How Janus kinase selectivity impacts efficacy and safety of abrocitinib for atopic dermatitis: an expert consensus panel

Atopic dermatitis is a chronic, itch-inducing inflammatory skin condition that significantly affects quality of life. Abrocitinib, an oral medication that selectively inhibits Janus kinase 1, targets inflammatory pathways involved in the disease. All Janus kinase inhibitors approved by the United States Food and Drug Administration for inflammatory conditions carry boxed warnings for serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis. A panel of eight dermatologists met to evaluate the safety of abrocitinib and the impact of Janus kinase selectivity on side effects. A literature search of PubMed, Scopus, and Google Scholar identified 246 English-language studies, of which 36 met inclusion. These were reviewed by the panel prior to a roundtable discussion. Using a modified Delphi method, the panel developed 10 consensus statements and assigned a strength of recommendation to each: seven statements were rated "A," one "B," and two "C." Abrocitinib provides rapid itch relief for people with moderate-to-severe atopic dermatitis. It shows greater selectivity for Janus kinase 1 than other treatments and higher efficacy than biologic therapies. Its safety profile is similar to other Janus kinase 1 inhibitors, with low risk of serious infections and a rate of cardiovascular events and thrombosis comparable to placebo.