JAKs in Practice: Panel Discusses Case Pearls at Elevate-Derm Conference

From managing cholesterol elevations to treating patients with multiple autoimmune diseases and navigating family planning conversations, an expert panel at the 2026 Elevate Derm Summer Conference in San Diego, California, used real-world cases to explore common clinical challenges associated with JAK inhibitor therapy.¹ Throughout the discussion, Eileen Cheever, PA-C, Victoria Garcia-Albea, NP, Keri Holyoak, PA-C, and Buchi Neita, PA-C, emphasized that thoughtful patient counseling, interdisciplinary collaboration, and individualized risk assessment can help clinicians address these challenges while allowing patients to continue therapies that provide meaningful disease control.

Cholesterol Conundrum

The first case was a 42-year-old female with moderate to severe atopic dermatitis. She had a body surface area (BSA) of 24% and an Eczema Area and Severity Index (EASI) score of 30. The patient failed topicals, phototherapy, and dupilumab and was “miserable.” Medically, the patient had a body mass index of 30, her baseline LDL was 108, and has PCOS; there is also a maternal history of MI at age 58. After a shared decision-making discussion and finding baseline CBC/CMP normal, upadacitinib 15 mg daily was initiated.

The patient achieved a meaningful clinical response when she presented at the 12-week follow-up. Her BSA was reduced to about 3% and a 85% improvement on EASI. She also reported her sleep was normalized. The labs complicated the picture, with a total cholesterol of 244 (triglycerides 176, LDL 192, HDL 58).

With the patient’s history and an atherosclerotic cardiovascular disease 10-year risk of 5.9%, the primary care provider was consulted before making further treatment decision. A repeated panel confirmed the LDL and found A1C of 5.7%. Her blood pressure was 130/82.

In balancing the cardiovascular concerns ²and the treatment efficacy, the PCP was consulted. The decision was made to continue the JAK inhibitor and initiate rosuvastatin 10 mg.

This strategy proved successful. At 3 months follow-up, her AD remained well-controlled. Moreover, there was no statin intolerance and no adverse effects from the JAK inhibitor, and cholesterol levels were stabilized.

“The takeaway from this case (and the lecture prior) is that cholesterol elevations are expected, so prepare for them,”Cheever said. She emphasized counseling patients and collaborating with PCPs as feasible to address the cholesterol issues to avoid giving up on the JAK inhibitors, which can be so helpful for patients. “So really make sure you're not unnecessarily pulling your patients off these medications without looking at other options to be able to treat what’s going on.”

Complicated Comorbidities

A complex autoimmune history also can be challenging, the panel agreed. They shared the case of a 68-year-old White female with a 10-year history of mild to moderate AD, long-standing biopsy-confirmed morphea with recent progression of more widespread plaques , and seronegative rheumatoid arthritis. In addition to recent exacerbation of the AD, the patient also developed prurigo nodularis. Her baseline disease burden on presentation was 20% BSA and itch was 6 out of 10.

The patient’s medical history also included Sjogren syndrome, Celiac disease, and asthma. She reported hypertension, hypercholesterolemia, GERD, and irritable bowel syndrome. Her baseline CBC and CMP were within normal limits; her cholesterol was 250 with LDL at 168.

Treatment failures included topical corticosteroids and topical calcineurin inhibitors. She also was treated with hydroxychloroquine, methotrexate, and leflunomide for the RA. She had the best response on adalimumab and hydroxychloroquine, but discontinued due to lack of insurance coverage.

To address her goals of controlling AD, improving morphea, and addressing RA, 15 mg upadacitinib was added to hydroxychloroquine.

Treatment was deemed successful. At 4 weeks, the BSA was 0% and itch was 0/10. In addition, the patient reported improvement in RA symptoms and less duration and reduced violaceous borders for the morphea. This trend continued at the 3-month follow-up, with the morphea and RA stable and improved and o% BSA and 0/10 itch.

The successful outcome was a result of the clinician exploring the medical history and considering the interplay of the various inflammatory and autoimmune issues occurring, the panel agreed. “Make sure that you're reviewing patient history, understanding what they're coming in with, so you can hopefully offer them the best treatment possible,” Neita told attendees.

“And of course, interdisciplinary collaborations… that collaboration is really, really important, especially in these drugs where there are some complexities.”

Considerations and Conclusions

Across every scenario, the panel returned to the same principle: successful JAK inhibitor use depends less on rigid algorithms than on thoughtful patient assessment, proactive counseling, and collaboration across specialties. Whether managing expected laboratory changes, multiple autoimmune conditions, or reproductive planning, the panelists encouraged clinicians to anticipate and resolve issues rather than abandon therapies that may be providing meaningful disease control.

References

1. Cheever E, Garcia-Albea V, Holyoak K, NeitaB. JAK Workshop: Case-Based Roundtable Discussion. Presented at the 2026 Elevate-Derm Summer Conference; July 29-August 2, 2026; San Diego, California.

2. Ingrassia JP, Maqsood MH, Gelfand JM, et al. Cardiovascular and Venous Thromboembolic Risk With JAK Inhibitors in Immune-Mediated Inflammatory Skin Diseases: A Systematic Review and Meta-Analysis. JAMA Dermatol. 2024;160(1):28-36. doi: 10.1001/jamadermatol.2023.4090.