The Consumer’s Guide to JAK Inhibitors for Severe Eczema

Historically, “Severe eczema is something that we only really had a few treatments for, and it was really limited to topical steroids or oral immunosuppressants,” Dr. Garshick says. With JAK inhibitors, “We’re able to reduce the inflammation in terms of the skin and the itching without necessarily turning off the whole immune system. And so, we’re hopeful that these newer medications become easier to tolerate.”

Although four JAK inhibitors have been evaluated for use in eczema, only three have received FDA approval for the condition:

• upadacitinib (Rinvoq)
• abrocitinib (Cibinqo)
• ruxolitinib (Opzelura)

Even though JAK inhibitors are new to the eczema treatment landscape, this class of drugs has been used to treat other conditions, such as rheumatoid arthritis (RA), since 2012.

Oral and topical steroids and other immunosuppressants offer quick relief of severe symptoms, which is why they are often prescribed for eczema — at least for short-term use. While biologics may be safer than immunosuppressants for long-term use, they also take longer to start working. One of the potential advantages of JAK inhibitors is that they may start to relieve symptoms in as little as three days, with significant results in four weeks, the NEA says.

Some treatments, such as steroids, work quickly but are also associated with potentially harmful side effects. As a result, they’re generally not prescribed for more than a month, according to the NEA. That’s why some people may opt for alternatives such as JAK inhibitors, which can be used continuously to manage the condition.

Like all medications, JAK inhibitors have side effects. But, given their treatment record for other diseases, such as RA, they’re generally thought to be safe even after years of use, the NEA notes.

That said, there are some things to consider if your dermatologist prescribes a JAK inhibitor for you. Some potential side effects include an increased risk of:

• Upper respiratory infection (such as the common cold)
• Nausea
• Headache
• Bronchitis
• Ear infection

These side effects are more common if you already have an elevated risk of them, according to a study published in March 2023 in Dermatology and Therapy.

Other, rarer side effects, including tuberculosis, shingles, pneumonia, cancer, and blood clotting problems, have occurred during safety studies of medications that work in similar ways, according to the American Academy of Dermatology.

JAK inhibitors are often compared to biologics, because they both offer targeted treatment (meaning they target specific areas of the immune system, as opposed to the entire immune system) for eczema. JAK inhibitors target different pathways in the body than biologics, though.

JAK inhibitors can be swallowed as a pill or applied to the skin in a topical form. In contrast, biologics are either injected or given by infusion in intervals, ranging from weekly to monthly.

More established prescription treatments, such as topical steroids, are usually paid for by insurance, but coverage for newer treatment options can vary by carrier. Some insurance companies may require you to try other treatments before starting a newer one, such as a JAK inhibitor, Garshick says. “The hope is that the more [treatments] that are available, the greater the likelihood of hopefully getting an option for each insurance plan and for each person who really needs it,” she adds.

Even with insurance coverage, JAK inhibitors may come with significant out-of-pocket costs. Talk to your insurance company about your options. Your doctor may be able to point you to patient assistance programs or other financial options to help lower the cost, or you can visit Medicine Assistance Tool, a search engine for drug assistance programs.