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Janus Kinase (JAK) Inhibitors to Treat Eczema

Reviewed by: HU Medical Review Board | Last reviewed: October 2023 | Last updated: October 2023

Janus kinase (JAK) inhibitors are the newest class of drugs approved to treat eczema. They reflect a growing understanding of how the immune system drives atopic dermatitis (eczema) symptoms like redness and itch.1

When are JAK inhibitors recommended?

JAK inhibitors might be used when:2-4

  • Other topical treatments no longer work
  • Immunosuppressants did not or no longer work
  • Biologics did not or no longer work

Treatment guidelines for atopic dermatitis have not been updated since 2014. These guidelines tell doctors which medicines to use and when. Future guidelines should include more details about JAK inhibitors.5,6

How do JAK inhibitors work?

JAK belongs to a family of special proteins called enzymes. JAK enzymes are involved in sending immune signals that lead to inflammation. People with eczema have an abnormal immune response that results in too much inflammation.1,7

JAK inhibitors work by turning off certain reactions inside cells that turn on inflammation. This can help reduce itching and restore clear skin.1,7

JAK inhibitors come as a topical cream applied to the skin or as a pill taken by mouth. The cream targets inflammation only where it is applied to the skin, so it is called a local treatment. The tablet targets inflammation throughout the body, so it is called a systemic treatment.1,8

Examples

As of 2022, there are 3 JAK inhibitors approved by the US Food and Drug Administration (FDA) to treat eczema:2-4

  • Opzelura™ (ruxolitinib) – Topical treatment for adults and children 12 years and older with mild to moderate atopic dermatitis
  • Rinvoq® (upadacitinib) – Systemic treatment for adults and children 12 years and older with moderate to severe atopic dermatitis
  • Cibinqo™ (abrocitinib) – Systemic treatment for adults with moderate to severe atopic dermatitis

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. The most common side effects of JAK inhibitors include:2-4

  • Nausea
  • Headache
  • Fatigue
  • Diarrhea

Possible serious and life-threatening side effects include:2-4

  • Increased risk of infections and cancer
  • Higher cholesterol
  • Low blood cell counts
  • Heart disease
  • Blood clots and/or stroke

Opzelura, Rinvoq, and Cibinqo all have a boxed warning, the strictest warning from the FDA. They have this warning because they may cause rare yet serious side effects, including:2-4

  • Infections
  • Increased risk of death in people 50 and older who have heart problems
  • Cancer, especially in people who currently smoke or used to smoke
  • Heart problems, such as heart attack and stroke
  • Blood clots

These are not all the possible side effects of JAK inhibitors. Talk to your doctor about what to expect when taking a JAK inhibitor. You also should call your doctor if you have any changes that concern you when taking a JAK inhibitor.

Other things to know

Because JAK inhibitors weaken your immune system, they limit your body’s ability to fight infections. Before starting a JAK inhibitor, your doctor may need to order certain lab tests and perform an exam. You may also need to get certain vaccines before starting treatment.2-4

People with certain health conditions should not take JAK inhibitors. Your doctor will need to monitor you while you are being treated.2-4

Do not use more than 1 JAK inhibitor at a time. For example, do not take both a topical and an oral JAK inhibitor. They should also not be taken in combination with an immunosuppressant drug or a biologic drug.2-4

Before beginning treatment for eczema, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.