Optimizing Abrocitinib Use for Atopic Dermatitis in India: Expert Recommendations for Patient Selection, Dosing, and Long‑Term Remission

Sanjiv Kandhari,1 Abhishek De,2 Krupa Shankar,3 Ravichandran G,4 Rickson Pereira,5 Soumya Jagadeesan,6 Maitreyee Panda,7 Vinay Singh,8 Uma Chakravadhanula,9 Pravin Banodkar10 1Department of Dermatology, Dr. Kandhari’s Skin and Dental Clinic, New Delhi, India; 2Department of Dermatology, Calcutta National Medicine College and Hospital, Kolkata, West Bengal, India; 3Department of Dermatology, Mallige Hospital, Bengaluru, Karnataka, India; 4Department of Dermatology, Apollo Gem Hospital, Chennai, Tamil Nadu, India; 5Department of Dermatology, Dr. Rickson’s Dermatherapie Clinic, Mumbai, Maharashtra, India; 6Department of Dermatology, Amrita Hospital, Kochi, Ernakulam, Kerala, India; 7Department of Dermatology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India; 8Department of Dermatology, Vibrance Skin Laser and Cosmetic Clinic, Delhi, India; 9Department of Dermatology, IDEA Skin and Hair Clinic, Hyderabad, Andhra Pradesh, India; 10Department of Dermatology, Skin Crest Clinic, Mumbai, Maharashtra, IndiaCorrespondence: Sanjiv Kandhari, Department of Dermatology, Dr. Kandhari’s Skin and Dental Clinic, New Delhi, 110057, India, Email [email protected]: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder which significantly impairs quality of life due to persistent pruritus, sleep disturbance, and recurrent flares. Conventional systemic therapies, such as cyclosporine and methotrexate, often provide inadequate itch and disease control, with limited safety and poor long-term tolerability. The introduction of targeted small-molecule therapies, particularly Janus kinase (JAK) inhibitors, has substantially transformed AD management by enabling rapid itch relief and sustained clinical improvements. Abrocitinib, an oral selective JAK1 inhibitor, has demonstrated rapid and clinically meaningful reduction in pruritus, improvement in skin lesions, and a favorable benefit–risk profile in pivotal clinical trials. However, guidance regarding its optimal real-world use in Indian patients remains limited. This expert recommendation aims to provide practical, experience-based recommendations for the initiation, dosing, monitoring, and long-term management of abrocitinib in patients with moderate-to-severe AD in India. A multistep approach was employed, including a targeted literature review conducted between September and November 2025, a nationwide survey of 36 experienced dermatologists, and two virtual expert panel meetings involving 10 senior clinicians. Experts have identified abrocitinib as a valuable systemic option, particularly for patients with pruritus‑dominant disease, head and neck involvement, hand eczema, elderly patients with comorbidities, and those inadequately controlled with biologics or other systemic agents. Baseline assessment of hematologic, hepatic, renal, lipid, infectious, cardiovascular, and thrombotic risks was emphasized, with follow-up monitoring recommended at four weeks and following dose modifications. An induction dose of 200 mg once daily was preferred for most patients, with 100 mg reserved for the selected populations. Strategies for maintenance, dose tapering, and treatment transitions were also discussed. Overall, these expert recommendations provide practical real-world guidance supporting the individualized, safe, and effective use of abrocitinib in the Indian clinical setting, while emphasizing the importance of structured monitoring and long-term treatment planning.Keywords: atopic dermatitis, abrocitinib, Janus kinase inhibitors, itching management, strategy, real-world, India