Topical Janus kinase inhibitors in atopic dermatitis: a safety network meta-analysis

BACKGROUND: Topical Janus kinase (JAK) inhibitors are being developed for the treatment of mild to moderate atopic dermatitis. However, comparative evidence on their safety profiles is still limited. AIM: This study aimed to compare the relative safety of topic JAK inhibitors in patients with atopic dermatitis. METHOD: Phase 2 and 3 clinical trials (RCTs) evaluating the efficacy and safety of topical JAK inhibitors in atopic dermatitis were searched on Medline, EMBASE and clinicaltrials.gov. The following outcomes were considered: any adverse event (AE), serious AEs, AEs leading to treatment discontinuation, any infection, any application site reaction. RESULTS: Ten RCTs were included in this network meta-analysis. Tofacitinib was associated with a reduced risk of any AE when compared with ruxolitinib (OR 0.18, 95% CrI 0.03–0.92). The analyses for the remaining outcomes did not identify other statistically significant risk differences between the topical JAK inhibitors. CONCLUSION: Although tofacitinib seems to present a reduced risk of any adverse event compared with ruxolitinib, this was the only statistically significant result found between JAK inhibitors. Therefore, such findings should be interpreted with caution considering the scarce data available and the heterogeneity between the studies, and there is no robust evidence allowing pointing out clinically important differences between the safety profiles of the existing topical JAK inhibitors. Further pharmacovigilance activities are needed to confirm the safety profile of these drugs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11096-023-01569-x.