Dr Raj Chovatiya Outlines Who Is a Good Candidate for Oral JAK Inhibitors

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This content was produced independently by The American Journal of Managed Care^® and is not endorsed by the American Academy of Dermatology.

A patient's medical history may not necessarily mean there is a definite treatment risk, and that is where the art of medicine comes in, says Raj Chovatiya, MD, PhD, associate professor at the Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology and Immunology Research.

Transcript

What are the key considerations when determining whether a patient with atopic dermatitis (AD) is a suitable candidate for oral Janus kinase (JAK) inhibitors, and how do these considerations differ among various patient demographics such as pediatric versus adult populations, or patients with specific comorbidities?

So, in one sense, when it came to atopic dermatitis therapy for moderate to severe patients, it used to be easy but difficult at the same time. Easy in the sense that we didn't have that many choices; difficult because we didn't have that many choices. So, it was really hard to actually treat folks.

Now, fast forward a number of years, and today we have a handful of options, the newest ones of which are the oral JAK inhibitors. A question that I oftentimes get asked is, "We have choices of biologic therapies and oral JAK inhibitors, when am I thinking about using one or the other?" I let the data and the label and clinical experience guide that decision making process. So, in theory, oral JAK inhibitors are theoretical first-line agents for many of your moderate to severe patients that are 12 [years] and above.

When it comes to thinking about practically speaking the way that those labels are constructed, usually you're going to be thinking about somebody who's had a systemic therapy previously. That could really be anything from a steroidal therapy to a steroid-sparing agent, biologic, what not, and then an oral JAK inhibitor might be what you consider.

Beyond that, there's a few points of the label that are important to think about. The box warning statement is one that is complex and worthy of a very long bit of discussion in its own right. But the bottom line is that if your patient has a very strong history of, or active, cardiovascular issues, malignancy, infectious issue, thromboembolic problem, [then] they're probably not the best candidate. But, I think that this is a bit of a gray area as well, because we understand that medical history doesn't necessarily convey 100% risk for patients. This is where the art of medicine comes in. There is a lot of shared decision making that goes in place when it comes to thinking about what you value, what the patient values, and what the risk-benefit trade off is going to be.