The Show Must Go On

An Update on Clinical Experiences and Clinical Studies on Novel Pharmaceutical Developments for the Treatment of Atopic Dermatitis

Tatjana Honstein; Thomas Werfel


Curr Opin Allergy Clin Immunol. 2020;20(4):386-394. 

In This Article

Targeting Janus Kinases for the Topical Treatment of Atopic Dermatitis With Ruxolitinib or Delgocitinib

JAK inhibitors have the advantage over therapeutic antibodies that they can also be applied topically, and thus, represent an alternative for milder or localized disease conditions. Ruxolitinib is a selective JAK1 and JAK2 inhibitor. The topical application in a cream was tested a phase 2 study with 307 atopic dermatitis patients. After randomization, subjects were treated with different concentrations of ruxolitinib, the vehicle control or vehicle control with 0.1-containing triamcinolone cream for 8 weeks. All treatments with the inhibitor resulted in a significant improvement of the EASI score compared with the placebo control. More patients achieved EASI 50, EASI 75, EASI 90, and IGA improvement with the 1.5% ruxolitinib ointment than with triamcinolone treatment.[49] In a separate publication, the data from the same study were shown describing a clinically meaningful reduction in itch and quality of life burden.[50] Application-site pain was the most frequent treatment-related adverse effect.

Delgocitinib is a broader acting kinase inhibitor of TYK2 and other JAK kinases. In a phase III trial, an ointment with delgocitinib was tested on 158 volunteers with atopic dermatitis. After the first 4 weeks, the application of the ointment showed a significant change in EASI, IGA as well as pruritus NRS. The most frequent adverse effect was nasal pararyngitis, followed by acne and eczema herpeticum. The latter was considered treatment-related in 1.9% of cases.[51] A long-term study with a larger cohort of 330 subjects, duration of 52 weeks and an open label design confirmed the positive results.[52] In addition to studies on adults, a 4-week phase II study was performed in pediatric atopic dermatitis patients. There was a significant improvement of EASI, IGA, and pruritus score compared with the control also in this age group. Here, 50% in the highest dosage treatment group achieved EASI75 compared with 8.6% of the control population.[53]