Practical management of JAK inhibitors: safety considerations
Abstract
Janus Kinase (JAK) inhibitors are increasingly used in dermatology and serve as highly effective therapeutic options for the treatment of atopic dermatitis, psoriasis, vitiligo, and alopecia areata. JAK inhibitors received a black box warning after a large, controlled study confirmed that rheumatoid arthritis patients treated with high-dose tofacitinib are exposed to a higher safety risk compared to those receiving TNF inhibitor treatment. However, in clinical trials focusing on dermatologic conditions, the risk of serious adverse events of JAK inhibitors was low. Most adverse effects (such as infections, herpes zoster infection, lymphopenia, neutropenia, and elevated transaminase levels) are likely due to a class effect. JAK inhibitors do not inherently increase the risk of arterial/venous thromboembolic (ATE/VTE) events, gastrointestinal perforation, or malignant disorders. Overall, JAK inhibitors can be used safely; however, post-marketing pharmacovigilance studies remain crucial for further safety assessment.