Preliminary clinical activity of a topical JAK1/2 inhibitor in the treatment of psoriasis

Background: Janus-associated kinases (JAKs) are involved in signal transduction from a variety of cytokines implicated in the pathogenesis of psoriasis, including interleukin (IL)-12, IL-23, and interferon-gamma. INCB018424, a small molecule inhibitor of JAK1 and JAK2, inhibits cytokine-induced JAK/signal transducers and activators of transcription signaling and the resultant production of inflammatory proteins (eg, IL-17). Objective: We sought to demonstrate proof of concept in patients with stable plaque psoriasis. Methods: Patients were dosed with vehicle, 0.5% or 1.0% INCB018424 phosphate cream once a day or 1.5% twice a day for 28 days. Additional groups included two active comparators (calcipotriene 0.005% cream or betamethasone dipropionate 0.05% cream). Results: Both the 1% and the 1.5% cream improved lesion thickness, erythema, and scaling and reduced lesion area compared with placebo. A composite lesion score decreased by greater than 50% with the efficacious doses of INCB018424 compared with 32% for vehicle controls. Topical application of INCB018424 was well tolerated with few mild adverse events noted. Mean plasma concentrations of INCB018424 after topical application of 0.5% to 1.5% cream were in the low nanomolar range, representing a fraction (<1%) of the half maximal inhibitory concentration (IC50) in whole blood for inhibition of cytokine-stimulated signal transducers and activators of transcription-3 phosphorylation. Limitations: This study was limited by the relatively short study duration and small sample size. Conclusion: Topical INCB018424 is safe, is well tolerated, and exhibits clinical activity in the topical treatment of psoriasis. (J Am Acad Dermatol 2012;67:658-64.)