Topical steroids plus baricitinib is more effective than steroids alone for atopic dermatitis

Reference

Guttman-Yassky E, Silverberg JI, Nemoto O, et al. Baricitinib in adult patients with moderate-to-severe atopic dermatitis: A phase 2 parallel, double-blinded, randomized placebo-controlled multiple-dose study. J Am Acad Dermatol 2019;80(4):913-921.

Synopsis

Baricitinib is a systemic inflammatory inhibitor that is currently approved for the treatment of rheumatoid arthritis. These investigators identified 124 patients,18 years or older, with moderate-to-severe atopic dermatitis for at least 2 years and an inadequate response to emollients plus topical corticosteroids, systemic corticosteroids, or immunosuppressants. The diagnosis was based on a validated symptom severity scoring tool. In addition to topical 0.1% triamcinolone cream, eligible patients randomly received (concealed allocation assignment) once-daily baricitinib 2 mg, baricitinib 4 mg, or placebo. Individuals masked to treatment group assignment assessed the primary outcome of the proportion of patients who achieved a 50% or more improvement from baseline in disease severity score. Complete follow-up occurred for 97.6% of participants at 16 weeks. Using intention-to-treat analysis, significantly more patients who received baricitinib 4 mg achieved at least a 50% reduction in symptom score severity from baseline than did those who received the placebo (number needed to treat = 4.2; 95% CI 2.4 - 37.4). The response rate with baricitinib 2 mg was not statistically different than that with the placebo. There were no significant group differences in drop-out rates due to adverse events.