Baricitinib: therapeutic potential for moderate to severe atopic dermatitis

ABSTRACT

Introduction

Atopic dermatitis (AD) is a chronic inflammatory skin disease mediated by multiple signals including janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway. Current therapeutic armamentarium consists of a limited number of drugs which may result in the insufficient management of AD. Preclinical evidence regarding inhibition of JAK/STAT led to the development of a promising class of therapeutics, namely, JAK inhibitors. Baricitinib, a novel JAK1/JAK2 inhibitor is currently under investigation in AD clinical trials.

Areas covered

This review offers an overview of Baricitinib and examines clinical efficacy and safety data in patients with moderate-to-severe AD.

Expert opinion

Baricitinib showed promising preliminary data in terms of efficacy in phase II and III trials, with a very rapid onset of response and great improvements of itch and sleep disturbances. These aforementioned aspects combined with the advantage of an oral formulation have reduced drug production costs compared to biologic agents and could lead to consideration of baricitinib as a first line systemic treatment. Also, in some countries, it could be a therapeutic option in the case of contraindication or failure of conventional systemic drugs prior to biologic therapies. Data related to long-term safety and efficacy will be important to refine the place-in-therapy of this drug.

KEYWORDS:

• Atopic dermatitis
• baricitinib
• JAK
• JAK inhibitors
• small molecules

Article highlights

• Current conventional drugs for atopic dermatitis (AD) do not always provide therapeutic control of the disease.

• Thorough understanding the immune landscape in AD will shed light on emerging disease-specific therapeutic options.

• JAK/STAT inhibitors represent a new promising drug class for AD treatment.

• Baricitinib, a selective JAK1/2 inhibitor, was recently investigated in phase 3 AD clinical trials with encouraging results.

• Additional data concerning baricitinib long term efficacy and safety profile are needed.

Declaration of interest

A Chiricozzi served as an advisory board member and consultant and has received fees and speaker’s honoraria or has participated in clinical trials for Abbvie, Biogen, Fresenius Kabi, Leo Pharma, Lilly, Janssen, Novartis, Sanofi Genzyme, and UCB-Pharma. K Peris reports grants and personal fees for advisory board meetings from Almirall, AbbVie, Biogen, Lilly, Celgene, Galderma, Leo Pharma, Novartis, Pierre Fabre, Sanofi, Sandoz, Sun Pharma, and Janssen, outside of the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.