When do you consider the use of JAK inhibitors for cutaneous manifestations of myositis?

JAK inhibitors have been shown to be effective especially for skin manifestations in dermatomyositis in an open-label trial (Paik et al., PMID 33258553). However, given the limitations imposed by insurance companies, I consider JAK inhibitors most commonly in the following scenarios:

1. when the patient has failed at least 2 oral agents,
2. the patient cannot cope with the time requirements of IVIG infusions (usually younger patients),
3. patients with concomitant arthritis (which can be used as a separate ICD code to approve JAK inhibitors without the need of prior authorization),
4. patients with MDA5 DM (as JAK inhibitors have been shown to be effective for the skin, arthritis and lung manifestations).