Systematic Review on the Efficacy and Safety of Oral Janus Kinase Inhibitors for the Treatment of Atopic Dermatitis

Michelle Le; Melissa Berman-Rosa; Feras M Ghazawi; Marc Bourcier; Loretta Fiorillo; Melinda Gooderham; Lyn Guenther; Sameh Hanna; H Chih-Ho Hong; Ian Landells; Perla Lansang; Danielle Marcoux; Marni C Wiseman; Jensen Yeung; Charles Lynde; Ivan V Litvinov

doi:10.3389/fmed.2021.682547

Systematic Review on the Efficacy and Safety of Oral Janus Kinase Inhibitors for the Treatment of Atopic Dermatitis

Front Med (Lausanne). 2021 Sep 1:8:682547. doi: 10.3389/fmed.2021.682547. eCollection 2021.

Authors

Michelle Le¹, Melissa Berman-Rosa¹, Feras M Ghazawi², Marc Bourcier³, Loretta Fiorillo⁴, Melinda Gooderham⁵, Lyn Guenther⁶, Sameh Hanna⁷, H Chih-Ho Hong⁸, Ian Landells⁹, Perla Lansang¹⁰, Danielle Marcoux¹¹, Marni C Wiseman¹², Jensen Yeung^{10

13}, Charles Lynde⁷, Ivan V Litvinov¹

Affiliations

¹ Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada.
² Division of Dermatology, University of Ottawa, Ottawa, ON, Canada.
³ Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
⁴ Division of Pediatric Dermatology, University of Alberta, Edmonton, AB, Canada.
⁵ SKiN Centre for Dermatology, Probity Medical Research, and Queens University, Peterborough, ON, Canada.
⁶ Division of Dermatology, University of Western Ontario, London, ON, Canada.
⁷ Dermatology on Bloor, Toronto, ON, Canada.
⁸ Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada.
⁹ Division of Dermatology, Memorial University of Newfoundland, St. John's, NL, Canada.
¹⁰ Division of Dermatology, University of Toronto, Toronto, ON, Canada.
¹¹ Division of Pediatric Dermatology, University of Montreal, Montreal, QC, Canada.
¹² Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
¹³ Probity Medical Research, Waterloo, ON, Canada.

Abstract

Background: Atopic dermatitis is a chronic, relapsing and remitting disease that can be difficult to treat despite a recently approved biologic therapy targeting IL-4/IL-13 receptor. Oral janus kinase inhibitors (JAKi) represent a novel therapeutic class of targeted therapy to treat moderate-to-severe atopic dermatitis (AD). Objective: To review the efficacy, safety, and pharmacokinetic characteristics of oral JAKi in the treatment of AD. Methods: A PRISMA systematic review was conducted using MEDLINE, EMBASE (Ovid), and PubMed databases for studies assessing the efficacy, safety, and/or pharmacokinetic properties of oral forms of JAKi in the treatment of AD in pediatric or adult populations from inception to June 2021. Results: 496 papers were reviewed. Of 28 articles that underwent full text screening, 11 met our inclusion criteria for final qualitative review. Four studies examined abrocitinib; three studies examined baricitinib; three examined upadacitinib and one examined gusacitinib (ASN002). Significant clinical efficacy and a reassuring safety profile was reported for all JAKi agents reviewed. Rapid symptom control was reported for abrocitinib, baricitinib and upadacitinib. Limitations: Given the relatively limited evidence for each JAKi and the differences in patient eligibility criteria between studies, the data was not deemed suitable for a meta-analysis at this time. Conclusion: Given their ability to achieve rapid symptom control with a reassuring safety profile, we recommend considering the use of JAKi as a reliable systemic treatment option for adult patients with moderate-to-severe AD, who are unresponsive to topical or skin directed treatments.

Keywords: JAK inhibitor; abrocitinib; atopic dermatitis; baricitinib; eczema; gusacitinib; janus kinase; upadacitinib.

Publication types

Systematic Review