Atopic dermatitis patients on Janus kinase inhibitors have increased risk of infection compared to biologics: Study

A new study published in the Journal of European Academy of Dermatology and Venerology showed that compared to patients on biologics, the patients with moderate-to-severe atopic dermatitis on Janus kinase inhibitors (JAKi) were more susceptible to infections.

Biologics dupilumab (anti-IL-4/13) and tralokinumab (anti-IL-13) and Janus kinase (JAK) inhibitors abrocitinib (JAK1 selective), baricitinib (JAK1/2 selective), and upadacitinib (JAK1 selective) are the two primary types of new, targeted systemic treatments available for moderate-to-severe AD. These treatments have diverse infection risk profiles because of their different mechanisms of action. Biologics may have a more favorable profile, whereas JAK inhibitors (JAKi) may be more risky due to their wider immunosuppressive effects. By comparing the impact of presently available biologic and JAKi therapies on overall infection risk in AD patients in a daily practice scenario, this research seeks to close this gap.

From October 2017 to July 2024, this prospective, multicenter research assessed treatment-emergent infections in patients (age ≥12 years) taking biologics or JAKi from the BioDay registry. For each therapy, crude incidence rates were computed per 100 patient-years (PY). Using subgroup and sensitivity analyses in bio-/JAKi-naïve patients, hazard ratios (HR) for the rate of infections were estimated using Cox regression for recurrent occurrences, adjusted for possible confounders.

A total of 1793 individuals with 794 infections were included (4044.1 PY; 1886 biologic therapy sessions (TEs); 480 JAKi). When compared to biologics (13.6–22.0), JAKi had greater infection rates (58.4–65.5/100 PY), particularly for herpes infections (n = 195, 24.6%; JAKi 13.6–19.8 vs. biologicals 3.0–3.6).

In comparison to dupilumab, Cox regression showed higher rates with JAKi and a marginal rise with tralokinumab. These findings were validated by sensitivity analysis, with the exception of tralokinumab. Although absolute numbers were modest and relationships were not always significant, JAKi had greater rates of serious infections than dupilumab. An independent factor linked to infection was shown to be the history of infection, primarily fungal or viral skin infections.

Overall, in adults and adolescents with moderate-to-severe AD, this real-world investigation found a distinct infection risk profile linked to biologic and JAKi therapy. JAKi had a higher risk of extracutaneous and total skin infections than biologics.

Source:

van der Gang, L. F., Atash, K., Zuithoff, N. P. A., Haeck, I., Boesjes, C. M., Bacoş-Cosma, O. I., Loman, L., Kamsteeg, M., Stadhouders-Keet, S., Oosting, A. J., van Lynden-van Nes, A. M. T., Politiek, K., Gostynksi, A., Berntsen-Zandbergen, L., Christoffers, W. A., Flinterman, A., Touwslager, W. R. H., Velstra, B., Stewart, S. M., … de Bruin-Weller, M. S. (2025). Infection risk in atopic dermatitis patients treated with biologics and JAK inhibitors: BioDay results. Journal of the European Academy of Dermatology and Venereology: JEADV. https://doi.org/10.1111/jdv.20674