Summary

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• Olumiant (baricitinib) is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more tumor necrosis factor (TNF) blockers.
• This summary is based on the review of 30 systematic reviews/meta-analyses. ^[1-30]
• Clinical Disease Activity Index (CDAI) Remission and Low Disease Activity (LDA): In real-world settings, baricitinib achieved CDAI remission rates ranging from 8.7% to 60% at week 12 and CDAI LDA rates between 20.2% and 81.6% at week 24 in rheumatoid arthritis (RA) patients.
• Simple Disease Activity Index (SDAI) Remission: Baricitinib demonstrated SDAI remission rates of 12% at week 4, increasing to 45.4% by week 24 in RA patients.
• Comparison with Other JAK Inhibitors: Baricitinib was found to have lower probabilities of achieving remission and LDA compared to other JAK inhibitors like upadacitinib and tofacitinib, as indicated by a Bayesian network meta-analysis.
• Effectiveness in COVID-19: Baricitinib was recommended by the WHO for severe COVID-19 due to its proven efficacy in reducing mortality, particularly in patients requiring supplemental oxygen, with supportive evidence from the ACTT-2 and COV-BARRIER trials.
• Infection Risk: Baricitinib was associated with an increased risk of infections, particularly herpes zoster, with higher rates of treatment-emergent adverse events (TEAEs) compared to placebo.
• Serious Infections: The risk of serious infections was elevated with baricitinib use, especially in real-world settings, although no new safety signals were identified.
• COVID-19 Specific Safety: Baricitinib did not increase the incidence of adverse outcomes in COVID-19 patients, though caution is advised due to the potential for immunosuppression.
• Subgroup Findings: Baricitinib demonstrated variable remission rates between early and established rheumatoid arthritis (RA) patients, with higher remission rates in early RA (27-72%) compared to established RA (14-20%). In COVID-19 patients, baricitinib was particularly effective in reducing mortality in those requiring supplemental oxygen or non-invasive ventilation. The drug was primarily studied in older female RA patients with long disease duration and showed effectiveness in treating alopecia areata (AA) and atopic dermatitis (AD) with favorable safety profiles.