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临床实践中JAK1抑制剂阿布昔替尼治疗特应性皮炎的实用管理:特殊安全性考量

Practical Management of the JAK1 Inhibitor Abrocitinib for Atopic Dermatitis in Clinical Practice: Special Safety Considerations.

作者信息

Gooderham Melinda J, de Bruin-Weller Marjolein, Weidinger Stephan, Cork Michael J, Eichenfield Lawrence F, Simpson Eric L, Tsianakas Athanasios, Kerkmann Urs, Feeney Claire, Romero William

机构信息

SKiN Centre for Dermatology, Peterborough, ON, Canada.

Queen's University, Kingston, ON, Canada.

出版信息

Dermatol Ther (Heidelb). 2024 Aug;14(8):2285-2296. doi: 10.1007/s13555-024-01200-5. Epub 2024 Jul 2.

Abstract

Abrocitinib, an oral, once-daily, Janus kinase (JAK) 1-selective inhibitor, is approved for the treatment of adults and adolescents with moderate-to-severe atopic dermatitis (AD). Abrocitinib has shown rapid and sustained efficacy in phase 3 trials and a consistent, manageable safety profile in long-term studies. Rapid itch relief and skin clearance are more likely to be achieved with a 200-mg daily dose of abrocitinib than with dupilumab. All oral JAK inhibitors are associated with adverse events of special interest and laboratory changes, and initial risk assessment and follow-up monitoring are important. Appropriate selection of patients and adequate monitoring are key for the safe use of JAK inhibitors. Here, we review the practical use of abrocitinib and discuss characteristics of patients who are candidates for abrocitinib therapy. In general, abrocitinib may be used in all appropriate patients with moderate-to-severe AD in need of systemic therapy, provided there are no contraindications, e.g., in patients with active serious systemic infections and those with severe hepatic impairment, as well as pregnant or breastfeeding women. For patients aged ≥ 65 years, current long-time or past long-time smokers, and those with risk factors for venous thromboembolism, major adverse cardiovascular events, or malignancies, a meticulous benefit-risk assessment is recommended, and it is advised to start with the 100-mg dose, when abrocitinib is the selected treatment option.

摘要

阿布昔替尼是一种口服的、每日一次的 Janus 激酶(JAK)1 选择性抑制剂,已被批准用于治疗成人和青少年中重度特应性皮炎(AD)。阿布昔替尼在 3 期试验中显示出快速且持续的疗效,在长期研究中具有一致且可控的安全性。与度普利尤单抗相比,每日服用 200 毫克阿布昔替尼更有可能实现快速止痒和皮肤清除。所有口服 JAK 抑制剂都与特定不良事件和实验室指标变化相关,初始风险评估和随访监测很重要。正确选择患者并进行充分监测是安全使用 JAK 抑制剂的关键。在此,我们回顾阿布昔替尼的实际应用,并讨论适合接受阿布昔替尼治疗的患者特征。一般来说,只要没有禁忌证,例如患有活动性严重全身感染的患者、严重肝功能损害的患者以及孕妇或哺乳期妇女,阿布昔替尼可用于所有需要全身治疗的中重度 AD 患者。对于年龄≥65 岁的患者、目前长期或既往长期吸烟的患者以及有静脉血栓栓塞、重大不良心血管事件或恶性肿瘤风险因素的患者,建议进行细致的获益 - 风险评估,并且当选择阿布昔替尼作为治疗方案时,建议从 100 毫克剂量开始。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd11/11333678/a44e4da494e1/13555_2024_1200_Fig1_HTML.jpg

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