705 Not ‘just Another Kinase’: the Therapeutic Potential of JAK Inhibitors in the Treatment of Atopic Dermatitis

Background: Atopic dermatitis is a chronic, relapsing and remitting disease that can be difficult to treat despite recently approved biologic therapies targeting IL-4/IL-13 receptors. Oral Janus Kinase inhibitors (JAKi) represent a novel therapeutic class of targeted therapy to treat moderate-severe atopic dermatitis (AD). Objective: To review the efficacy, safety, and pharmacokinetic characteristics of JAKi in the treatment of AD. Methods: A PRISMA systematic review was conducted using MEDLINE, EMBASE (Ovid), and PubMed databases for studies assessing the efficacy, safety, and/or pharmacokinetics of oral forms of JAK inhibitors in the treatment of AD in pediatric or adult populations from inception to December 2020. Given the relatively limited evidence for each JAKi and the differences in patient eligibility criteria between studies, the data was not deemed suitable for a meta-analysis at this time. Results: 365 papers were reviewed. Of 21 articles that underwent full text screening, 8 met our inclusion criteria for final qualitative review. Three studies examined abrocitinib; three studies examined bariticinib; one examined gusacitinib (ASN002), and another upadacitinib. Significant clinical efficacy and a reassuring safety profile was reported for all JAKi agents reviewed. Rapid symptom control, as early as the first and second week of initiation, was reported for abrocitinib and baricitinib. The most common treatment-emergent adverse events included respiratory and gastrointestinal symptoms, which were mild and transient in nature, and amenable to symptomatic treatment. Conclusion: Given its rapid symptom control combined with a reassuring safety profile, we recommend considering the use of JAKi as a second-line systemic therapy for adult patients with moderate-severe AD who are unresponsive to topical treatment or biologic therapies.