II. Indications
-
Rheumatoid Arthritis
- Refractory to non-biologic DMARD
-
Alopecia Areata
- Severe Alopecia Areata in adults
III. Contraindications
- Severe hepatic Impairment
- GFR <60 ml/min
- Concurrent Immunosuppressants
- Biologic DMARDs
- Cyclosporine, azathoprine and other potent Immunosuppressants
- Probenacid (OAT3 transport inhibitor)
IV. Mechanism
V. Dosing: Adults
-
Rheumatoid Arthritis (refractory to non-biologic DMARD)
- Take 2 mg orally once daily
-
Alopecia Areata
- Start 2 mg orally once daily
- May advance to 4 mg orally once daily if lack of response to 2 mg/day
VI. Efficacy
-
Alopecia Areata
- Hair regrowth starts 8 to 12 weeks after starting Baricitinib and continues up through 36 weeks
- Best efficacy is with 4 mg dose
- Up to a third of patients will achieve <20% scalp baldness
VII. Adverse Effects
- See Janus Kinase Inhibitor
- Common (5% of patients)
- Upper Respiratory Infections
- Urinary Tract Infection
- Hyperlipidemia
- Headaches
- Nasopharyngitis
- Acne
- Increased Serum Creatinine kinase levels
- Serious: Class effects
- See Janus Kinase Inhibitor
- Serious infections
- Opportunistic infections
- Major cardiovascular events (0.5%)
- Malignancy including non-melanoma Skin Cancer (0.4%)
- Venous Thromboembolism
- Infection Reactivation (e.g. Tb reactivation, Shingles reactivation)
- Screen for Latent Tuberculosis before starting
- Gastrointestinal perforation
- Hepatotoxicity
- Myelosuppression
- Lymphopenia
- Avoid starting if Absolute Lymphocyte Count <500
- Anemia
- Avoid starting if Hemoglobin <8 mg/dl
- Neutropenia
- Avoid starting if Absolute Neutrophil Count (ANC) <1000
- Lymphopenia
VIII. Safety
- Avoid in pregnancy (Unknown safety)
- Use reliable Contraception during and for at least 4 weeks after stopping Baricitinib
- Avoid in Lactation
- Wait at least 4 days after last dose to begin Breast Feeding
- Monitoring (obtain baseline and recheck periodically)
- Complete Blood Count
- Liver Function Tests
- Lipid panel (after 3 months of use)
IX. Drug Interactions
- See Contraindications above