Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology, director of clinical research and patch testing, George Washington University School of Medicine and Health Sciences, explains efficacy and safety implications of JAK inhibitor use for atopic dermatitis.
The potential of JAK inhibitors to block multiple pathways associated with atopic dermatitis could lead to better treatment efficacy, but may also cause safety concerns such as off-target effects, said Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology, director of clinical research and patch testing, George Washington University School of Medicine and Health Sciences.
What are the pros and cons of JAK inhibitors for atopic dermatitis?
At a very high level, the potential of blocking multiple pathways may come with potentially better efficacy. And we have certainly seen that at the higher doses, where higher doses, particularly of upadacitinib and abrocitinib, have really set the bar for efficacy in the field, period.
On the flip side, by targeting more mechanisms, more pathways, there may be more potential safety concerns that come up, because we're not just blocking one aspect of our immune system, but multiple aspects. And when you're dealing with small molecules and oral agents, there's also the potential for getting off-target effects, which may happen in that things that go beyond just those cytokines and signals that we may want to inhibit can also occur potentially.
So, I think at a high level those are the pros and cons. There are, of course, many other potential nuances in terms of the speed of effect and the opportunity for oral agents and some of the other things that come up, which can also be strengths of the class.