The following is a summary of “Comparative safety of oral Janus kinase inhibitors versus dupilumab in patients with atopic dermatitis: A population-based cohort study,” published in the November 2024 issue of Allergy and Immunology by Tsai et al. 

Systemic Janus kinase inhibitors (JAKi) and dupilumab are effective for atopic dermatitis (AD). Dupilumab is safer, while oral JAKi may carry additional risks. 

Researchers conducted a retrospective study to compare the safety of oral JAKi and dupilumab in AD. 

They analyzed observational data from multiple US healthcare organizations, enrolling patients with AD treated with oral JAKi (upadacitinib, abrocitinib, baricitinib) or dupilumab. The 2 treatment groups were propensity scores matched 1:1 based on demographics, comorbidities, and prior medications, with safety outcomes assessed over 2 years using hazard ratios (HRs) and 95% CIs. 

The results showed that 14,716 patients were included, with 942 treated with oral JAKi and 13,774 with dupilumab. After matching, each group had 938 patients. Oral JAKi was not linked to increased risks of mortality, malignancies, cardiovascular events, or serious gastrointestinal issues. However, it showed higher risks of skin infections (HR = 1.35, 95% CI = 1.07-1.69), herpes infection (herpes simplex, HR = 1.64, 95% CI = 1.03-2.61; herpes zoster, HR = 2.51, 95% CI = 1.14-5.52), acne (HR = 2.09, 95% CI = 1.54-2.84), cytopenia (anemia, HR = 1.83, 95% CI = 1.39-2.41; neutropenia, HR = 4.02, 95% CI = 1.91-8.47; thrombocytopenia, HR = 1.76, 95% CI = 1.08-2.89), and hyperlipidemia (HR = 1.45, 95% CI = 1.09-1.92); the risk of ophthalmic complications was higher in those receiving dupilumab (HR = 1.49, 95% CI = 1.03-2.17). 

They found oral JAKi increased infection and lab abnormality risks. Long-term data were needed. 

Source: sciencedirect.com/science/article/abs/pii/S0091674924007760