Baricitinib

Baricitinib

  • Pregnancy category not classified yet

  • Olumiant

  • Oral

  • JAK1/2

FDA

  • Rheumatoid arthritis 

Off-label

  • Atopic dermatitis 
  • Psoriasis
  • Graft versus host disease (GVHD)
  • Juvenile dermatomyositis
  • Giant cell arteritis

Boxed warning

  • Serious infections, malignancy & thrombosis 

Infections

  • Viral, bacterial, fungal & opportunistic

Gastrointestinal

  • Perforation

Cutaneous

  • Herpes reactivation (VZV)

Laboratory

  • Anemia
  • Lymphopenia 
  • Neutropenia
  • Transaminitis 
  • Hyperlipidemia
  • Increase creatinine
  • Increase creatinine phosphokinase

  • Avoid combination with immunosuppressive agents & disease-modifying antirheumatic drugs (DMARDs) due to increased risk of complications

Baseline

  • Complete blood count with differential
  • Electrolytes
  • Liver function tests
  • Lipid profile
  • Hepatitis B & C
  • Tuberculosis evaluation
  • Pregnancy test 

Follow up 

  • Monitor for signs/symptoms of infections including tuberculosis 
  • Complete blood count with differential
  • Liver function test
  • Lipid profile
  • Repeat labs every 4-8 weeks after initiation, then every 3 months

Notes

  • Interrupt dose if hemoglobin drops <8g/dl, lymphocyte count <500 or ANC <1000
  • Avoid live vaccines