Davis, MD, a dermatologist at the Mayo Clinic, Rochester, Minn., and colleagues conducted a systematic evidence review of phototherapy such as narrowband and broadband UVB and systemic therapies, including biologics such as dupilumab and tralokinumab, JAK inhibitors such as upadacitinib and abrocitinib, and immunosuppressants such as methotrexate and azathioprine.

Next, the work group applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach for assessing the certainty of the evidence and formulating and grading clinical recommendations based on relevant randomized trials in the medical literature.
 

Recommendations, future studies

Of the 11 evidence-based recommendations of therapies for adults with AD refractory to topical medications, the work group ranks 5 as “strong” based on the evidence and the rest as “conditional.” “Strong” implies the benefits clearly outweigh risks and burdens, they apply to most patients in most circumstances, and they fall under good clinical practice. “Conditional” means the benefits and risks are closely balanced for most patients, “but the appropriate action may different depending on the patient or other stakeholder values,” the authors wrote.

In their remarks about phototherapy, the work group noted that most published literature on the topic “reports on the efficacy and safety of narrow band UVB. Wherever possible, use a light source that minimizes the potential for harm under the supervision of a qualified clinician.”

In their remarks about cyclosporine, they noted that evidence suggests an initial dose of 3 mg/kg per day to 5 mg/kg per day is effective, but that the Food and Drug Administration has not approved cyclosporine for use in AD. “The FDA has approved limited-term use (up to 1 year) in psoriasis,” they wrote. “Comorbidities or drug interactions that may exacerbate toxicity make this intervention inappropriate for select patients.” The work group noted that significant research gaps remain in phototherapy, especially trials that compare different phototherapy modalities and those that compare phototherapy with other AD treatment strategies.

“Larger clinical trials would also be helpful for cyclosporine, methotrexate, azathioprine, and mycophenolate to improve the certainty of evidence for those medications,” they added. “Furthermore, formal cost-effectiveness analyses comparing older to newer treatments are needed.”

They recommended the inclusion of active comparator arms in randomized, controlled trials as new systemic therapies continue to be developed and tested.

The work group ranked the level of evidence they reviewed for the therapies from very low to moderate. No therapy was judged to have high evidence. They also cited the short duration of most randomized controlled trials of phototherapy.

Using the guidelines in clinical care

According to Dr. Davis, the topic of which agent if any should be considered “first line” generated robust discussion among the work group members.

“When there are not robust head-to-head trials – and there are not – it is often opinion that governs this decision, and opinion should not, when possible, govern a guideline,” Dr. Davis said. “Accordingly, we determined based upon the evidence agents – plural – that deserve to be considered ‘first line’ but not a single agent.”

In her opinion, the top three considerations regarding use of systemic therapy for AD relate to patient selection and shared decision making. One, standard therapy has failed. Two, diagnosis is assured. And three, “steroid phobia should be considered,” and patients should be “fully informed of risks and benefits of both treating and not treating,” she said.

Dr. Sidbury reported that he serves as an advisory board member for Pfizer, a principal investigator for Regeneron, an investigator for Brickell Biotech and Galderma USA, and a consultant for Galderma Global and Micreos. Dr. Davis reported having no relevant disclosures. Other work group members reported having financial disclosures with many pharmaceutical companies. The study was supported by internal funds from the American Academy of Dermatology.

TOPLINE:

Use of Janus kinase (JAK) inhibitors is associated with a nearly fourfold increase in risk of acne compared with placebo, according to an analysis of 25 JAK inhibitor studies.

METHODOLOGY:

• Acne has been reported to be an adverse effect of JAK inhibitors, but not much is known about how common acne is overall and how incidence differs between different JAK inhibitors and the disease being treated.
• For the systematic review and meta-analysis, researchers identified 25 phase 2 or 3 randomized, controlled trials that reported acne as an adverse event associated with the use of JAK inhibitors.
• The study population included 10,839 participants (54% male, 46% female).
• The primary outcome was the incidence of acne following a period of JAK inhibitor use.

TAKEAWAY:

• Overall, the risk of acne was significantly higher among those treated with JAK inhibitors in comparison with patients given placebo in a pooled analysis (odds ratio [OR], 3.83).
• The risk of acne was highest with abrocitinib (OR, 13.47), followed by baricitinib (OR, 4.96), upadacitinib (OR, 4.79), deuruxolitinib (OR, 3.30), and deucravacitinib (OR, 2.64). By JAK inhibitor class, results were as follows: JAK1-specific inhibitors (OR, 4.69), combined JAK1 and JAK2 inhibitors (OR, 3.43), and tyrosine kinase 2 inhibitors (OR, 2.64).
• In a subgroup analysis, risk of acne was higher among patients using JAK inhibitors for dermatologic conditions in comparison with those using JAK inhibitors for nondermatologic conditions (OR, 4.67 vs 1.18).
• Age and gender had no apparent impact on the effect of JAK inhibitor use on acne risk.

IN PRACTICE:

“The occurrence of acne following treatment with certain classes of JAK inhibitors is of potential concern, as this adverse effect may jeopardize treatment adherence among some patients,” the researchers wrote. More studies are needed “to characterize the underlying mechanism of acne with JAK inhibitor use and to identify best practices for treatment,” they added.

SOURCE:

The lead author was Jeremy Martinez, MPH, of Harvard Medical School, Boston. The study was published online in JAMA Dermatology.

LIMITATIONS:

The review was limited by the variable classification and reporting of acne across studies, the potential exclusion of relevant studies, and the small number of studies for certain drugs.

