A Conversation About JAK Inhibitors in Atopic Dermatitis - Episode 7
Raj Chovatiya, MD, PhD, and Lisa Swanson, MD, FAAD, discuss how to talk about safety concerns with patients.
Raj Chovatiya, MD, PhD: I often tell my patients is that the biggest risk is not treating your disease and letting it go uncontrolled more than anything else. Our first goal is to get you under control, rather than thinking about the 5 things that might be wrong with this choice or that choice then end up doing nothing. For that reason, JAK inhibitors are here to stay, both in their topical and oral forms. They’re probably going to revolutionize the way we treat a lot of diseases, beyond atopic dermatitis. I love the idea of embracing and learning as much as you can to understand how to put it in the right context.
The boxed warning, for better or worse, definitely has impacted adoption and utilization by clinicians in the initial phase. As we just mentioned, there’s a lot of thinking and reading and experience that goes into this. The biggest recommendation I can make is, once you get comfortable, adopt new therapies, use them in your patients, and see how they might work in your own clinical experience. Use the data to guide your concerns. A great example is topical ruxolitinib. It unfortunately got a boxed warning just like the oral agents. There was a lot of concern. Is there going to be absorption of the medication? Is it like taking an oral agent? What might happen?
There was a trial performed, a maximum-use study that looked at individuals under nonrealistic conditions applying topical ruxolitinib to a high amount of body surface area. They also looked at what was going on in individuals taking an oral medication. They compared the 2, and they found that there isn’t accumulation of the topical. Its bioavailability is a very low amount. By and large, it’s not hitting thresholds that you’d need to inhibit certain proteins that you’re worried about related to the bone marrow or bone marrow suppression. Those are real numbers and real data that you can find a way to translate into something that makes sense for patients. I’m a big proponent of trying to incorporate all of that into the clinical practice.
Not to shortchange the oral agents, but we’re seeing a lot more new data coming out with long-term studies. There’s no drug without risk, but when it comes to the things on the boxed warning, there may not be that much of an elevated signal of these things beyond the normal population. That’s going to be 1 of those discussions that’s going to require more time to mature, but I’m already feeling optimistic about the direction we’re headed.
Lisa Swanson, MD, FAAD: I agree 100%. I love your comment at the beginning because I often tell patients and their families that there are significant adverse effects to not controlling atopic dermatitis. That’s something that a lot of people don’t necessarily think about. They’re focused on the medicine that we’re talking about and what potential risks could come with that, which is important. But the idea that not controlling the disease could harm that patient or their family member is significant and important to discuss with patients and their families. Atopic dermatitis is not a harmless little thing that’s just a nuisance. It has a major impact on quality of life, general health, and all those things that matter, like sleep.
Raj Chovatiya, MD, PhD: For sure. Not only for the individual but for the family unit itself. It’s a family disease in many ways, particularly for our kids and adolescents, and not just a disease of the individual.
Transcript edited for clarity