Baricitinib is effective in patients with atopic dermatitis who have failed dupilumab

New research shows that baricitinib could be an effective treatment option for patients with atopic dermatitis who are unresponsive to dupilumab.

A team, led by Linde de Wijs, Department of Dermatology, Erasmus MC University Medical Center, evaluated the efficacy and safety of baricitinib treatment in daily practice for patients with atopic dermatitis who did not respond to adequately to dupilumab.

Baricitinib

Baricitinib is the first-ever small molecule Janus kinase (JAK) inhibitor approved for the treatment of moderate to severe atopic dermatitis.

However, there are not many data on the efficacy and safety of daily practice for patients treated with baricitinib, which requires further observational studies conducted in clinical care.

“It is known that efficacy (everyday practice) may differ from efficacy (clinical trials),” the authors wrote. “This may in part be due to strict inclusion and exclusion criteria in clinical trials, such as the exclusion of patients who have previously been treated with dupilumab.”

The patients

In the prospective observational cohort study, investigators identified patients with atopic dermatitis who failed treatment with dupilumab and started treatment with baricitinib as part of standard care at Erasmus MC between December 2020 and June 2021.

Each patient was treated with 4 mg baricitinib once daily and visited the outpatient clinic at the start of treatment and after 4 and 12 weeks.

Investigators analyzed physician-reported scores and patient-reported outcome measure scores.

Overall, the study included 25 patients with a median age of 29 years. Most patients (84%) had been previously treated with at least 2 immunosuppressive therapies, including cyclosporine A (96%) and systemic (short-term) corticosteroids (68%). Each patient was previously treated with dupilumab for a median of 7 months.

Among the patient population, 18 consulted the service at 12 weeks and 4 patients stopped baricitinib before 12 weeks of treatment and 3 were still in follow-up.

Treatment resulted in significant improvements in Eczema Area and Severity Index (EASI) scores and patient-reported outcome measure scores. Here, 7 patients showed a good and sustained response, while 8 patients showed no response and 5 patients showed an initial response but worsened EASI scores over time. Additionally, 4 patients discontinued baricitinib treatment due to ineffectiveness or side effects.

EASI scores decreased significantly from baseline (median 12.8) to week 4 (median 6.2) (P= 0.003), but although there was a significant decrease from baseline to week 12 (median 9.6) (P= 0.006), median EASI scores increased between weeks 4 and 12.

“Baricitinib may be an effective treatment for a subset of AD patients who have failed treatment with dupilumab in daily practice,” the authors wrote. “We found three different treatment response groups, including responders, temporary responders and non-responders.”

The study, “Baricitinib for patients with atopic dermatitis who responded inadequately to treatment with dupilumab: early results from daily practice,” was published online in JEADV.

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