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Association of risk of incident acne and treatment with systemic Janus kinase inhibitors in atopic dermatitis: a systematic review and meta-analysis

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Abstract

Introduction

The therapeutic efficacy of systemic Janus kinase (JAK) inhibitors in moderate-to-severe atopic dermatitis (AD) is well established. However, the associated risk of incident acne, which is a prevalent adverse event in AD patients treated with systemic JAK inhibitors, has yet to be systematically analyzed.

Methodology

To evaluate the risk of incident acne in AD patients treated with systemic JAK inhibitors, an extensive database search (clinicaltrials.gov, PubMed) was performed to identify publications eligible for inclusion from January 2020 to October 2022. Five randomized clinical trials (RCTs) of abrocitinib, four RCTs of upadacitinib, and one RCT of baricitinib, encompassing a total of 7901 participants, were included in the analysis. The risk difference for incident acne between systemic JAK inhibitors and controls was assessed using Review Manager, version 5.3, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Meta-analysis elucidated a significant difference in the risk of incident acne between AD participants receiving 200 mg abrocitinib (Mantel–Haenszel risk difference, 3.69; 95% CI 1.60–8.48; P < 0.01), 15 mg upadacitinib (Mantel–Haenszel risk difference, 4.61; 95% CI 2.79–7.62; P < 0.00001), and 30 mg upadacitinib (Mantel–Haenszel risk difference, 6.82; 95% CI 4.59–10.13; P < 0.00001) compared with controls receiving placebo or dupilumab. In contrast, no significant difference was found in the risk of incident acne between participants receiving 100 mg abrocitinib, 2 mg baricitinib, and 4 mg baricitinib, as compared with controls.

Conclusions

Based on the current evidence, there is an increased risk of acne related to systemic JAK inhibitors, particularly with abrocitinib and upadacitinib. For patients predisposed to acne, the balance between the benefits of symptomatic relief from AD and the potential risk of acne may need to be carefully considered. This study contributes to a nuanced understanding of the risk profile of systemic JAK inhibitors and has the potential to guide personalized treatment decisions for AD patients.

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Availability of data and materials

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code availability

Not applicable.

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Funding

This study was supported by National High Level Hospital Clinical Research Funding (2022-PUMCH-B-092).

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Authors and Affiliations

  1. Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China

    Chen Sun, Zheng Su & Yue-Ping Zeng

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Contributions

All authors contributed to the study conception and design. CS, ZS, and Y-PZ were responsible for material preparation, data collection and analysis. The first draft of the manuscript was written by CS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yue-Ping Zeng.

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Sun, C., Su, Z. & Zeng, YP. Association of risk of incident acne and treatment with systemic Janus kinase inhibitors in atopic dermatitis: a systematic review and meta-analysis. Inflamm. Res. 72, 1861–1871 (2023). https://doi.org/10.1007/s00011-023-01789-x

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