Jennifer Hsiao, MD: JAK Inhibitors for Hidradenitis Suppurativa

Hidradenitis suppurativa (HS), a disease with a relatively dormant treatment space, may be soon inundated with systemic drugs of unique delivery and efficacy.

In the second segment of an interview with HCPLive during the Fall Clinical Dermatology 2023 Conference for PAs & NPs in Orlando, FL, this weekend, Jennifer Hsiao, MD, clinical associate professor of dermatology at Keck School of Medicine of USC, discussed developing Janus kinase (JAK) inhibitors for the treatment of HS—specifically, oral JAK-1 inhibitors upadacitinib (RINVOQ) and povorcitinib.

Upadacitinib, previously approved by the US Food and Drug Administration (FDA) for the treatment of atopic dermatitis as well as multiple rheumatic and gastric diseases,¹ was recently evidenced to benefit patients in a recent real-world retrospective cohort analysis. The data showed all 20 patients treated with Upadacitinib achieved a 50% improvement in Hidradenitis Suppurativa Clinical Response (HiSCR 50) from baseline to week 12.²

With its familiarity to prescribers and payers, it may become a feasible treatment option to complement adalimumab on the HS treatment market.

“I think trials are underway to see if that’s also a medication that can hopefully be able to gain approval and come on to the market as something easily accessible to patients,” Hsiao said.

Hsiao additionally noted povorcitinib’s “impressive phase 2 results,” wherein a significant rate of patients even achieved HiSCR 90 with the JAK-1 inhibitor.

“In the past, we never really talked about that 90 (percent) benchmark—it was always 50,” she explained. “That’s what I mean by improved depth of response, and really hoping for medications that show stronger efficacy data for our medications.”

Beyond the impressive clinical efficacy datapoints, Hsiao said it’s critical to continue to review late-stage JAK-1 inhibitors for their impact on patient-reported outcomes including pain, quality of life, and fatigue—the latter being a frequently reported symptom of patients with HS.

“Looking at medication efficacy—not just from how it’s looking on the skin, but also how it’s affecting the patients—is really important,” Hsiao said. “It’s exciting to see trials really incorporating that aspect, and we can use that to explain it to our patients when telling them what to expect with these new therapies.”

References

1. ^{Walter K. FDA Approves Upadacitinib for Patients With Crohn's Disease. HCPLive. Published May 18, 2023. https://www.hcplive.com/view/fda-approves-upadacitinib-patients-crohns-disease}
2. ^{Kozera E, Flora A, Frew JW. Real-world safety and clinical response of Janus kinase inhibitor upadacitinib in the treatment of hidradenitis suppurativa: A retrospective cohort study. J Am Acad Dermatol. 2022;87(6):1440-1442. doi:10.1016/j.jaad.2022.07.047}