Pharm

Baricitinib

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Baricitinib, Olumiant

  • See Also
  1. Janus Kinase Inhibitor
  • Indications
  1. Rheumatoid Arthritis
    1. Refractory to non-biologic DMARD
  2. Alopecia Areata
    1. Severe Alopecia Areata in adults
  • Contraindications
  1. Severe hepatic Impairment
  2. GFR <60 ml/min
  3. Concurrent Immunosuppressants
    1. Biologic DMARDs
    2. Cyclosporine, azathoprine and other potent Immunosuppressants
    3. Probenacid (OAT3 transport inhibitor)
  • Mechanism
  1. See Janus Kinase Inhibitor
  • Dosing
  • Adults
  1. Rheumatoid Arthritis (refractory to non-biologic DMARD)
    1. Take 2 mg orally once daily
  2. Alopecia Areata
    1. Start 2 mg orally once daily
    2. May advance to 4 mg orally once daily if lack of response to 2 mg/day
  • Efficacy
  1. Alopecia Areata
    1. Hair regrowth starts 8 to 12 weeks after starting Baricitinib and continues up through 36 weeks
    2. Best efficacy is with 4 mg dose
      1. Up to a third of patients will achieve <20% scalp baldness
  • Adverse Effects
  1. See Janus Kinase Inhibitor
  2. Common (5% of patients)
    1. Upper Respiratory Infections
    2. Urinary Tract Infection
    3. Hyperlipidemia
    4. Headaches
    5. Nasopharyngitis
    6. Acne
    7. Increased Serum Creatinine kinase levels
  3. Serious: Class effects
    1. See Janus Kinase Inhibitor
    2. Serious infections
    3. Opportunistic infections
    4. Major cardiovascular events (0.5%)
    5. Malignancy including non-melanoma Skin Cancer (0.4%)
    6. Venous Thromboembolism
    7. Infection Reactivation (e.g. Tb reactivation, Shingles reactivation)
      1. Screen for Latent Tuberculosis before starting
    8. Gastrointestinal perforation
    9. Hepatotoxicity
    10. Myelosuppression
      1. Lymphopenia
        1. Avoid starting if Absolute Lymphocyte Count <500
      2. Anemia
        1. Avoid starting if Hemoglobin <8 mg/dl
      3. Neutropenia
        1. Avoid starting if Absolute Neutrophil Count (ANC) <1000
  • Safety
  1. Avoid in pregnancy (Unknown safety)
    1. Use reliable Contraception during and for at least 4 weeks after stopping Baricitinib
  2. Avoid in Lactation
    1. Wait at least 4 days after last dose to begin Breast Feeding
  3. Monitoring (obtain baseline and recheck periodically)
    1. Complete Blood Count
    2. Liver Function Tests
    3. Lipid panel (after 3 months of use)
  • Drug Interactions
  1. See Contraindications above
  • Resources
  1. Baricitinib (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=866e9f35-9035-4581-a4b1-75a621ab55cf
  • References
  1. Pheasant (2023) Am Fam Physician 108(5): 513-4 [PubMed]