Topical and systemic JAK inhibitors in hand eczema – a narrative review

ABSTRACT

Introduction

Hand eczema is a chronic inflammatory skin disease characterized by significant prevalence and impact on patients’ Quality of Life (QoL). Because of its complex and diverse clinical picture, HE management requires patient-specific treatment which may constitute a challenge. First described in the 1990s, Janus kinase inhibitors (JAK inhibitors) state a group of modern therapeuticals, which exhibit good bioavailability and are well tolerated by patients in both – topical and systemic – routes of administration. They are an immunomodulating small molecules, impacting JAKs’ enzymatic activity.

Areas covered

This review provides a summary of available data concerning JAK inhibitors’ use in HE patients, regarding also clinical trials for the HE treatment.

Expert opinion

Recent studies are introducing JAK inhibitors as an alternative for other topical and systemic therapies in HE patients. Treatment targeting specific immune pathways enables precise management and extends range of potential therapeutic options. Despite early promising results, future studies need to evaluate JAK inhibitors’ safety, potential risks and benefits resulting from the treatment, as well as impact of the therapy on patients’ QoL.

KEYWORDS:

• ARQ-252
• baricitinib
• delgocitinib
• gusacitinib
• hand eczema
• JAK inhibitors
• ruxolitinib
• upadacitinib

Article highlights

• Hand eczema is a chronic inflammatory skin disease impacting severely on patients’ Quality of Life (QoL).

• Janus kinase inhibitors (JAK inhibitors) are modern therapeuticals characterized by good bioavailability and tolerance.

• JAK inhibitors may state an alternative for other topical and systemic therapies in HE.

• Further studies, especially in non-AD-related HE patients group, need to be performed to evaluate this group of pharmaceuticals.

• JAK inhibitors have not been yet approved for hand eczema diagnosis by either FDA or EMA.

Declaration of interests

J Szepietowski acted as a global coordinator and principal investigator in the phase III studies of ruxolitinib cream: TRuE-AD1 [NCT03745638]; TRuE-AD2 [NCT03745651]. J Szepietowski also acted as: Advisory Board/Consultant: AbbVie, Leo Pharma, Novartis, Sandoz, Sanofi-Genzyme, Trevi, Viofor. Speaker: AbbVie, Janssen-Cilag, Eli-Lilly, Leo-Pharma, Sanofi-Genzyme. Clinical trials: AbbVie, Amgen, BMS, Galderma, Galapagos, Incyte, InfraRX, Janssen-Cilag, Menlo Therapeutics, Merck, Novartis, Pfizer, Regeneron, UCB, Trevi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.