Getting JAK’d With Amy Spizuoco, DO, FAOCD

Despite research pointing to their relative safety and efficacy, some clinicians are still hesistant about Janus kinase (JAK) inhibitors, Amy Spizuoco, DO, FAOCD, told Dermatology Times about her session at the 2024 Society for Dermatology Physician Assistants Annual Summer Dermatology Conference.

Usually, it is simply because it is a new class of medications, and some clinicians believe the medications they have used for a long time are good enough, explained Spizuoco, who is associate clinical instructor in the department of dermatology at The Icahn School of Medicine at Mount Sinai in New York and a board certified dermatologist and dermatopathologist with True Dermatology in New York City, New York. The session she is co-hosting with Matthew Zirwas, MD, was designed to help clinicians feel more comfortable with prescribing the JAK inhibitors, by explaining efficacy and speed in itch response, how to mitigate risk of zoster and eczema herpeticum, and issues in evaluating the risks of venous thromboembolism and major adverse cardiovascular events.

With newer drugs, explaining the risk and benefit issues can sometimes be intimidating, so the session covers how to confidently discuss black box warnings.

“What I tell my patients is, depending on which JAK inhibitor, I try to focus on the main or the most common side effects, which is always going to be a headache or nausea,” Spizuoco explained.

“I try to alert my patients that the FDA really only approves medications that are safe and effective, and if they thought that they were detrimental to your health, they wouldn't be approved and available for us to use,” she added. “That being said, let the patients know that, in my opinion, the efficacy outranks the risks that are posed. And the risks are just a small population of the patients that were in clinical trials that it occurred with. Meanwhile, most of the patients in the trials did get a great efficacious results.”

What about those patients who have heard of the JAK inhibitors and are really excited about them, but the JAK inhibitors are contraindicated for the patient? Spizuoco helps those patients understand why the medication is not a good fit at the time, and what they might be able to do make it a better fit. “Explain that they may have some risk factors—such as if they are a smoker or a have high BMI—that the JAK inhibitors might not be the best medication for them. And maybe encourage them to mitigate or minimize those risk factors. For example, quit smoking, go on a diet and exercise, and be more healthy so that these medications would be more appropriate, beneficial, and pose less risk factors to them as well.”

Are you attending the 2024 SDPA Annual Summer Dermatology Conference? Share your insights and favorite take-aways via Dermatology Times’ social media or email us at DTEditor@mmhgroup.com.