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JAK1 Inhibitor — Atopic Eczema Pregnancy: Contraindicated — teratogenic in animal studies; effective contraception required during and for 1 month after treatment

Abrocitinib

Brand names: Cibinqo

Adult dose

Dose: 100–200 mg once daily
Route: Oral
Frequency: Once daily
Max: 200 mg/day
Selective JAK1 inhibitor for moderate-to-severe atopic eczema in adults and adolescents ≥12 years. Faster onset than biologics (significant itch relief within 2 days). Start at 100 mg/day; increase to 200 mg/day if inadequate response after 12 weeks. Avoid in patients at high cardiovascular risk (MHRA/FDA class-wide JAK warnings).

Paediatric dose

Dose: 100–200 mg once daily (≥12 years and ≥25 kg) mg/kg
Route: Oral
Frequency: Once daily
Max: 200 mg/day
BNFc: licensed from 12 years and ≥25 kg body weight. Dose as per adult: 100 mg OD initially, may increase to 200 mg OD. Specialist paediatric dermatology initiation.

Dose adjustments

Renal

Reduce to 50 mg once daily if eGFR 30–59 mL/min/1.73m²; avoid if eGFR <30

Hepatic

Avoid in severe hepatic impairment

Paediatric weight-based calculator

BNFc: licensed from 12 years and ≥25 kg body weight. Dose as per adult: 100 mg OD initially, may increase to 200 mg OD. Specialist paediatric dermatology initiation.

Clinical pearls

  • MHRA 2023 class-wide JAK inhibitor warning: restrict to patients ≥65 years who failed alternative therapy, or those with high risk of DVT/PE, MI, stroke, or malignancy — INFORM ALL PATIENTS of cardiovascular, thrombotic, and malignancy risks before prescribing
  • JADE COMPARE trial: abrocitinib 200 mg superior to dupilumab in Week 2 itch NRS (itch relief onset) — oral route and rapid itch relief are key advantages
  • Platelet monitoring: abrocitinib causes dose-dependent thrombocytopenia — check platelet count at weeks 4 and 12; interrupt if <50 × 10⁹/L
  • Herpes zoster prophylaxis: MHRA recommends VZV vaccination before starting (if not immune); aciclovir/valaciclovir prophylaxis in high-risk patients
  • Wash-out period: before switching FROM abrocitinib TO biologic, allow 2 weeks washout (pharmacodynamic reversal)
  • NICE TA877 (2023): abrocitinib 200 mg for moderate-to-severe atopic eczema in adults when dupilumab not suitable or failed

Contraindications

  • Active serious infection (including TB)
  • Active malignancy
  • Pregnancy
  • High cardiovascular risk (recent MI, stroke, heart failure — MHRA class warning)
  • Thrombotic risk factors (MHRA/FDA warning)
  • Combination with other JAK inhibitors or biologics

Side effects

  • Nausea (most common early side effect)
  • Headache
  • Herpes zoster reactivation
  • Thrombocytopenia
  • Nasopharyngitis
  • Acne
  • Thromboembolism (VTE)
  • MACE (major adverse cardiovascular events)
  • Malignancy (long-term)

Interactions

  • Strong CYP2C19 inhibitors (fluvoxamine, omeprazole) — increase abrocitinib levels; reduce to 100 mg
  • P-gp inhibitors — increase exposure
  • Live vaccines — avoid

Monitoring

  • EASI/IGA at 16 weeks
  • FBC including platelets (weeks 4 and 12)
  • Lipids
  • Infection and TB screening
  • Cardiovascular risk assessment

Reference: BNFc; BNF 90; BNFc; JADE COMPARE Trial (Bieber et al. NEJM 2021); NICE TA877; MHRA Drug Safety Update (2023) JAK Inhibitors; SPC Cibinqo. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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