Summary

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• This summary is based on the review of 78 systematic review(s)/meta-analysis(es). ^[1-78]
• Rheumatoid Arthritis (RA): Baricitinib demonstrated significant improvement in the Disease Activity Score of 28 Joints (DAS28) compared to placebo, with an odds ratio (OR) of 1.24 (95% CI, P = 0.15) in the modified intent-to-treat population, and ranked lower than tocilizumab but higher than opinercept. Additionally, when combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), baricitinib effectively achieved the American College of Rheumatology 20/50/70 Response Criteria (ACR20/50/70) and DAS28(CRP) < 2.6 at 24 weeks.
• COVID-19: Baricitinib significantly reduced mortality with a relative risk (RR) of 0.68 and demonstrated faster recovery and shorter hospital stays compared to placebo. When combined with Remdesivir, it improved clinical recovery at 14 days and reduced mortality rates.
• Alopecia Areata (AA): Baricitinib 4 mg resulted in the best efficacy in improving the Severity of Alopecia Tool (SALT) score, particularly showing notable hair regrowth in patients with severe AA (SALT score ≥ 50).
• Population Considerations: Baricitinib was effective in patients with moderate to severe RA unresponsive to prior treatments, and showed efficacy across various severities of COVID-19 in hospitalized patients. In AA patients, higher doses correlated with more significant improvements in SALT scores, particularly in those with very severe AA (SALT score 95-100).
• Infection Risks: Baricitinib was associated with a higher risk of any-grade infections (RR 1.34) and opportunistic infections (RR 2.69) compared to other treatments, indicating a notable risk profile for infections relative to filgotinib, peficitinib, and upadacitinib.
• Adverse Events: While there was an increased risk of adverse events, the rates of serious infections and critical adverse events were not significantly higher compared to placebo. Common adverse events included hypercholesterolemia.
• Safety Profile: No significant increase in major adverse cardiovascular events (MACE) or venous thromboembolic events (VTE) was observed. Baricitinib had a lower incidence of adverse effects than tocilizumab, particularly regarding secondary infections and thrombotic events in COVID-19 patients.
• Comparative Safety: In rheumatoid arthritis (RA) studies, rituximab was noted as the safest drug, while baricitinib demonstrated a lower incidence of adverse effects compared to tocilizumab in the context of COVID-19 treatment.
• RA Population: Baricitinib was studied in patients with moderate to severe RA who were insensitive or under-responsive to conventional synthetic DMARDs, demonstrating efficacy particularly in those with prior biologic DMARD failure.
• COVID-19 and Alopecia Areata Populations: In COVID-19 patients, efficacy was noted across varied severity levels, especially in those requiring oxygen support, while adults with severe Alopecia Areata (SALT score ≥ 50) showed significant response to baricitinib, with better outcomes in patients with very severe AA (SALT score 95-100).