Consensus on the Use of JAKinibs for Atopic Dermatitis in Australia and New Zealand. An eDelphi by the Australasian Medical Dermatology Group

With its chronicity and varied symptomatology, moderate to severe atopic dermatitis (AD) remains a significant challenge for both patients and health care professionals. Novel targeted therapies, including the JAK inhibitors (JAKi) offer significant hope. There are many systematic reviews and meta-analyses of the use of JAKi for the management of atopic dermatitis, but few offer practical advice for the clinician. The aim of this consensus development was to place the current literature for JAKi use in atopic dermatitis within the clinical context of practice in Australasia. The Australasian Medical Dermatology Group (AMDG) reviewed the evidence for the use of JAKi in the management landscape of atopic dermatitis, adding in their cumulative experience, and used an eDelphi process to agree on best practice. In the first round of 133 eDelphi clinical practice statements, consensus was achieved in 117 (88%—complete 27.8%, close 60.1%), with no consensus in 16 (12.0%) of the statements. The 16 clinical practice statements that did not reach consensus were reviewed and revised to 15 statements and then subjected to a second round: complete consensus was achieved in 5/15 statements, close consensus in 6/15, and no consensus in 4/15. Over the two eDelphi rounds, consensus was achieved in 128/132 (97%—complete 32%, close 64%) and no consensus in 4/132 (3%). Statements regarding screening for prior varicella infection, age-appropriate cancer screening intervals, and management of flares did not reach full consensus. This study highlights areas where further research is needed to assist practicing dermatologists in safe prescribing and management of atopic dermatitis with JAK inhibitors.