The authors of this meta-analysis evaluated 10 randomized controlled trials involving 4689 patients to compare, with placebo and other topical drugs, the efficacy and safety of topical Janus kinase (JAK) and phosphodiesterase-4 (PDE4) inhibitors in the treatment of Atopic Dermatitis. Topical JAK inhibitors included tofacitinib, delgocitinib and ruxolitinib, and PDE4 inhibitors included crisaborol and difamilast. All JAK and PDE4 inhibitors resulted in a higher Investigator's Global Assessment (IGA) response. Topical JAK inhibitors were superior to tacrolimus and hydrocortisone, which did not show significantly higher efficacy than placebo. In ranking analysis, tofacitinib 2% twice daily showed the greatest efficacy. JAK and PDE4 inhibitors presented a safety profile noninferior to placebo.
Topical JAK and PDE4 inhibitors are promising options for the management of atopic dermatitis. Their official price, however, looms extremely high.