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. 2024 Nov 14:5:1486271.
doi: 10.3389/falgy.2024.1486271. eCollection 2024.

Baricitinib as monotherapy and with topical corticosteroids in moderate-to-severe atopic dermatitis: a systematic review and meta-analysis of dose-response

Ibrahim H I Almoghayer  1 , Abdul Mateen Soomro  2 , Shah Dev  3 , Muskan Turesh  3 , Ateesh Kumar  4 , Ravi Kumar  2 , Aashish Meghjiani  4 , Syeda Lamiya Mir  4 , Muhammad Hassaan  4 , Rehan Qureshi  4 , Vishal Kumar  4 , Taimoor Ashraf  5 , F N U Deepak  6 , Mohammad Arham Siddiq  7 , Abdul Haseeb  7 , Ayush Kumar  8
Affiliations

Baricitinib as monotherapy and with topical corticosteroids in moderate-to-severe atopic dermatitis: a systematic review and meta-analysis of dose-response

Ibrahim H I Almoghayer et al. Front Allergy. .

Abstract

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disorder that affects millions worldwide, presenting challenges in managing symptoms and quality of life. Current treatments include topical corticosteroids (TCS), but novel approaches, such as Janus kinase (JAK) inhibitors, show promise. Baricitinib, a selective JAK1 and JAK2 inhibitor, targets cytokines involved in AD and offers potential benefits beyond traditional therapies.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to evaluate the efficacy and safety of baricitinib in treating moderate-to-severe AD. We followed PRISMA guidelines and assessed data from PubMed, Cochrane Central, ScienceDirect, and ClinicalTrials.gov up to August 2024. The analysis included trials comparing baricitinib to placebo, with or without TCS, evaluating outcomes such as Investigator's Global Assessment (IGA) scores, Eczema Area and Severity Index (EASI) scores, and safety profiles.

Results: Six RCTs involving 2,595 participants met the inclusion criteria. Baricitinib demonstrated significant improvements in IGA scores, EASI scores, Dermatology Life Quality Index (DLQI), and other outcome measures compared to placebo. The efficacy was consistent across different dosages (1 mg, 2 mg, 4 mg) and whether baricitinib was used with or without TCS. Safety analyses revealed a significant increase in treatment-emergent adverse events (TEAEs), particularly with the 2 mg and 4 mg dosages and with TCS.

Conclusion: Baricitinib, both alone and in combination with TCS, significantly improves symptoms and quality of life in patients with moderate-to-severe AD, with efficacy consistent across dosages. The safety profile is overall acceptable, though a significant increase in TEAEs was observed, particularly with higher dosages and when used with TCS. Ongoing monitoring of TEAEs is recommended, and future trials with longer follow-up periods are suggested to better understand long-term outcomes.

Keywords: JAK inhibitors; atopic dermatitis; baricitinib; eczema area and severity index; treatment-emergent adverse events.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Prisma flow diagram.
Figure 2
Figure 2
(A) Risk of bias summary. (B) Risk of bias graph.
Figure 3
Figure 3
Forest plot for IGA score of 0 or 1.
Figure 4
Figure 4
Forest plot for EASI 50.
Figure 5
Figure 5
Forest plot for EASI 75.
Figure 6
Figure 6
Forest plot for EASI 90.
Figure 7
Figure 7
Forest plot for change from baseline in DLQI score.
Figure 8
Figure 8
Forest plot for SCORAD 75.
Figure 9
Figure 9
Forest plot for SCORAD 90.
Figure 10
Figure 10
Forest plot for itch NRS.
Figure 11
Figure 11
Forest plot for skin infections requiring antibiotic treatment.
Figure 12
Figure 12
Forest plot for skin Pain NRS.
Figure 13
Figure 13
Forest plot for BSA affected.
Figure 14
Figure 14
Forest plot for POEM.
Figure 15
Figure 15
Forest plot for TEAEs.
See this image and copyright information in PMC

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