Practical Management of the JAK1 Inhibitor Abrocitinib for Atopic Dermatitis in Clinical Practice: Special Safety Considerations.

IF 3.5 3区 医学 Q1 DERMATOLOGY
Dermatology and Therapy Pub Date : 2024-08-01 Epub Date: 2024-07-02 DOI:10.1007/s13555-024-01200-5
Melinda J Gooderham, Marjolein de Bruin-Weller, Stephan Weidinger, Michael J Cork, Lawrence F Eichenfield, Eric L Simpson, Athanasios Tsianakas, Urs Kerkmann, Claire Feeney, William Romero
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Abstract

Abrocitinib, an oral, once-daily, Janus kinase (JAK) 1-selective inhibitor, is approved for the treatment of adults and adolescents with moderate-to-severe atopic dermatitis (AD). Abrocitinib has shown rapid and sustained efficacy in phase 3 trials and a consistent, manageable safety profile in long-term studies. Rapid itch relief and skin clearance are more likely to be achieved with a 200-mg daily dose of abrocitinib than with dupilumab. All oral JAK inhibitors are associated with adverse events of special interest and laboratory changes, and initial risk assessment and follow-up monitoring are important. Appropriate selection of patients and adequate monitoring are key for the safe use of JAK inhibitors. Here, we review the practical use of abrocitinib and discuss characteristics of patients who are candidates for abrocitinib therapy. In general, abrocitinib may be used in all appropriate patients with moderate-to-severe AD in need of systemic therapy, provided there are no contraindications, e.g., in patients with active serious systemic infections and those with severe hepatic impairment, as well as pregnant or breastfeeding women. For patients aged ≥ 65 years, current long-time or past long-time smokers, and those with risk factors for venous thromboembolism, major adverse cardiovascular events, or malignancies, a meticulous benefit-risk assessment is recommended, and it is advised to start with the 100-mg dose, when abrocitinib is the selected treatment option.

Abstract Image

JAK1 抑制剂阿罗西替尼治疗特应性皮炎的临床实践管理:特殊安全性考虑。
阿罗西替尼是一种口服、每日一次的 Janus 激酶 (JAK) 1 选择性抑制剂,已被批准用于治疗成人和青少年中重度特应性皮炎 (AD)。阿罗西替尼在三期试验中显示出快速、持续的疗效,在长期研究中显示出稳定、可控的安全性。与杜比鲁单抗相比,阿罗西替尼每日200毫克的剂量更有可能实现快速止痒和皮肤清除。所有口服 JAK 抑制剂都会引起特别关注的不良事件和实验室变化,因此初始风险评估和后续监测非常重要。适当选择患者和充分监测是安全使用 JAK 抑制剂的关键。在此,我们回顾了阿罗西替尼的实际应用,并讨论了适合阿罗西替尼治疗的患者的特征。一般来说,只要没有禁忌症,阿罗西替尼可用于所有需要全身治疗的中重度AD患者,如活动性严重全身感染患者、严重肝功能损害患者、孕妇或哺乳期妇女。对于年龄≥65岁的患者、目前长期或过去长期吸烟者,以及有静脉血栓栓塞、重大不良心血管事件或恶性肿瘤风险因素的患者,建议进行细致的获益-风险评估,当选择阿罗西替尼作为治疗方案时,建议从100毫克剂量开始。
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来源期刊
Dermatology and Therapy
Dermatology and Therapy Medicine-Dermatology
CiteScore
6.00
自引率
8.80%
发文量
187
审稿时长
6 weeks
期刊介绍: Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.
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