A case series of acne following Janus kinase inhibitors in patients with atopic dermatitis

Lee, Sang‐Doo; Ahn, Hye‐Jin; Shin, Min Kyung

doi:10.1016/j.jdcr.2022.09.029

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…The JAK/STAT pathway is activated in lesions with acne, 18 and may play both stimulatory and regulatory roles in the pathogenesis of acne; this pathway may promote type 1 helper T cell (Th1)/Th17 immune responses to Cutibacterium acnes and may regulate mammalian target of rapamycin complex 1 pathway, accelerating the generation of acne. [17][18][19] The acne developed during upadacitinib treatment is manageable with general treatment for acne, such as topical adapalene or benzoyl peroxide, or improves without treatment. 15 In this study, we aimed to detect background factors that predict the occurrence of HZ and acne during upadacitinib treatment in patients with moderate-to-severe AD in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…The precise mechanism for JAK inhibitor‐induced acne has not been elucidated. The JAK/STAT pathway is activated in lesions with acne, 18 and may play both stimulatory and regulatory roles in the pathogenesis of acne; this pathway may promote type 1 helper T cell (Th1)/Th17 immune responses to Cutibacterium acnes and may regulate mammalian target of rapamycin complex 1 pathway, accelerating the generation of acne 17–19 . The acne developed during upadacitinib treatment is manageable with general treatment for acne, such as topical adapalene or benzoyl peroxide, or improves without treatment 15 …”

Section: Introductionmentioning

confidence: 99%

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Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib

Hagino

Saeki

Fujimoto

et al. 2023

The Journal of Dermatology

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Upadacitinib, an oral Janus kinase 1 inhibitor approved for treating atopic dermatitis (AD), can cause adverse events such as herpes zoster (HZ) and acne. We aimed to identify background factors predicting the occurrence of HZ and acne during upadacitinib treatment in patients with AD. From August 2021 to December 2022, 112 Japanese patients with moderate‐to‐severe AD (aged ≥12 years) were treated with upadacitinib 15 mg/day (78 patients) or 30 mg/day (34 patients) plus topical corticosteroids or delgocitinib limited to head and neck for 3–9 months. AD patients with the occurrence of HZ during upadacitinib treatment had higher incidences for history of HZ and of bronchial asthma than those without in the upadacitinib 15 mg, 30 mg, and whole groups. AD patients with occurrence of HZ had higher pretreatment values of lactate dehydrogenase and eczema area and severity index on head and neck compared to those without in the upadacitinib 15 mg and whole groups. Logistic regression analysis revealed that history of HZ was associated with the occurrence of HZ in the upadacitinib 15 mg and whole groups. The proportion of underage patients (<18 years) was higher in patients with occurrence of acne compared to those without in the upadacitinib 30 mg group, but no significant differences were found in the other background factors between the two patient populations. History of HZ may predict the occurrence of HZ during upadacitinib treatment in patients with AD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib

Hagino

Saeki

Fujimoto

et al. 2023

The Journal of Dermatology

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“…While JAK inhibitors hold promise as a valuable treatment option for patients with inflammatory conditions, acne has been a commonly reported adverse effect in clinical trials of JAK inhibitors . However, little is known about the overall incidence of acne from JAK inhibitors and how this differs between different drug classes and the underlying conditions being treated .…”

Section: Introductionmentioning

confidence: 99%

“…14 While JAK inhibitors hold promise as a valuable treatment option for patients with inflammatory conditions, acne has been a commonly reported adverse effect in clinical trials of JAK inhibitors. 15 However, little is known about the overall incidence of acne from JAK inhibitors and how this differs between different drug classes and the underlying conditions being treated. 16 In this systematic review and meta-analysis, we analyzed the risk of acne associated with JAK inhibitors IMPORTANCE Janus kinase (JAK) inhibitors are increasingly used across a range of dermatologic conditions.…”

