Abrocitinib delivers rapid and substantial relief in refractory CHE

Oral Janus kinase 1 (JAK1) inhibition produced marked improvements in signs, symptoms, and patient-reported outcomes in adults with moderate-to-severe chronic hand eczema (CHE) refractory to prior therapy. Benefits were observed across both atopic and non-atopic disease subtypes, addressing a population with high unmet medical need.

Therapeutic options for CHE remain limited, particularly for patients with a non-atopic phenotype. Abrocitinib, a selective JAK1 inhibitor already approved for atopic dermatitis, was therefore evaluated in a randomised, double-blind, placebo-controlled phase 2b study presented during a late-breaking session [1]. Dr Robert Bissonnette (Innovaderm Founder and CEO, Canada), who presented the trial results, emphasised that evidence on pharmacological efficacy, especially in non-atopic HE, had been limited prior to this study.

A total of 82 adults with moderate-to-severe CHE refractory to previous treatment were randomised to abrocitinib 200 mg once daily, 100 mg once daily, or placebo. Importantly, enrolment was not restricted by atopic status, enabling assessment of efficacy across disease subtypes.

Both active treatment arms demonstrated highly significant reductions in the modified Total Lesion Symptom Score (mTLSS) at week 16 (primary endpoint) compared with placebo: 81.4% with the 200 mg dose and 78.1% with the 100 mg dose versus 46.5% with placebo (P<0.001 for both comparisons). The onset of effect was rapid, with the 200 mg dose separating significantly from placebo as early as week 2.

Subgroup analyses confirmed that efficacy was not limited to atopic patients. In individuals with non-atopic CHE, mTLSS reductions were 79.2% and 71.3% for the 200 mg and 100 mg doses, respectively, compared with 36.9% for placebo. Treatment success, defined as at least a 2-grade improvement to clear or almost clear skin, was achieved by 55.6% and 44.4% of patients receiving 200 mg and 100 mg, respectively, versus 18.5% in the placebo group. Patient-reported outcomes also favoured abrocitinib, with reductions in pain up to 90% and in pruritus of 66% to 77%. “Again, this was a highly statistically significant finding,” Dr Bissonette noted.

The safety profile was consistent with previous experience. Adverse events were predominantly mild to moderate, with nasopharyngitis among the most commonly reported. One case of breast cancer occurred in the 200 mg arm; overall tolerability was considered in line with earlier studies.

Dr Bissonette concluded that abrocitinib has the potential to rapidly induce meaningful improvements in skin clearance, pain, and pruritus, including in non-atopic phenotypes that have historically lacked evidence-based treatment options.

Bissonnette R. Efficacy and Safety of Abrocitinib in Patients with Chronic Hand Eczema: A Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial. S023: Late-Breaking Research: Session 1. AAD 2026, 27–31 March, Denver, CO, USA.