Raj Chovatiya, MD, PhD: What Clinicians Need to Know About JAK Inhibitors

During his HCPLive interview, Raj Chovatiya, MD, PhD, spoke with the editorial team about the most important points covered in his talk titled ‘What You Need to Know NOW About JAK Inhibitors,’ presented at the 2023 Fall Clinical Dermatology Conference in Las Vegas.

Chovatiya is known for his role as director for the Center for Eczema and Itch at Northwestern, as well as an assistant professor of dermatology at the Feinberg School of Medicine at Northwestern University.

“In my talk, I tried to take a slightly different approach just because I feel like we've seen so much data from different drugs, but it's sort of hard to put it all together sometimes,” Chovatiya said. “And so the JAK/STAT pathway is fascinating, first really discovered and described in the context of interferon signaling for antiviral responses in the 90s. But it's very fascinating that the development led to this understanding of 4 very highly conserved proteins involved in a lot of different immunologic responses, systemic homeostatic responses.”

He added that there was not really a clear idea from their founding that clinicians were looking at a pathway that could perhaps underlie a lot of different disease states.

“But it's really in the past decade or decade or 2 that it's really come to our understanding that there are a lot of clinical implications for inhibiting 1 or more of these proteins in terms of potentially targeting some very important diseases, especially in dermatology,” Chovatiya said.

Chovatiya explored the topic of the wider understanding of context behind the black box warnings for JAK inhibitors.

“So it's very tangible what the possible benefits are for these therapies,” Chovatiya said. “Now, in terms of drawbacks, you have to understand that a lot of these drugs inhibit a conserved element of all of these JAK proteins, and just to make it super sciency for a second, it's a conserved aspect of the ATP binding site, meaning that even with different drugs that can be very selective, but there is the potential of even low rates of binding to other aspects of the JAK/STAT pathway.”

He explained that this is probably the reason why, depending on the patient and the context, some of those side effects may be seen and box warning labels are utilized.

“In the case of atopic dermatitis, we've had some recent updates on long term safety data that have been very, very promising and some really nice real world data that has shown how quick and deep responses can be,” Chovatiya said. “We've also had some newer data in hidradenitis suppurativa and vitiligo, both in terms of phase 2 readouts where upadacitinib is going to undergo development. Two diseases that sorely need more therapies for our patients, particularly in the case of HS.”

Chovatiya continued delving into newer data surrounding JAK inhibitor use in conditions such as vitiligo, HS, and alopecia areata.

“In the case of some other oral JAK inhibitors, baricitinib, which is approved for alopecia areata there are some really nice updates in terms of really long term therapy, number 1, and number 2, what happens when you change around doses and perhaps even withdraw therapy in terms of individual response,” he said. “There's a newer oral JAK inhibitor that's really quite exciting, ritlecitinib, and also approved for alopecia areata. The subtle difference here is that this one now can treat adolescents, which we didn't have for in the case of baricitinib.”

To find out more new data from Chovatiya’s talk, view the full interview above.

The quotes contained here were edited for clarity purposes.