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confidence: 99%

Janus Kinase Inhibitors and Adverse Events of Acne

Martinez,

Manjaly,

Manjaly

et al. 2023

JAMA Dermatol

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ImportanceJanus kinase (JAK) inhibitors are increasingly used across a range of dermatologic conditions. Adverse events of acne have been noted in some studies in clinical practice, but the scope of this outcome across JAK inhibitors has not been established.ObjectiveTo systematically analyze all published phase 2 and 3 placebo-controlled randomized clinical trials (RCTs) of JAK inhibitors for the risk of acne as an adverse effect of these medications.Data SourcesComprehensive search of Ovid MEDLINE and PubMed databases through January 31, 2023.Study SelectionInclusion criteria were phase 2 and 3 placebo-controlled RCTs of JAK inhibitors published in English with reported adverse events of acne.Data Extraction and SynthesisTwo reviewers independently reviewed and extracted information from all included studies.Main Outcomes and MeasuresThe primary outcome of interest was the incidence of acne following JAK inhibitor use. A meta-analysis was conducted using random-effects models.ResultsA total of 25 unique studies (10 839 unique participants; 54% male and 46% female) were included in the final analysis. The pooled odds ratio (OR) was calculated to be 3.83 (95% CI, 2.76-5.32) with increased ORs for abrocitinib (13.47 [95% CI, 3.25-55.91]), baricitinib (4.96 [95% CI, 2.52-9.78]), upadacitinib (4.79 [95% CI, 3.61-6.37]), deucravacitinib (2.64 [95% CI, 1.44-4.86]), and deuruxolitinib (3.30 [95% CI, 1.22-8.93]). Estimated ORs were higher across studies investigating the use of JAK inhibitors for the management of dermatologic compared with nondermatologic conditions (4.67 [95% CI, 3.10-7.05]) as well as for JAK1-specific inhibitors (4.69 [95% CI, 3.56-6.18]), combined JAK1 and JAK2 inhibitors (3.43 [95% CI, 2.14-5.49]), and tyrosine kinase 2 inhibitors (2.64 [95% CI, 1.44-4.86]).Conclusions and RelevanceIn this systematic review and meta-analysis, JAK inhibitor use was associated with an elevated odds of acne. Patients should be properly counseled on this potential adverse effect of these medications before treatment initiation. Future studies are needed to further elucidate the pathophysiology of this association.

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“…The occurrence of acne has been associated with oral JAK inhibitors (a systemic immunosuppressant used to treat severe AD), particularly in the population with AD, compared with other indications ( 14 ). The association between AD and acne has been poorly studied at the population level.…”

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confidence: 99%

Prevalence of Isotretinoin Therapy in Adolescents and Young Adults With and Without Atopic Dermatitis: A Nationwide Prescription-based Population Study

et al. 2023

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Although isotretinoin has anti-inflammatory and immunomodulatory properties, it can exacerbate atopic dermatitis. National estimates of the extent to which patients with atopic dermatitis are affected by severe acne and isotretinoin tolerability are lacking. The aim of this study is to investigate isotretinoin therapy in patients with atopic dermatitis and to compare the nationwide prevalence with individuals without atopic dermatitis. All Norwegian residents were followed for 17 years until age 20–22 years in 2020. Approximately 28% of patients with atopic dermatitis had been treated for acne, and 8% had received isotretinoin before age 23 years. In those over 17 years old, significantly more patients with atopic dermatitis were treated with isotretinoin than those without. At age 22 years, 2.21% (95% confidence interval 1.92–2.49) of patients with atopic dermatitis were treated with isotretinoin, compared with 1.55% (95% confidence interval 1.44–1.65) of those without, representing 42.8% (1.43; 95% confidence interval 1.24–1.65) higher use in patients with atopic dermatitis. Patients who received long-term treatment (probable severe atopic dermatitis) tolerated isotretinoin similarly to patients who received short-term treatment (probable mild atopic dermatitis). There was significantly higher use of topical corticosteroids during isotretinoin therapy in patients with atopic dermatitis. Conclusively, severe acne (isotretinoin therapy) was associated with atopic dermatitis at the population level in young adults.

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A case series of acne following Janus kinase inhibitors in patients with atopic dermatitis

Cited by 11 publications

References 16 publications

Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib

Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib

Janus Kinase Inhibitors and Adverse Events of Acne

Prevalence of Isotretinoin Therapy in Adolescents and Young Adults With and Without Atopic Dermatitis: A Nationwide Prescription-based Population Study

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