Atopic dermatitis (AD), also known as atopic eczema, is a chronic, pruritic, relapsing inflammatory dermatological condition. Treatment mainly aims at reducing itch and inflammation, eliminating flare-ups, and reducing side effects. Topical agents are considered as a primary treatment for mild-to-moderate AD and include topical corticosteroids, topical calcineurin inhibitors (TCI), topical phosphodiesterase 4 (PDE4) inhibitor crisaborole (Eucrisa), and more recently, the first topical Janus kinase (JAK) inhibitor, ruxolitinib cream 1.5% (Opzelura) approved for use in patients with mild-to-moderate AD.



In the topical ruxolitinib clinical studies, more than half of patients with mild-to-moderate AD achieved clear or almost clear skin as well as significant itch relief after 8 weeks. Nasopharyngitis was the most common AE experienced by 3% of patients vs 1% in control patients. Other AEs included diarrhea, bronchitis, ear infections, increase in eosinophil count, and hives, which occurred in 1% of ruxolitinib patients and less than 1% for control patients.



There is a black box warning on the label, which is primarily based on the oral JAKi, tafacitinib (Xeljanz, Pfizer). It is important to note that about 6% of topical ruxolitinib cream is absorbed into the bloodstream, a roughly 85% reduction from oral ruxolitinib.



What are your thoughts on the safety of a topical vs oral JAKi? What has been your experience with AEs from the topical therapies?

Atopic dermatitis (AD), also known as atopic eczema, is a chronic, pruritic, relapsing inflammatory dermatological condition. Treatment mainly aims at reducing itch and inflammation, eliminating flare-ups, and reducing side effects. Topical agents are considered as a primary treatment for mild-to-moderate AD and include topical corticosteroids, topical calcineurin inhibitors (TCI), topical phosphodiesterase 4 (PDE4) inhibitor crisaborole (Eucrisa), and more recently, the first topical Janus kinase (JAK) inhibitor, ruxolitinib cream 1.5% (Opzelura) approved for use in patients with mild-to-moderate AD.



In the topical ruxolitinib clinical studies, more than half of patients with mild-to-moderate AD achieved clear or almost clear skin as well as significant itch relief after 8 weeks. Nasopharyngitis was the most common AE experienced by 3% of patients vs 1% in control patients. Other AEs included diarrhea, bronchitis, ear infections, increase in eosinophil count, and hives, which occurred in 1% of ruxolitinib patients and less than 1% for control patients.



There is a black box warning on the label, which is primarily based on the oral JAKi, tafacitinib (Xeljanz, Pfizer). It is important to note that about 6% of topical ruxolitinib cream is absorbed into the bloodstream, a roughly 85% reduction from oral ruxolitinib.



What are your thoughts on the safety of a topical vs oral JAKi? What has been your experience with AEs from the topical therapies?

Atopic dermatitis (AD), also known as atopic eczema, is a chronic, pruritic, relapsing inflammatory dermatological condition. Treatment mainly aims at reducing itch and inflammation, eliminating flare-ups, and reducing side effects. Topical agents are considered as a primary treatment for mild-to-moderate AD and include topical corticosteroids, topical calcineurin inhibitors (TCI), topical phosphodiesterase 4 (PDE4) inhibitor crisaborole (Eucrisa), and more recently, the first topical Janus kinase (JAK) inhibitor, ruxolitinib cream 1.5% (Opzelura) approved for use in patients with mild-to-moderate AD.



In the topical ruxolitinib clinical studies, more than half of patients with mild-to-moderate AD achieved clear or almost clear skin as well as significant itch relief after 8 weeks. Nasopharyngitis was the most common AE experienced by 3% of patients vs 1% in control patients. Other AEs included diarrhea, bronchitis, ear infections, increase in eosinophil count, and hives, which occurred in 1% of ruxolitinib patients and less than 1% for control patients.



There is a black box warning on the label, which is primarily based on the oral JAKi, tafacitinib (Xeljanz, Pfizer). It is important to note that about 6% of topical ruxolitinib cream is absorbed into the bloodstream, a roughly 85% reduction from oral ruxolitinib.



What are your thoughts on the safety of a topical vs oral JAKi? What has been your experience with AEs from the topical therapies?