Baricitinib: A Review in Moderate to Severe Atopic Dermatitis
Sheridan M. Hoy
Abstract
Baricitinib (Olumiant®) is an oral small molecule inhibitor of Janus kinase (JAK)1 and JAK2, which have been implicated in the pathogenesis of atopic dermatitis (AD). In phase III studies in adults with moderate to severe AD who were inadequately controlled with topical corticosteroids (TCS) or systemic treatments (e.g. ciclosporin), or for whom these therapies were not advisable, baricitinib, alone or in combination with TCS, achieved significant and/or clinically relevant improvements in multiple measures of disease severity, pruritus, skin pain, sleep disturbance and health-related quality of life (HR-QOL) over 16 weeks. Benefit onset was rapid, with efficacy generally sustained over the longer term (treatment duration ≤ 68 weeks). In this patient population, the safety profile of baricitinib was consistent with that established in the moderate to severe rheumatoid arthritis (RA) population. Although further longer-term data would be beneficial, current evidence indicates that baricitinib, alone or in combination with TCS, provides an oral alternative to subcutaneous biologics for the treatment of moderate to severe AD in adults who are candidates for systemic therapy. A better understanding of the multiple factors that cause atopic dermatitis (AD; a chronic, relapsing, inflammatory skin disease often known as eczema) has led to the development of novel therapies that target various inflammatory pathways involved in the disease process. Baricitinib (Olumiant®), a Janus kinase (JAK)1 and JAK2 inhibitor that targets inflammatory pathways in AD, is a once-daily oral treatment approved in the EU for moderate to severe AD in adults who are candidates for systemic therapy. In such patients, baricitinib, alone or in combination with topical corticosteroids, improved disease severity, pruritus, skin pain, sleep disturbance and health-related quality of life compared with placebo over 16 weeks. Benefit onset was rapid and generally sustained over the longer term (treatment duration ≤ 68 weeks). The safety profile of baricitinib in patients with moderate to severe AD is consistent with that seen in adults with moderate to severe rheumatoid arthritis treated with the drug. Thus, baricitinib provides a convenient oral alternative to subcutaneous biologics for the treatment of moderate to severe AD.