Brett King, MD, discusses Janus Kinase Inhibitor Use in Dermatology.
In this video
Speaking from the Elevate-Derm meeting in Palm Springs, Dr. King traces the JAK inhibitor boxed warning back to its true source: not the dermatology clinical trials, but the ORAL Surveillance long-term safety study of tofacitinib—a drug dermatology doesn't even have—in rheumatoid arthritis patients 50 and older who carried an additional cardiovascular risk factor. In that population "optimized" for a major cardiac event or malignancy, those events happened more often than with a TNF inhibitor, but not dramatically, and, as he puts it, "those patients just aren't our patients in dermatology."
He argues that clinicians first have to be comfortable with the class themselves, then communicate effectively without being dismissive of the warning—telling patients "you don't look like the patient in this clinical trial that gave us the boxed warning." He points to data on upadacitinib and baricitinib across dermatologic and rheumatologic diseases showing that rates of malignancy, thrombosis, and major events are much lower in dermatology patients. "It's not opinion," he says—dermatology patients are on the whole healthier, so the risk is simply not the same.
- The JAK inhibitor boxed warning derives from ORAL Surveillance—a tofacitinib safety study in RA patients 50+ with a cardiovascular risk factor—not from dermatology trials.
- Don't dismiss the boxed warning, but frame it honestly: most dermatology patients don't resemble the high-risk trial population.
- Data on upadacitinib and baricitinib show lower rates of malignancy, thrombosis, and major events in dermatology patients than in rheumatology patients.
- Being comfortable with the class yourself and communicating clearly is essential—patients won't take these medicines otherwise.
- With good information, patients can make good decisions; these drugs offer potential "no other medicine can do."
