Stopping the itch: moving beyond topical steroids for atopic dermatitis

Published online: October 17, 2019

Atopic dermatitis (AD) is a common inflammatory skin disorder characterized by red, itchy, and oozing skin lesions that profoundly reduce patients’ quality of life. Many of the common topical treatments for AD are limited by how much they improve symptoms, particularly itch, and are not recommended for long-term use. Targeting multiple immune factors at once by disrupting the Janus kinase (JAK) family of proteins has emerged as a promising way to treat AD.

In an article recently published in The Journal of Allergy and Clinical Immunology (JACI), Kim and colleagues evaluated the use of ruxolitinib cream, a selective inhibitor of JAK1 and JAK2, in adult patients with AD. Safety and disease improvements were compared between patients treated with cream containing either ruxolitinib (daily application of 0.15%, 0.5%, or 1.5% or twice-daily application of 1.5%), a mid-potency corticosteroid (triamcinolone twice daily), or vehicle (cream with no active drug twice daily). After 8 weeks of double-blind treatment, all patients could apply 1.5% ruxolitinib cream twice daily for an additional 4 weeks (open-label extension period). The effects of treatment were measured by the Eczema Area and Severity Index (EASI), Investigator’s Global Assessment, and itch numeric rating scale tools.

All ruxolitinib cream regimens, regardless of potency, demonstrated clear improvement of disease by 4 weeks of treatment (primary efficacy endpoint) with further improvements seen by Week 8. The greatest improvement was observed in patients treated with 1.5% ruxolitinib cream twice daily (highest strength). Compared with vehicle, significant reductions in itch occurred as rapidly as within 36 hours at this dose, reaching near-maximal improvements by Week 4 that were sustained through 12 weeks. At Week 4, a 71.6% improvement in EASI score was observed with 1.5% ruxolitinib cream twice daily. Clear or almost-clear skin was observed in 38.0% of patients who applied 1.5% ruxolitinib cream twice daily at Week 4 compared with 7.7% of patients who applied vehicle. In addition to disease and itch improvements, patients also showed a significant reduction in inflammatory markers in the blood (ie, TARC/CCL17; 1.5% ruxolitinib cream twice daily at Week 8). Patients switching to 1.5% ruxolitinib cream twice daily in the open-label extension of the study showed further substantial improvement of disease (Weeks 8 to 12). The safety profile of ruxolitinib cream was comparable to that of vehicle and not associated with clinically significant application site reactions.

In summary, ruxolitinib cream provided rapid and sustained control of signs and symptoms of AD and is anticipated to offer a novel and effective topical treatment option for patients with AD beyond the existing medications, such as topical corticosteroids, calcineurin inhibitors, and phosphodiesterase 4 inhibitors.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Graphical Abstract