Among adult Japanese patients with moderate to severe atopic dermatitis (AD), baricitinib may be highly efficacious, according to real-world study results reported in The Journal of Dermatology.
Although oral baricitinib, a reversible Janus kinase ½ inhibitor, has been approved in Japan for more than a year in patients 16 years of age or older for the treatment of moderate to severe AD, evidence of efficacy is based solely on clinical trials. Researchers sought to demonstrate real-world evidence of the effectiveness of baricitinib in patients with AD.
The investigators conducted a single-center retrospective cohort study at the Gunma University Hospital, Japan from July 2020 to December 2021 that included 14 adult patients (41.0±17.8 years of age; 12 men) with moderate to severe AD treated with baricitinib for 12 weeks. Most patients had experienced AD since childhood, and AD was severe in 5 of the patients. All patients used topical steroids and moisturizers plus baricitinib 4 mg/day, and all patient baseline assessments included Investigator’s Global Assessment [IGA], affected body surface area [BSA], Eczema Area and Severity Index [EASI], and were reassessed at weeks 4 and 12.
All patients reported an improvement in itching within days. At week 4, all patients showed significant improvement of skin rash, including head and neck, it was noted. Analysis showed that of the 14 patients, 12 patients achieved EASI-50, 10 patients achieved EASI-75, and 4 patients achieved EASI-90. At week 12, all patients showed further improvements, with all reaching EASI-50, 9 patients EASI-75, and 5 patients reaching EASI-90. Eosinophil count and other important serum levels decreased by week 4, including immunoglobulin E, which decreased 71% at week 4 and 77% by week 12. The most frequent adverse effects were acne (4 patients), pharyngitis (3 patients), phlegmone and herpes zoster (1 patient each).
Study limitations included hematological biomarkers and serum levels that tend to decrease; 2 patients switched treatment from baricitinib. It was also allowed that the observation time for IgE may not have been sufficient as the study authors wrote, “… the type of AD in which serum levels of IgE and TARC tend to decrease after treatment is still unknown, therefore further study is needed for proper assessment.”
The researchers concluded, “Our results suggest that baricitinib might be fast-acting against itching and highly effective against skin eruptions. Although no serious side effects were observed in our case, safety requires a detailed examination of long-term use.”
Uchiyama A, Fujiwara C, Inoue Y, Motegi SI. Real-world effectiveness and safety of baricitinib in Japanese patients with atopic dermatitis: A single-center retrospective study. J Dermatol. Published online March 6, 2022. doi:10.1111/1346-8138.16350