Starting with Dupixent (dupilumab), various new drugs -- including JAK inhibitors -- have emerged for atopic dermatitis, expanding treatment options for patients. JAK inhibitors have drawn attention for their oral administration and rapid effectiveness, although some have raised safety concerns.

Among the JAK1 inhibitors, Cibinqo (abrocitinib) has gained attention for its convenient oral dosing, growing body of long-term safety data, and its differentiation from existing biologics through improvements in skin barrier function.

Korea Biomedical Review sat down with Dr. Adelaide A. Hebert, Professor of Dermatology at McGovern Medical School in Houston, Texas, who recently visited Korea for the International Atopic Dermatitis Summit Seoul (IASS 2025), to learn more about the clinical value of Cibinqo and how its prescribing landscape is evolving in the treatment of atopic dermatitis.

Question: Please tell us about your presentation at IASS 2025.

Answer: My presentation, “Beyond EASI score, the optimal approach to treat atopic dermatitis with abrocitinib,” was on the clinical value of changing the prescribing landscape in atopic dermatitis.

In clinical research, various endpoints related to atopic dermatitis are utilized. While evaluating patients using these endpoints is essential, the most important thing is to evaluate whether the patient is experiencing improvement in their symptoms, not just the clinician's satisfaction.

I also explained that improvements should be seen in skin symptoms, including pruritus, skin pain, productivity, crusting, sleep, patient quality of life, pigmentation, and skin barrier restoration.

Q: Is the Eczema Area and Severity Index (EASI) an accurate measure of atopic dermatitis? What other atopy markers should be considered in clinical practice besides the EASI?

A: The EASI score quantifies a patient's condition as observed by a healthcare provider, so it has limitations in that it does not reflect the patient's own distress or emotional response to itching. For this reason, a recent focus has been on the Patient-Oriented Eczema Measure (POEM). It provides a more precise assessment of the subjective factors associated with atopic dermatitis. In particular, it can include symptoms, such as itching, that are not reflected in the EASI score.

The presentation also covered an indicator called SCORAD (SCORing Atopic Dermatitis), a more comprehensive measure of symptoms, including sleep disturbance, drainage, crusting, and itching, whereas the EASI score does not. There is a need for metrics that better assess how patients feel and view their disease and, more importantly, how they experience it throughout their lives.

Q: There have been many new drugs for atopic dermatitis in recent years. How have they changed the treatment landscape?

A: Various new drugs have emerged for atopic dermatitis. In particular, biologics, including dupilumab, have been a breakthrough in treating atopic dermatitis. However, not all patients respond to biologics, and there are side effects. To successfully treat patients suffering from atopic dermatitis, multiple treatment options are needed in addition to dupilumab.

Therapies such as dupilumab and JAK inhibitors are indicated for patients with moderate to severe atopic dermatitis. Patients with atopic dermatitis are living with severe eczema and other symptoms and need more aggressive treatment.

Q: Dupilumab is still actively prescribed in the treatment of severe atopy. What are Cibinqo's clinical benefits compared to biologics like dupilumab?

A: The clinical value of Cibinqo is that it is an oral small molecule with a very rapid onset of action. Pruritus, in particular, often significantly improves within one to two days. Patient compliance is also high. This may contribute to patients' adherence to their doctor's prescriptions, as stopping the drug can lead to an immediate flare-up of inflammation. On the other hand, dupilumab has a relatively slow onset of action, so patients may not notice any problems if the disease flares up again.

Cibinqo also has the advantage of not causing conjunctivitis. Some biologics can cause ocular redness, inflammation, and other side effects, but Cibinqo is free of these. It also comes in three dose options: 50 mg, 100 mg, and 200 mg. This is an advantage over biologics because it allows for more flexibility in dosing based on patient response, age, and renal function.

Some studies comparing Cibinqo to dupilumab have shown less water loss in the transepidermal layer of non-lesional skin with Cibinqo than with dupilumab. Studies have also reported increased expression of filaggrin and loricrin, essential proteins that protect the skin barrier, in the Cibinqo group, whereas this was not observed in the dupilumab group. The importance of restoring the skin barrier in the treatment of atopic dermatitis is one of the benefits of Sibinko's treatment.

Q: Has there been a case study of a patient who switched from another JAK inhibitor to Cibinqo?

A: The presentation described a patient who was switched from another JAK inhibitor to Cibinqo. This patient had previously tried various medications, and within a month of taking 100 mg of Cibinqo, her symptoms improved dramatically, especially her erythema and spongy dermatitis, which she described as a miracle.

This patient had previously experienced improvement with systemic steroids. However, systemic steroids are limited for long-term use due to safety concerns and can leave significant marks such as stretch marks. Despite trying various treatments, steroids were the first time she felt her symptoms improved.

In my personal clinical experience, upadacitinib has more side effects than Cibinqo, so I prefer Cibinqo because it is a safer drug. In addition, I believe Cibinqo has the advantage in terms of dosing flexibility, as there are two dosing options for upadacitinib, whereas Cibinqo offers three.

Q: What is the rationale for Cibinqo being considered a safer agent than other JAK inhibitors?

A: Cibinqo is a selective JAK1 inhibitor, which means it has a mechanism of action that is less likely to cause side effects in the JAK pathway. For example, tofacitinib, a JAK3 inhibitor used to treat rheumatoid arthritis, is associated with a risk of major adverse cardiovascular events (MACE), such as blood clots and embolism. However, because Cibinqo selectively inhibits JAK1, its molecular structure makes it less likely to cause side effects.

Q: Atopic dermatitis is a disease that ranges from mild to severe. What is your advice to each patient?

A: There is no cure for atopic dermatitis. People often expect to be cured after a single treatment, but this is not possible. However, there are advances in medications for mild, moderate, and severe cases. Treatment should be tailored accordingly. Patients with moderate or severe atopic dermatitis should seek the help of a dermatologist.

Also, allergists have recently discovered that food is not a major trigger for atopic dermatitis, so there is no need to restrict children from eating certain foods. On the contrary, restricting them can increase the likelihood of developing an allergy to that food.

The use of topical steroids, regardless of severity, is also helpful. Although there are many concerns about steroids, they've been around since the 1950s and are very safe when used as directed by a doctor. Most are covered by insurance and inexpensive, so you can afford them..