Raj Chovatiya, MD, PhD, and Lisa Swanson, MD, FAAD, explore the burden of itch in atopic dermatitis, and why JAK inhibitors may be able to provide relief.
Raj Chovatiya, MD, PhD: For years, we’ve known that there are many domains of activity in atopic dermatitis. We’ve begun to understand that there are issues related to signs of the disease, symptoms of the disease, comorbidities, and quality of life. You can find a way to connect itch to all those aspects of life. Once we realized that itch was so important, it started making its way into studies and became an important end point that we treat for, in terms of looking for clinically meaningful improvement. This made us better clinicians because we were thinking about key symptoms. But we also have to figure out how we relate this to mental health concerns, like anxiety, depression, ADHD in kids. How do we relate this to quality-of-life burdens? People are focused on their itchy skin and can’t sleep at night. There are increased accidents. As a small example, people are probably distracted from itching as well. The rapidity and depth of response for itch may be the 1 thing we need to think more about when it comes to therapy. This is where both topical ruxolitinib, abrocitinib, and upadacitinib shine.
Lisa Swanson, MD, FAAD: The rapid itch relief goes back to mechanism of action and the basic science part of JAK inhibition. By taking the baton away, you’re stopping that relay race for not only IL-4 and IL-13 but also IL-31 and TSLP. You’re stopping all those things in their tracks, and a lot of those things are having a key impact on the itch. This is 1 situation where I accept some basic science into the conversation because—Raj, you know how much I love basic science—it definitely relates to what we clinically observe with our patients with these therapies.
Transcript edited for clarity