PracticeUpdate Dermatology Best of 2018

CONFERENCE COVERAGE 28

American Academy of Dermatology Annual Meeting 2018 16–20 FEBRUARY 2018 • SAN DIEGO, CALIFORNIA, USA By the PracticeUpdate Editorial Team

Courtesy of the AAD

Janus Kinase Inhibitors May Revolutionize Dermatology Therapy has the potential to become the standard of care for vitiligo.

J anus kinase (JAK) inhibitors stand to revolution- ize dermatology in the years ahead, participants attending the 2018 AAD Annual Meeting were told. “We are soon going to have effective treatments for some of our most desperate patients. It is challenging to repeatedly see patients with psychosocially devas- tating and/or physically uncomfortable diseases and have little, if anything, to offer them,” Brett King MD, PhD, from Yale University in New Haven and Yale Der- matology-Middlebury, told Elsevier’s PracticeUpdate . Alopecia areata, atopic dermatitis, and vitiligo are highly visible dermatologic conditions that can have a negative effect on patients’ quality of life and overall health. While these conditions may not seem alike on the surface, they are all fueled by the body’s immune system, Dr. King noted. JAK inhibitors seem to address immune system dysfunction in all three diseases. JAK family of molecules are essential to the signal cascade originating from type I and type II cytokine receptors. JAK inhibitors are small molecules that inter- rupt cytokine signaling and thus have great potential to treat many disease types involved in disrupted immune function, including allergies and autoimmune diseases. They have also shown some benefit for the treatment of certain malignancies that arise from imbalances in complex immune functioning. Until approximately four years ago, for example, severe alopecia areata had no FDA-approved or reliably

effective therapy. The landscape has changed signifi- cantly since 2014, said Dr. King. He and his colleagues successfully regrew hair in a patient who had nearly complete hair loss using the JAK inhibitor tofacitinib, which is FDA-approved for rheumatoid arthritis and bone marrow diseases. “Immediately, the enormous unmet need in this dis- ease became evident,” said Dr. King. A clinical trial was conducted that confirmed the original result and paved the way for a large retrospective study as well as smaller ones, both in adults and adolescents, he noted. “Only a short time later, this and other work has spawned so much interest that there are randomized, double-blind, placebo-controlled trials sponsored by the pharmaceutical industry happening, which is very hopeful for our patients who are desperate for treatment.” During his hour-long session, Treating Alopecia Areata, Vitiligo and Atopic Dermatitis: JAK Inhibitors, Something New for Dermatology, Dr. King noted that the only FDA-approved therapy for vitiligo is a topical depigmenting agent. “[This] is the opposite of what patients want, which is to restore pigment,” he said. Topical steroids and topical calcineurin inhibitors are somewhat effective, as is phototherapy, in treating vitiligo, but JAK inhibitors appear to produce much greater benefits, especially when used in combina- tion with other therapeutic modalities. Dr. King and his

Dr. Brett King

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