BACKGROUND Janus kinase inhibitors (JAKinibs) have the potential to dramatically alter the landscape of atopic dermatitis (AD) management due to their promising efficacy results from phase 3 trials and rapid onset of action. However, JAKinibs are not without risk, and their use is not appropriate for all AD patients, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD. OBJECTIVE This consensus expert opinion statement from the International Eczema Council (IEC) provides a pragmatic approach to prescribing JAKinibs, including choosing appropriate patients, dosing, clinical and lab monitoring, as well as long-term use. METHODS An international cohort of authors from the IEC with expertise in JAKinibs selected topics of interest and were formed into authorship groups covering 10 subsections. The groups performed topic-specific literature reviews, consulted up-to-date adverse event (AE) data, referred to product labels and provided analysis and expert opinion. The manuscript guidance and recommendations were reviewed by all authors as well as the IEC Research Committee. RESULTS We recommend JAKinibs be considered for patients with moderate to severe AD seeking the benefits of rapid reduction in disease burden and itch, oral administration, and the potential for flexible dosing. Baseline risk factors should be assessed prior to prescribing JAKinibs, including increasing age, venous thromboembolisms, malignancy, cardiovascular health, kidney/liver function, pregnancy and lactation, and immunocompetence. Patients being considered for JAKinib therapy should be current on vaccinations and we provide a generalized framework for laboratory monitoring, though clinicians should consult individual product labels for recommendations as there are variations among the JAKinib class. Patients who achieve disease control should be maintained on the lowest possible dose, as many of the observed AEs occurred in a dose-dependent manner. Future studies are needed in AD patients to assess the durability and safety of continuous long-term use of JAKinibs, combination medication regimens, and the effects of flexible, episodic treatment over time. CONCLUSIONS The decision to initiate a JAKinib should be shared among patient and provider, accounting for AD severity and personal risk/benefit assessment, including consideration of baseline health risk factors, monitoring requirements and treatment costs.

中文翻译：

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国际湿疹理事会使用口服 JAK 抑制剂治疗特应性皮炎的实用指南。


背景 Janus 激酶抑制剂 (JAKinibs) 有可能显着改变特应性皮炎 (AD) 治疗的前景，因为其 3 期试验的疗效结果令人鼓舞且起效迅速。然而，JAKinib 并非没有风险，并且其使用并不适合所有 AD 患者，这使得皮肤科医生在治疗中度至重度 AD 患者时应了解和考虑这一类药物。目的 国际湿疹理事会 (IEC) 的这份共识专家意见声明提供了一种实用的 JAKinib 处方方法，包括选择合适的患者、剂量、临床和实验室监测以及长期使用。方法 来自 IEC 的具有 JAKinibs 专业知识的国际作者群体选择了感兴趣的主题，并组成了涵盖 10 个小节的作者小组。这些小组进行了特定主题的文献综述，查阅了最新的不良事件（AE）数据，参考了产品标签并提供了分析和专家意见。所有作者以及 IEC 研究委员会都对稿件指南和建议进行了审查。结果 我们建议中度至重度 AD 患者考虑使用 JAKinibs，寻求快速减轻疾病负担和瘙痒、口服给药以及灵活给药潜力的益处。在开 JAKinib 处方之前应评估基线危险因素，包括年龄增长、静脉血栓栓塞、恶性肿瘤、心血管健康、肾/肝功能、妊娠和哺乳以及免疫功能。 考虑接受 JAKinib 治疗的患者应及时接种疫苗，我们提供了实验室监测的通用框架，但由于 JAKinib 类别之间存在差异，临床医生应查阅个别产品标签以获取建议。实现疾病控制的患者应维持尽可能低的剂量，因为许多观察到的 AE 均以剂量依赖性方式发生。未来需要在 AD 患者中进行研究，以评估持续长期使用 JAKinibs、联合用药方案的持久性和安全性，以及灵活、间歇性治疗随时间推移的效果。结论 启动 JAKinib 的决定应由患者和提供者共同决定，考虑 AD 严重程度和个人风险/效益评估，包括考虑基线健康风险因素、监测要求和治疗成本。