Cardiovascular Complications in Dermatology Patients on JAK-STAT Inhibitors

Original Article: Short-Term Cardiovascular Complications in Dermatology Patients Receiving JAK-STAT Inhibitors: A Meta-Analysis of Randomized Clinical Trials

What are the key takeaways of this article?

In this meta-analysis by Ireland et al., the authors investigate whether Janus kinase-signal transducer and activation of transcription inhibitors (JAK-STATi) used for dermatologic indications display an increased risk of major adverse cardiovascular events (MACE) or venous thromboembolism (VTE) when compared with placebo.

The medication class of JAK-STATi, including both Janus kinase and tyrosine kinase 2 (TYK2) inhibitors, are used for a variety of dermatological conditions including systemic lupus erythematosus and alopecia areata. Certain recognizable medications within this class, and ones included in this study, are baricitinib, itacitinib, and tofacitinib. Unfortunately, many of these medications have a black box warning against their use in patients over 65 years of age or with cardiovascular risk factors due to possible MACE and VTE, resulting in their use generally being recommended to patients who have failed trials of more established therapies, such as TNF-inhibitors.

Forty-two randomized controlled trials (RCTs) were included in this meta-analysis with adult patients receiving JAK-STATi therapy for conditions such as alopecia areata, psoriasis, vitiligo, atopic dermatitis, lichen plants, or hidradenitis suppurativa, while the comparator patients received systemic placebo or a topical medication. The most common JAK-STATis evaluated were abrocitinib and baricitinib with studies ranging anywhere from 2 to 52 weeks. Overall, Ireland et al. found no statistically significant increase in MACE or VTE between the placebo and JAK-STATi groups. The pooled risk ratio (RR) for JAK-STATi to placebo was found to be 1.13 for MACE (p=0.87) and 2.79 for VTE (p=0.35). Additionally, the authors found no significant difference in MACE or VTE based on dermatosis or medication used by the patient.

It is important to note that this study was conducted with dermatologic patients in mind, which is a noteworthy differentiation from patients taking JAK-STATi medications for rheumatological or hematological conditions. Moreover, previous literature that does describe an increased cardiovascular risk had a mean age of 61.20 years, whereas this study has a younger mean age of 39.86 for dermatology patients.

Overall, the results of this study are noteworthy in that it may reassure clinicians for the use of these medications for short intervals in patients with a low cardiovascular risk. However, while these results are promising, it is still important for prescribers to use their best judgment and remain cautious regarding the risk vs benefit of JAK-STATi medications in their specific patients

Publication Date: April 27th, 2024

Reference: Ireland, Patrick A et al. “Short-Term Cardiovascular Complications in Dermatology Patients Receiving JAK-STAT Inhibitors: A Meta-Analysis of Randomized Clinical Trials.” JAMA dermatology vol. 160,3 (2024): 281-289. doi:10.1001/jamadermatol.2023.5509

Summary By: Taylor Skinner