Should atopic dermatitis patients starting JAK inhibitors take prophylactic acyclovir?

Abstract

Background: JAK inhibitors are cytokine modulators that are effective in the treatment of numerous autoimmune diseases. However, given their immunosuppressive effects, they may, at least potentially, increase the risk of severe herpes infection in individuals with atopic dermatitis.Objective: To assess the utility of preventative antiviral treatment when initiating JAK inhibitors for atopic dermatitis in order to decrease risk of eczema herpeticum.Results: JAK inhibitors, specifically tofacitinib and baricitinib, used for the treatment of atopic dermatitis confer an increased risk of herpes simplex virus infection. Acyclovir and valacyclovir are effective, safe, and affordable for herpes simplex virus prophylaxis. 26.Bieber T, Thyssen JP, Reich K, et al. Pooled safety analysis of baricitinib in adult patients with atopic dermatitis from 8 randomized clinical trials.

A real‐world Australian experience of upadacitinib for the treatment of severe atopic dermatitis

“…Prompt administration of antiviral therapy has been shown to improve outcomes in herpetic infections 8 . Furthermore, the prophylactic use of antiviral therapy has been suggested for AD patients on JAK inhibitors 9 …”

“…8 Furthermore, the prophylactic use of antiviral therapy has been suggested for AD patients on JAK inhibitors. 9 In part due to the use of immunosuppressive and immunomodulatory therapies, patients with autoimmune inflammatory conditions are recommended to receive the HZ vaccine. 10 In Australia, both a live attenuated (Zostavax) and recombinant varicella vaccine (Shingrix) are available.…”