abrocitinib: clinical use

Prescribing considerations

• Initiation and supervision should be by a clinician experienced in diagnosing and treating atopic dermatitis.
• Assess infection risk; screen for tuberculosis and viral hepatitis and review immunisation status.
• Review renal and hepatic function and medicines affecting CYP2C19, CYP2C9 or P-glycoprotein.
• Assess venous thromboembolism, cardiovascular and malignancy risks. In people aged 65 years or over, current or long-term former smokers, and those with cardiovascular or malignancy risk factors, use only when no suitable alternative is available.
• Avoid live attenuated vaccines during or immediately before treatment; consider shingles immunisation before starting.
• Perform periodic skin examination, especially where skin-cancer risk is increased.

Contraindications and cautions

• Hypersensitivity to abrocitinib or an excipient
• Active serious systemic infection, including active tuberculosis
• Severe hepatic impairment
• Pregnancy
• Breastfeeding

Monitoring

• Full blood count, including platelets, lymphocytes, neutrophils and haemoglobin, before and during treatment.
• Lipids before and during treatment according to cardiovascular risk.
• Monitor for infection during and after treatment and reassess venous thromboembolism risk periodically.
• Consider hepatitis B DNA monitoring where serology indicates previous infection; consult a liver specialist if viral DNA is detected.

Clinical pharmacology

Abrocitinib preferentially inhibits JAK1-dependent cytokine signalling and downstream STAT activation. It is metabolised mainly through CYP2C19 and CYP2C9; active metabolites are predominantly eliminated in urine.

Formulation and product differences

• The selected product is a pink, oval film-coated tablet containing lactose.
• Tablets should be swallowed whole and are essentially sodium-free.
• No special storage restrictions are specified.

Tablet

Route: Oral

Strengths: 50 mg, 100 mg, 200 mg