Baricitinib in atopic dermatitis

Atopic dermatitis (AD) is the most common chronic cutaneous inflammatory disease of childhood

• affects up to 25% of children; its prevalence in adulthood is currently unknown, since studies reported that AD may affect 0.3-14.3% of adult population (1)
  
  
• AD has a typical chronic-relapsing course, featured by itch, erythema, and dry skin, which negatively affect patient’s quality of life
  
  
• Baricitinib is an oral JAK (Janus kinase) inhibitor highly selective for JAK1 and JAK2
  
  
• in the molecular signaling of AD, a critical role is played by the Janus kinase (JAK)/signal transducers and activators of transcription (STAT) pathway
  • dysregulation of JAK/STAT pathways is involved in inflammatory chronic diseases other than AD, such as psoriasis, lichen planus, cutaneous lupus erythematosus, alopecia areata, rheumatoid arthritis (RA), and autosomal dominant hyper-IgE syndrome
    
    
• Baricitinib is excreted via renal (approximately 75% of a dose) and gastrointestinal (approximately 20%) elimination, mainly as the unchanged drug
  • exposure to it is increased in patients with mild or moderate renal impairment; dosage reduction is required in patients with creatinine clearance of 30-60 mL/min, while it is not recommended in patients with creatinine clearance <30 mL/min (1)
    
    
• Treatment with baricitinib improved the signs and symptoms of moderate-to-severe AD compared to placebo, but it will be essential to better understand the safety profile of this drug (1)

NICE suggest that Baricitinib is recommended as an option for treating moderate to severe atopic dermatitis in adults, only if (2):

• the disease has not responded to at least 1 systemic immunosuppressant, such as ciclosporin, methotrexate, azathioprine and mycophenolate mofetil, or these are not suitable, and
• the company provides it according to the commercial arrangement

Reference:

• Napolitano M et al.Profile of Baricitinib and Its Potential in the Treatment of Moderate to Severe Atopic Dermatitis: A Short Review on the Emerging Clinical Evidence. J Asthma Allergy. 2020; 13: 89-94
• NICE (March 2021). Baricitinib for treating moderate to severe atopic dermatitis.