Baricitinib for atopic dermatitis patients who responded inadequately to dupilumab treatment: First daily practice results

Background: 

Baricitinib is the first JAK inhibitor registered for the treatment of moderate-to-severe atopic dermatitis (AD). Efficacy and safety were shown in clinical trials, but daily practice data is sparse. 

Objectives: 

To evaluate the effectiveness and safety of baricitinib treatment in daily practice in AD patients who have inadequately responded to dupilumab. 

Methods: 

In this prospective observational cohort study, AD patients who failed dupilumab treatment and started baricitinib treatment in context of standard care at the Erasmus MC (the Netherlands) were included. We analysed physician-reported scores and patient-reported outcome measure scores (PROMs). 

Results: 

Twenty-five patients were included. Baricitinib treatment resulted in significant improvement of Eczema Area and Severity Index (EASI) scores and PROMs. Seven patients showed a good and sustained response (EASI50), eight patients showed no response (<EASI50), and five patients showed an initial response but worsening of EASI scores in time. Overall, baricitinib was well tolerated. Four patients discontinued baricitinib treatment due to ineffectiveness or side effects. 

Conclusions: 

Baricitinib can be an effective treatment for a subset of AD patients who failed dupilumab treatment in daily practice. We found three different treatment response groups including responders, temporarily responders, and non-responders.