Baricitinib is currently being studied for the treatment of atopic dermatitis. Baricitinib is part of the family of oral Janus kinase inhibitors that are an emerging modality in the treatment of chronic allergic inflammatory disorders due to their ability to inhibit signaling of multiple pathways of cytokines.
We discussed in another blog post, Abrocitinib which is also being studied for eczema. That drug is being developed by Pfizer. At this current time it is not available, but should be getting FDA approval soon.
Baricitinib, sold under the brand name Olumiant among others, is a drug for the treatment of rheumatoid arthritis in adults whose disease was not well controlled using RA medications called tumor necrosis factor antagonists.
In November 2020, the FDA issued an Emergency Use Authorization (EUA) for the combination of baricitinib with remdesivir, for the treatment of suspected or laboratory confirmed COVID-19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).
Olumiant is current being manufactured by Lilly Pharmaceuticals, and its indication is a once-daily pill to treat adults with moderately to severely active rheumatoid arthritis (RA) who have tried at least one other medicine called a tumor necrosis factor (TNF) antagonist, such as Humira® (adalimumab), Enbrel® (etanercept), and Remicade® (infliximab), that did not work well or could not be tolerated.
In a recent study published in the JAMA Dermatology, a phase 3 placebo-controlled trial assessed the efficacy of baricitinib in patients with moderate-to-severe atopic dermatitis in combination with a topical steroid. At week 16, 31% of patients treated with 4 mg and 24% of patients treated with 2 mg of baricitinib once daily achieved clear or almost clear skin assessed by the Investigator Global Assessment for Atopic Dermatitis score (IGA) , compared with 15% of patients treated with topical steroids alone.
Baricitinib was well tolerated. There seems to be a clinical benefit for the combo treatment of baricitinib with topical steroids.
The first author of the study Dr. Kristian Reich stated “The combination of novel systemic therapies such as baricitinib with topical treatment modalities evolves as the standard in the treatment of patients with more severe atopic dermatitis. The study shows that about one third of patients receiving this combination therapy are likely to achieve a high level of skin improvement.”
It will be interesting when aborcitinib and baricitinib are both approved, which drug will do clinically better. But most of all how will these Janus Kinase inhibitors compare to Dupixent (dupiliumb) which has become the “go to” treatment for patients with severe eczema. Dupixent is a self injection every 2 weeks, whereas the Janus Kinase inhibitors are once daily pills. There are some associated side effects with Dupixent, notably conjunctivitis. The Janus Kinase inhibitors are already on the market for other conditions, notably rheumatoid arthritis.