From the Guidelines
Upadacitinib is more effective than baricitinib for treating atopic dermatitis, based on current evidence from the 2024 guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies 1. The guidelines provide strong recommendations for the use of upadacitinib, dupilumab, tralokinumab, abrocitinib, and baricitinib for moderate to severe atopic dermatitis. Key points to consider when choosing between upadacitinib and baricitinib include:
- Upadacitinib is approved by the FDA for use in adults with moderate to severe atopic dermatitis who have failed other systemic therapies or when use of those therapies is inadvisable 1.
- Baricitinib is not approved by the FDA for use in atopic dermatitis, but is recommended off-label for adults with moderate to severe atopic dermatitis 1.
- The efficacy and safety of upadacitinib and baricitinib may vary depending on individual patient factors, comorbidities, and insurance coverage.
- Both medications require laboratory monitoring, including lipid panels and complete blood counts, and neither should be used with other immunosuppressants like cyclosporine or methotrexate 1.
- The decision to initiate these therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
From the Research
Efficacy Comparison of Baricitinib and Upadacitinib
- The efficacy of baricitinib and upadacitinib for atopic dermatitis has been compared in several studies 2, 3, 4.
- A network meta-analysis found that upadacitinib 30mg was superior to all regimens, including baricitinib, in terms of investigator global assessment (IGA) and eczema area and severity index (EASI) response 2.
- Another study found that switching from baricitinib 4mg to upadacitinib 30mg effectively improved rash and pruritus in patients with moderate-to-severe atopic dermatitis 3.
- A network meta-analysis of treatments for adolescent atopic dermatitis found that upadacitinib and dupilumab demonstrated superior efficacy, while baricitinib exhibited weaker performance across all indicators 4.
Safety Comparison of Baricitinib and Upadacitinib
- The safety profiles of baricitinib and upadacitinib have been evaluated in several studies 2, 5, 6, 4.
- A study found that upadacitinib 30mg caused more treatment-emergent adverse events (TEAEs) compared to baricitinib and placebo 2.
- Another study found that baricitinib 4mg combined with topical corticosteroids had a safety profile consistent with previous studies, with the most common adverse events being nasopharyngitis, herpes simplex, influenza, and headache 5.
- A network meta-analysis found that there were significant differences in the incidence rates of adverse reactions among various medications, including baricitinib and upadacitinib 4.