Ruxolitinib Cream Improves Clinical Outcomes in Moderate-to-Severe Non-Atopic Chronic Hand Eczema: Responses by Subtype

Chronic hand eczema (CHE) is characterized by persistent or recurrent inflammatory lesions on the hands and wrists. Ruxolitinib (Janus kinase [JAK]1/JAK2 inhibitor) cream has demonstrated efficacy in atopic and nonatopic hand eczema. In a phase 2 study in adults with moderate-to-severe nonatopic CHE (NCT05906628), 1.5% ruxolitinib cream twice daily (BID) demonstrated tolerability and efficacy at Week 16, with improvements maintained to Week 32 with as-needed BID treatment. This post hoc analysis evaluated clinical outcomes by CHE subtype. Adults with CHE, Investigator’s Global Assessment (IGA)-CHE score of 3/4 (moderate/severe), CHE-related Itch Numerical Rating Scale score ≥4, and no atopic dermatitis were randomized 1:1 to 1.5% ruxolitinib cream or vehicle BID for 16 weeks of double-blind treatment. All patients then applied 1.5% ruxolitinib cream to active lesions BID as needed in a 16-week open-label extension. Outcomes included achievement of an IGA-CHE score of 0/1 (clear/almost clear) with a ≥2-grade improvement from baseline (IGA-CHE treatment success [IGA-CHE-TS]) and a ≥75%/≥90% improvement from baseline in Hand Eczema Severity Index (HECSI-75/HECSI-90). As-observed outcomes were evaluated descriptively by CHE subtype. Among 186 randomized patients (allergic contact dermatitis [ACD], n=30; contact urticaria/protein contact dermatitis [CU/PCD], n=1; hyperkeratotic eczema, n=26; irritant contact dermatitis [ICD], n=51; vesicular eczema, n=28; unclassified, n=60; subtypes not mutually exclusive), greater IGA-CHE-TS response rates were observed at Week 16 with ruxolitinib cream versus vehicle across etiologic and clinical subtypes (ACD, 46.7% vs 20.0%; hyperkeratotic eczema, 63.6% vs 16.7%; ICD, 56.0% vs 9.1%; vesicular eczema, 61.5% vs 0%; unclassified, 61.5% vs 15.4%); the 1 patient with CU/PCD (randomized to ruxolitinib cream) did not achieve IGA-CHE-TS at Week 16 but did so at Week 32. HECSI-75 and HECSI-90 response rates were also substantially greater at Week 16 with ruxolitinib cream versus vehicle across subtypes. At Week 32, responses were maintained or further improved with as-needed treatment for most subtypes and endpoints, and patients who crossed over from vehicle had substantially improved responses. In summary, ruxolitinib cream improved clinical outcomes in patients with moderate-to-severe CHE in all evaluated subtypes. These results, in combination with existing data in atopic hand eczema, support ruxolitinib cream as a potential treatment option for patients with CHE irrespective of subtype. (Funding, Incyte Corporation).