Christopher Bunick, MD, PhD, Highlights JAK Inhibitors in AD Care

At the Fall Clinical Dermatology Conference 2025 in Las Vegas, Nevada, Christopher Bunick, MD, PhD, associate professor of dermatology at Yale School of Medicine, discussed the evolving management of atopic dermatitis (AD), focusing on the role of oral Janus kinase (JAK) inhibitors in achieving optimal treatment outcomes. The session, which included insights from David Cotter, MD, PhD, and Linda Stein Gold, MD, highlighted recent advances in both clinical trials and real-world practice.

A central theme of the discussion was the shift in standards of care for AD patients, emphasizing the importance of achieving “optimal treatment targets.” These targets include clinically meaningful endpoints such as itch reduction to a Numeric Rating Scale (NRS) of 0–1, skin clearance reflected by Investigator Global Assessment (IGA) 0–1, and Eczema Area and Severity Index (EASI) 90. Bunick described a composite approach combining these measures to define minimal disease activity, providing a framework for clinicians to assess patient response comprehensively.

In addition, the Dermatology Times editor-in-chief highlighted challenges in clinical practice, such as therapeutic inertia, biologic cycling, and repeated steroid use, which can delay the initiation of advanced systemic therapies. He stressed the importance of timely treatment escalation for patients who do not reach optimal targets on biologics, noting that oral JAK inhibitors offer a versatile option by targeting a broader spectrum of cytokine pathways, including Th2, IL-22, and IFN-γ, thereby addressing the heterogeneity of AD.

Safety profiles were another key focus. For the first time nationally, data comparing adverse events—specifically malignancy, major adverse cardiovascular events (MACE), and venous thromboembolism (VTE)—between JAK inhibitors and biologics were presented. Notably, recent findings published in the British Journal of Dermatology on tralokinumab, an IL-13–targeted biologic, indicate that rates of these events are comparable to those observed with the JAK inhibitor upadacitinib. Bunick emphasized that these data highlight a baseline risk of adverse events in AD patients independent of therapy. Treatment with either biologics or JAK inhibitors may confer benefits by reducing systemic inflammation, which is reflected in lower MACE rates on therapy (approximately 0.1–0.2 events per 100 patient-years) compared to the background rate of 0.63 events per 100 patient-years.

Looking ahead to 2026, Bunick underscored the need for greater transparency from biologic manufacturers regarding adverse events in areas of special interest. Such data are essential for guiding clinical decisions, supporting patient safety, and ensuring confidence in advanced systemic therapies.