Abrocitinib

How it works

It selectively inhibits JAK1, dampening signalling of cytokines such as interleukin-4, interleukin-13, interleukin-31 and interferons that drive atopic inflammation and itch.

Prescribing in practice

• As a JAK inhibitor it carries MHRA-highlighted class risks of serious infection, venous thromboembolism, major adverse cardiovascular events and malignancy, so it is used with particular caution in those aged 65 and over, current or past smokers, and patients with cardiovascular or thrombotic risk factors.
• Screen for and treat active or latent infection (including tuberculosis and viral hepatitis) before starting, avoid live vaccines during treatment, and consider varicella-zoster status given the herpes zoster risk.
• It should be avoided in pregnancy, and effective contraception is advised during treatment and for a period afterwards as per the SPC.

Monitoring

Check a full blood count, lipids and liver function before and during treatment, and remain vigilant for infection and thromboembolic symptoms.

Counselling the patient

• Report fever, persistent cough or other signs of infection promptly.
• Seek urgent help for leg swelling, chest pain or breathlessness suggesting a clot.
• Avoid live vaccines and discuss any planned pregnancy with your clinician.

Evidence & guidelines

The JADE phase 3 programme established abrocitinib's efficacy in moderate-to-severe atopic dermatitis, and NICE has appraised it as an option within that indication.