An evaluation of abrocitinib for moderate-to-severe atopic dermatitis

ABSTRACT

Introduction

Atopic dermatitis (AD) is a common itchy inflammatory skin condition that affects many individuals. For many years, the landscape of AD treatment remained unchanged; however, there has been developing therapies that directly target the underlying immunological mechanism of AD. Janus kinase (JAK) inhibitors are small molecules that have shown anti-inflammatory and anti-itch effects in AD. Recently, abrocitinib, an oral JAK 1 inhibitor, was approved by the Food and Drug Administration for atopic dermatitis.

Areas covered

By downregulating the immune cascade, abrocitinib has demonstrated the ability to curb symptoms of AD, including rapidly reducing pruritus in 2–3 days, and is safe and well-tolerated overall despite a low increased risk in infection. The data discussed was obtained from a comprehensive literature review utilizing PubMed.

Expert opinion

Abrocitinib has strong efficacy, likely due to its broader mechanism of action provided by the inhibition of key regulatory molecule, JAK. Results have demonstrated that it is more efficacious at curbing symptoms of AD than dupilumab, the current treatment of choice for refractory, moderate-to-severe AD. While abrocitinib provides a great alternative treatment, particularly for non-responders and AD subtypes, it also demonstrates a stronger side effect profile that must be considered.

KEYWORDS:

• Abrocitinib
• atopic dermatitis
• eczema
• JAK inhibitor
• small molecules

Article highlights

• Abrocitinib is a selective JAK 1 inhibitor that has been shown to significantly reduce AD-associated dermatitis and pruritus; improvements in itch have been demonstrated following 2 weeks of treatment

• Abrocitinib is comparable to dupilumab in improving disease-related findings

• Renal function should be evaluated prior to abrocitinib initiation and dose adjustments should be considered in patients with renal insufficiency

• Abrocitinib is overall safe and well-tolerated. The most common adverse effects, including nausea, headache, nasopharyngitis, upper respiratory infections, and acne, are mild and non-serious; although, there is a small increased risk in infection such as herpes virus

Declaration of interest

G Yosipovitch has been an investigator and consultant to Galderma, Pfizer, Sanofi Regeneron, Eli Lilly, Bellus, Kiniksa, Leo and 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

One peer reviewer has declared potential conflicts of interest pertaining to: Pfizer, Abbvie, BMS, Lilly, Sanofi. One peer reviewer is speaker and adviser for the following: Abbvie, Amgen, Janssen, Eli Lilly, Leo, Novartis, Pfizer, Sun, Ortho, Regeneroni/Sanofi, EPI, UCB.Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Information resources

For additional reading on this topic, we suggest the related studies included in this review. These consist of, ‘Efficacy and Safety of Oral Janus Kinase 1 Inhibitor Abrocitinib for Patients With Atopic Dermatitis: A Phase 2 Randomized Clinical Trial’ by Gooderham et al. in JAMA Dermatology, ‘Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial’ by Simpson et al. in The Lancet, ‘Efficacy and Safety of Abrocitinib in Patients With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial’ conducted by Silverberg et al. in JAMA Dermatology, ‘Abrocitinib versus Placebo or Dupilumab for Atopic Dermatitis’ by Bieber et al. in the New England Journal of Medicine, and ‘Efficacy and Safety of Abrocitinib in Combination With Topical Therapy in Adolescents With Moderate-to-Severe Atopic Dermatitis: The JADE TEEN Randomized Clinical Trial’ by Echenfield et al. in JAMA Dermatology.

Additional information

Funding

This paper was not funded.