Abrocitinib

How it works

It selectively inhibits Janus kinase 1 (JAK1), interrupting signalling of cytokines such as interleukin-4, interleukin-13 and interleukin-31 that drive inflammation and itch in atopic dermatitis.

Prescribing in practice

• MHRA advises caution with JAK inhibitors because of risks of serious infection, venous thromboembolism, major cardiovascular events and malignancy, with restricted use in those over 65, smokers and patients with cardiovascular or cancer risk factors.
• Screen for and exclude active serious infection, including tuberculosis and viral hepatitis, before starting treatment.
• Live vaccines should be avoided during therapy and it is not recommended in pregnancy.

Monitoring

Monitor full blood count, lipids and signs of infection or thromboembolism during treatment.

Counselling the patient

• Report fever, persistent cough or other signs of infection promptly.
• Seek urgent advice for leg swelling, chest pain or breathlessness suggesting a clot.
• Ensure you are up to date with recommended vaccinations before starting.

Evidence & guidelines

NICE recommends abrocitinib as an option for moderate-to-severe atopic dermatitis, and the JADE clinical trial programme demonstrated improvements in skin clearance and itch.