Real-World Evidence for Baricitinib in the Treatment of Atopic Dermatitis and Alopecia Areata: Systematic Literature Review 2020-2023

IntroductionBaricitinib is an oral selective Janus kinase 1/2 inhibitor approved for the treatment of the immune-mediated inflammatory skin diseases atopic dermatitis (AD) and alopecia areata (AA). We report the findings of a systematic literature review of real-world outcomes with baricitinib in patients with AD or AA.MethodsDatabases, conference proceedings, and other sources were searched for publications covering July to November 2023 that provided real-world evidence in baricitinib-treated patients; extracted study variables included study population characteristics, interventions, and outcomes.ResultsIn total, 76 publications meeting inclusion criteria were identified, most of which were single-centre studies; 1134 unique patients with AD and 598 unique patients with AA were included. Studies in AD mostly focused on effectiveness outcomes, followed by treatment patterns, patient-reported outcomes, and safety. Most AA publications focused on effectiveness outcomes, followed by safety then treatment patterns.ConclusionOverall, baricitinib consistently improved the signs and symptoms of AD in patients receiving baricitinib in real-world settings, was effective for the treatment of AA in both adult and paediatric patients and was associated with improvements in patient-reported outcomes. The most common reasons for baricitinib discontinuation in AD were ineffectiveness and adverse events, although discontinuation rates due to adverse events were low. Patients initiating baricitinib for AD had often been treated previously with a biologic and were frequently receiving immunosuppressive and topical treatments before treatment initiation. Treatment discontinuation and prior treatment data were limited for studies in AA, but several studies reported concomitant minoxidil use in patients with AA treated with baricitinib. No new safety signals for baricitinib were observed in patients with AD or AA, and no serious adverse events were reported. In conclusion, real-world data on baricitinib in the treatment of AD and AA support the effectiveness and tolerability reported in clinical trials.