For the treatment of AD, also known as eczema, the panel suggested that topical therapies such as ruxolitinib might be okay under certain conditions but should not be used in most patients with mild-to-moderate disease refractory to moisturization alone.
Guideline authors wrote in the Annals of Allergy, Asthma & Immunology that topical ruxolitinib should be reserved for patients who have not responded to other topical therapies and are not concerned about the product’s unproven association with an increased risk of cancer, thromboembolism, serious infection, and mortality.
The recommendation about the use of the topical JAK inhibitor product in adolescents and adult patients was noted as being conditional with low-certainty evidence.
Still, the guidelines recommended the use of oral JAK inhibitors “after careful consideration of risks and possible benefits in adults and adolescents with moderate-severe AD refractory, intolerant, or unable to use mid- to high-potency topical treatment and systemic treatment inclusive of a biologic recommended previously.”
Oral JAK inhibitors have a boxed warning about adverse effects, but it is unclear if the topical agent is absorbed enough to create the same issues.
The guidelines also include recommendations on the use of:
• Topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, phosphodiesterase-4 inhibitors [crisaborole], occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy)
• Dilute bleach baths
• Dietary avoidance/elimination
• Allergen immunotherapy
• Systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, and systemic corticosteroids], and ultraviolet phototherapy (light therapy).
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