Can Abrocitinib Offer New Hope for Challenging Skin Disorders?

🔍 Key Finding Abrocitinib, a JAK1 inhibitor, demonstrated effectiveness and tolerability in treating 16 diverse skin disorders, including pyoderma gangrenosum, livedoid vasculopathy, and hidradenitis suppurativa, often showing rapid improvement where conventional therapies failed. Further research is needed to confirm these findings, as the current evidence base primarily consists of case reports and series.

🔬 Methodology Overview

• Design: Case series and scoping review
• Data Sources: PubMed database (searched before September 1, 2023)
• Selection Criteria: Studies on the use of abrocitinib for skin disorders excluding atopic dermatitis.
• Analysis Approach: Qualitative synthesis of findings from case reports and case series.
• Cases: Three patients diagnosed with pyoderma gangrenosum, livedoid vasculopathy, and hidradenitis suppurativa, respectively, treated with abrocitinib.
• Review Scope: Off-label use of abrocitinib in various dermatological conditions.

📊 Results

• Abrocitinib was used off-label to treat 16 different skin disorders (28 cases total) besides moderate to severe atopic dermatitis.
• The most common off-label uses included lichen sclerosus (10 cases), alopecia areata (5 cases), and lichenoid amyloidosis (2 cases).
• Other off-label uses included pyoderma gangrenosum, livedoid vasculopathy, hidradenitis suppurativa, eruptive pruritic papular porokeratosis, Hailey-Hailey disease, necrobiosis lipoidica, occupational airborne allergic contact dermatitis, Netherton syndrome, oral lichen planus, nipple and areola eczema, and prurigo nodularis (1 case each).
• Substantial clinical improvement was seen within a median of 12 weeks (range 3–96 weeks).
• Abrocitinib was used as monotherapy or in combination with other medications.
• Most common adverse events were headache, nausea, acne, dizziness, and upper respiratory tract infection, which were generally mild and self-resolving.
• 2 of 28 patients (7.1%) experienced mild adverse events with 200mg abrocitinib, but not with 100mg.

💡 Clinical Impact Abrocitinib demonstrates promise as a safe and effective treatment for various inflammatory skin disorders beyond atopic dermatitis, offering a potential alternative for patients unresponsive to conventional therapies. This expands the therapeutic options available to dermatologists, particularly for challenging conditions like pyoderma gangrenosum, livedoid vasculopathy, and hidradenitis suppurativa.

🤔 Limitations

• Limited long-term safety data for abrocitinib.
• Primarily based on case reports and case series, limiting the strength of evidence.
• Dose-dependent relationship of adverse events, with higher incidence at higher doses.
• Potential for serious adverse events such as herpes zoster, thrombocytopenia, and thrombosis, although rare.
• Lack of large-scale, randomized controlled trials to confirm findings.
• Limited comparison with other established treatments for the same conditions.
• Need for further research to determine optimal dosing and long-term efficacy and safety.

✨ What It Means For You Abrocitinib shows promise as a safe and effective treatment for various inflammatory skin disorders, offering an alternative, particularly for patients unresponsive to traditional therapies or biologics. Further research, including larger controlled trials, is needed to confirm these findings and establish optimal treatment protocols.

Reference Chen P, Liang J, Li C, Li Q, Liu W, Zhu J, Chen W, Zhang X. Abrocitinib as a Novel Treatment for Multiple Skin Disorders: 3 Case Reports and a Scoping Review. Clinical, Cosmetic and Investigational Dermatology. 2024;17:35–40. https://doi.org/10.2147/CCID.S446369