Exploring the Clinical Impact of Topical Ruxolitinib Cream in Atopic Dermatitis

In a recent Dermatology Times Between the Lines custom video series, “Clinical Impact of Topical Ruxolitinib Cream: Physician Satisfaction and Treatment Patterns in Atopic Dermatitis,” Lawrence Eichenfield, MD, provided insights into the clinical implications of topical ruxolitinib (Opzelura) cream for atopic dermatitis (AD).

Eichenfield, chief of pediatric and adolescent dermatology at Rady Children’s Hospital-San Diego, professor of dermatology and pediatrics, and vice-chair of the Department of Dermatology at University of California, San Diego School of Medicine, focused on 2 poster presentations of new data presented at the 2024 American Academy of Dermatology Annual Meeting, which offer perspectives into the effectiveness and real-world application of ruxolitinib cream for managing mild to moderate AD.

Study No. 1: Ruxolitinib as Monotherapy

The first study, which Eichenfield coauthored, evaluated real-world experiences with ruxolitinib cream as monotherapy.

Study design and patient demographics

Conducted through the Adelphi AD Disease Specific Program, the retrospective data collection spanned from August 2022 to March 2023 and included patients 18 years and older who had been using ruxolitinib cream for at least 1 month.

Participants’ demographics were diverse. Ages ranged from 18 to 71 years, with an average age of 36 years. Sixty-three percent of patients were White, 12% were Black or African American, 15% were Asian, and 11% were other racial/ethnic backgrounds. More than 60% of the participants were female. Most had moderate AD, with an average disease duration of 5 years. Common comorbidities included allergic rhinitis, anxiety, hyperlipidemia, diabetes with complications, chronic hand eczema, pulmonary diseases, and depression.

Reasons for switching to ruxolitinib

Physicians cited several reasons for switching patients to ruxolitinib cream. Inadequate response to prior medications and lack of long-term disease control were the most common reasons (approximately 33% each). Other reasons included patient concerns about the safety of previous treatments, lack of adherence, and dissatisfaction with the mode of administration.

Clinical outcomes and physician satisfaction

Study findings showed significant improvements in disease control with ruxolitinib cream; Eichenfield said the body surface area affected by AD decreased by nearly 58%. The global assessment scores also showed substantial improvement, with many patients transitioning from moderate to mild or almost clear conditions.

Physician satisfaction with ruxolitinib cream was high, with the majority of physicians reporting satisfaction with treatment outcomes. According to Eichenfield, at baseline, most patients had moderate AD, with a small percentage having severe or mild disease. By the end of the study, 37.3% of patients had mild AD, reflecting a significant improvement.

Eichenfield said that 91.5% of users reported satisfaction with the treatment. This indicated that ruxolitinib provided significant relief and effective control of symptoms, even in heterogeneous groups with varying severity and concurrent therapies.

Study No. 2: Before and After Ruxolitinib Initiation

A separate analysis using the US payer claims database examined treatment patterns before and after starting ruxolitinib. The retrospective study included patients 12 years and older with AD, tracking data 6 months before and after their initial prescription.

Patient demographics and baseline medications

The study included more than 1000 patients, with a mean age of 38.8 years. Fifty-six percent of patients were White, 10% were Black or African American, and 15% were other racial/ethnic backgrounds. Comorbidities included allergic rhinitis (15%), anxiety (15%), asthma (10%), and others.

According to Eichenfield, at baseline, most patients (52.3%) were using topical corticosteroids. Additional medications included topical calcineurin inhibitors (14%), PDE4 inhibitors (4%), oral corticosteroids (20%), and biologics (18.8%).

Ruxolitinib use and outcomes

Following ruxolitinib initiation, Eichenfield said there was a notable reduction in the use of other topical therapies. The mean refill rate for ruxolitinib was 1.6 over 6 months, with 44% of patients using it as monotherapy. Importantly, 72% of patients did not require new treatment classes after starting ruxolitinib.

Findings also showed a 40% to 50% decrease in the use of other topical corticosteroids and nonsteroidal agents after ruxolitinib initiation, suggesting that ruxolitinib effectively streamlined therapy regimens and maintained disease control, according to Eichenfield.

For patients on oral corticosteroids, Eichenfield said the average dosage decreased from 77 mg to 52.9 mg after ruxolitinib initiation. Moreover, 92.3% of biologic-naive patients did not progress to systemic agents, and 17.4% of those on biologics discontinued their use after starting ruxolitinib.

Conclusions and Clinical Implications

The findings from these studies underscore the effectiveness of ruxolitinib cream as a nonsteroidal therapy for mild to moderate AD, Eichenfield said. The real-world data align with clinical practice, demonstrating substantial improvements in disease control and high levels of physician and patient satisfaction.

“I think that the clinical data here is very consistent with clinical practice—[and] that there’s sort of a streamlining of the use of other topical agents with the use of ruxolitinib in the clinical practice,” Eichenfield concluded. “We do know also that sometimes our regimens of care with topical medicines are quite complex. We may be using a mild topical steroid or a nonsteroidal for delicate skin areas and a more potent topical corticosteroid in other areas....Ruxolitinib brings a very high efficacy as a nonsteroidal.”