In which type of patient do you recommend a JAK inhibitor as first-line systemic therapy (biologic-naive) with moderate-to-severe atopic dermatitis?

A JAKi is almost never my first-line systemic therapy for AD. I generally reach for biologics targeting IL4/13 first and move to JAKi if those are ineffective or not tolerated. The main scenario where I would choose a JAKi first would be someone who had needle phobia or refused biologics.

Agree that JAKi would virtually never be my first line without a trial of biologics due to the safety profile. From a therapeutic perspective, JAKi would probably work better for psoriasiform dermatitis, but I would first investigate that thoroughly for etiology, including drug eruption, eczematous PRP, psoriasis with co-existing allergic contact dermatitis, or HIV related atypical psoriasis, prior to moving to treatment.