DISCLOSURES:

The studies were mainly funded by the pharmaceutical industry. Mr. Martinez disclosed no relevant financial relationships. Several coauthors have ties with Dexcel Pharma Technologies, AbbVie, Concert, Pfizer, 3Derm Systems, Incyte, Aclaris, Eli Lilly, Concert, Equillium, ASLAN, ACOM, and Boehringer Ingelheim.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Use of Janus kinase (JAK) inhibitors is associated with a nearly fourfold increase in risk of acne compared with placebo, according to an analysis of 25 JAK inhibitor studies.

METHODOLOGY:

• Acne has been reported to be an adverse effect of JAK inhibitors, but not much is known about how common acne is overall and how incidence differs between different JAK inhibitors and the disease being treated.
• For the systematic review and meta-analysis, researchers identified 25 phase 2 or 3 randomized, controlled trials that reported acne as an adverse event associated with the use of JAK inhibitors.
• The study population included 10,839 participants (54% male, 46% female).
• The primary outcome was the incidence of acne following a period of JAK inhibitor use.

TAKEAWAY:

• Overall, the risk of acne was significantly higher among those treated with JAK inhibitors in comparison with patients given placebo in a pooled analysis (odds ratio [OR], 3.83).
• The risk of acne was highest with abrocitinib (OR, 13.47), followed by baricitinib (OR, 4.96), upadacitinib (OR, 4.79), deuruxolitinib (OR, 3.30), and deucravacitinib (OR, 2.64). By JAK inhibitor class, results were as follows: JAK1-specific inhibitors (OR, 4.69), combined JAK1 and JAK2 inhibitors (OR, 3.43), and tyrosine kinase 2 inhibitors (OR, 2.64).
• In a subgroup analysis, risk of acne was higher among patients using JAK inhibitors for dermatologic conditions in comparison with those using JAK inhibitors for nondermatologic conditions (OR, 4.67 vs 1.18).
• Age and gender had no apparent impact on the effect of JAK inhibitor use on acne risk.

IN PRACTICE:

“The occurrence of acne following treatment with certain classes of JAK inhibitors is of potential concern, as this adverse effect may jeopardize treatment adherence among some patients,” the researchers wrote. More studies are needed “to characterize the underlying mechanism of acne with JAK inhibitor use and to identify best practices for treatment,” they added.

SOURCE:

The lead author was Jeremy Martinez, MPH, of Harvard Medical School, Boston. The study was published online in JAMA Dermatology.

LIMITATIONS:

The review was limited by the variable classification and reporting of acne across studies, the potential exclusion of relevant studies, and the small number of studies for certain drugs.

DISCLOSURES:

The studies were mainly funded by the pharmaceutical industry. Mr. Martinez disclosed no relevant financial relationships. Several coauthors have ties with Dexcel Pharma Technologies, AbbVie, Concert, Pfizer, 3Derm Systems, Incyte, Aclaris, Eli Lilly, Concert, Equillium, ASLAN, ACOM, and Boehringer Ingelheim.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Use of Janus kinase (JAK) inhibitors is associated with a nearly fourfold increase in risk of acne compared with placebo, according to an analysis of 25 JAK inhibitor studies.

METHODOLOGY:

• Acne has been reported to be an adverse effect of JAK inhibitors, but not much is known about how common acne is overall and how incidence differs between different JAK inhibitors and the disease being treated.
• For the systematic review and meta-analysis, researchers identified 25 phase 2 or 3 randomized, controlled trials that reported acne as an adverse event associated with the use of JAK inhibitors.
• The study population included 10,839 participants (54% male, 46% female).
• The primary outcome was the incidence of acne following a period of JAK inhibitor use.

TAKEAWAY:

• Overall, the risk of acne was significantly higher among those treated with JAK inhibitors in comparison with patients given placebo in a pooled analysis (odds ratio [OR], 3.83).
• The risk of acne was highest with abrocitinib (OR, 13.47), followed by baricitinib (OR, 4.96), upadacitinib (OR, 4.79), deuruxolitinib (OR, 3.30), and deucravacitinib (OR, 2.64). By JAK inhibitor class, results were as follows: JAK1-specific inhibitors (OR, 4.69), combined JAK1 and JAK2 inhibitors (OR, 3.43), and tyrosine kinase 2 inhibitors (OR, 2.64).
• In a subgroup analysis, risk of acne was higher among patients using JAK inhibitors for dermatologic conditions in comparison with those using JAK inhibitors for nondermatologic conditions (OR, 4.67 vs 1.18).
• Age and gender had no apparent impact on the effect of JAK inhibitor use on acne risk.

IN PRACTICE:

“The occurrence of acne following treatment with certain classes of JAK inhibitors is of potential concern, as this adverse effect may jeopardize treatment adherence among some patients,” the researchers wrote. More studies are needed “to characterize the underlying mechanism of acne with JAK inhibitor use and to identify best practices for treatment,” they added.

SOURCE:

The lead author was Jeremy Martinez, MPH, of Harvard Medical School, Boston. The study was published online in JAMA Dermatology.

LIMITATIONS:

The review was limited by the variable classification and reporting of acne across studies, the potential exclusion of relevant studies, and the small number of studies for certain drugs.

DISCLOSURES:

The studies were mainly funded by the pharmaceutical industry. Mr. Martinez disclosed no relevant financial relationships. Several coauthors have ties with Dexcel Pharma Technologies, AbbVie, Concert, Pfizer, 3Derm Systems, Incyte, Aclaris, Eli Lilly, Concert, Equillium, ASLAN, ACOM, and Boehringer Ingelheim.
 

A version of this article appeared on Medscape.com.