P088 Janus kinase inhibitor treatment in coexisting atopic dermatitis and irritable bowel disease: real-world experience and therapeutic outcomes
Year: 2025
Type: conference-abstract
Abstract: Atopic dermatitis (AD) is associated with an increased risk of inflammatory bowel disease (IBD), particularly in severe disease. Janus kinase inhibitors (JAKis) are approved for both conditions, offering potential therapeutic benefits for concurrent disease. However, clinical response in patients with both conditions remains poorly characterized. Here we present a case series of the first seven patients with concurrent AD and IBD treated with JAKis in a tertiary dermatology centre (September 2022 to December 2024). AD response was defined as ≥ 75% improvement in Eczema Area and Severity Index (EASI 75) and IBD response as clinical remission. Seven male patients were included (Table). The primary indication was AD in five patients (median baseline EASI 16, range 5.9–54) with quiescent IBD, concurrent active disease in one (EASI 41) and acute IBD flare in one. JAKi therapy achieved remission in both active cases of IBD and maintained disease control in four of five patients with quiescent IBD. Only two patients achieved EASI 75 with a JAKi: one maintained response (EASI 54→5.1) with stable ulcerative colitis at 24 months and the other demonstrated early improvement in both AD (EASI 41→7.4) and Crohn disease at 4 months. Two patients required cotherapy with biologics after inadequate AD response, while three discontinued JAKis due to lack of efficacy or adverse events, including two cases of herpes zoster and one flare of ulcerative colitis. Despite the apparent efficacy treating IBD in this series, only two of seven patients (29%) achieved satisfactory cutaneous response to JAKi monotherapy, contrasting with established efficacy data in isolated AD. These findings raise questions about underlying disease mechanisms in this phenotype, warranting further investigation.TableTreatment of seven patients with atopic dermatitis (AD) and irritable bowel disease (IBD) with Janus kinase inhibitors (JAKis)Age (years)Primary indicationBefore JAKi treatmentOn JAKi treatmentDisease statusAD treatmentIBD treatmentJAKi therapyOutcomes50ADEASI 54; UC controlledNoneGuselkumab (stopped)Upadacitinib 24 months (ongoing)EASI 75 achieved (5.1); UC remission22AD, CDEASI 41; CD activeMethotrexate (stopped)Infliximab (stopped)Upadacitinib 4 months (ongoing)EASI 75 achieved (7.4); CD remission29ADEASI 13; UC controlledNoneAZA, allopurinol (stopped)Upadacitinib 8 months (ongoing)EASI 10.3; added methotrexate (6 months), switched to tralokinumab (0 months); UC stable26UCEASI 2.4; UC activeCiclosporinInfliximab, AZA (stopped)Upadacitinib 10 months (ongoing)EASI 4.8; switched from ciclosporin to tralokinumab; UC remission63ADEASI 16; UC controlledNoneVedolizumab/mesalazineUpadacitinib 14 months (stopped)EASI 24; UC flare39ADEASI 27.9; CD controlledNoneAdalimumab/MTX (stopped)Sequential 6 months: baricitinib → upadacitinib → abrocitinib (stopped)EASI 30; disseminated herpes zoster; CD stable26AD (+ alopecia totalis)EASI 5.9, UC controlledNoneMesalazineUpadacitinib 26 months (considering switch)EASI 7.2; herpes zoster; UC stableAZA, azathioprine; CD, Crohn disease; MTX, methotrexate; UC, ulcerative colitis.
Source: British Journal of Dermatology
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4411733176