From the Guidelines
Baricitinib is approximately 25-40% less effective than upadacitinib for the treatment of atopic dermatitis, with upadacitinib achieving higher rates of skin clearance and itch reduction in clinical practice. According to the guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies 1, upadacitinib 15-30mg daily achieves EASI-75 (75% improvement in eczema severity) in approximately 65-80% of patients, while baricitinib 2-4mg daily achieves this in about 40-50% of patients. The higher doses of upadacitinib (30 mg daily) demonstrate the highest efficacy at reducing EASI scores up to 16 weeks of treatment among all currently available treatments in a network meta-analysis and were superior to baricitinib 1.
Some key points to consider when choosing between these medications include:
- Efficacy: Upadacitinib tends to work more rapidly, with significant improvements often seen within 1-2 weeks, compared to 2-4 weeks with baricitinib.
- Safety profiles: Upadacitinib potentially carries slightly higher risks of certain adverse effects like herpes zoster and blood clots.
- Monitoring: Both medications are oral JAK inhibitors taken once daily, and patients should be monitored for infections, lipid changes, and other potential side effects regardless of which medication is chosen.
- JAK inhibition: Upadacitinib's greater selectivity for JAK1 inhibition may contribute to its higher efficacy, as it more specifically targets the inflammatory pathways involved in atopic dermatitis.
The American Academy of Dermatology guidelines support the use of both upadacitinib and baricitinib for the treatment of atopic dermatitis, but with a strong recommendation for upadacitinib and a conditional recommendation for baricitinib due to its off-label status for this indication 1. Overall, the choice between these medications should be based on individual patient needs and circumstances, taking into account their efficacy, safety profiles, and potential for adverse effects.
From the Research
Comparison of Baricitinib and Upadacitinib for Atopic Dermatitis
- The effectiveness of baricitinib compared to upadacitinib for the treatment of atopic dermatitis is not directly compared in the provided studies.
- However, study 2 indicates that upadacitinib 30 mg may be more effective than baricitinib as a second-line systemic therapy, with network meta-analyses suggesting that upadacitinib 30 mg and abrocitinib 200 mg may be more effective than dupilumab and baricitinib.
- Study 3 reviews the use of baricitinib in moderate to severe atopic dermatitis, stating that it achieved significant improvements in disease severity and health-related quality of life over 16 weeks, with benefits generally sustained over the longer term.
- Studies 4, 5, and 6 provide information on the efficacy and safety of upadacitinib in patients with moderate to severe atopic dermatitis, but do not directly compare it to baricitinib.
Efficacy of Upadacitinib
- Study 4 reports that upadacitinib 30 mg showed the greatest clinical benefit, with a mean primary efficacy end point of 74% improvement in Eczema Area and Severity Index from baseline at week 16.
- Study 5 found that upadacitinib 30 mg plus topical corticosteroids resulted in a significantly higher proportion of patients achieving at least a 75% reduction in EASI score from baseline (77%) compared to placebo (26%).
- Study 6 demonstrates that upadacitinib treatment maintained efficacy through 52 weeks, with 75% improvement in EASI achieved by 82.0% and 84.9% of patients continuing the 15-mg and 30-mg doses, respectively.
Safety of Upadacitinib and Baricitinib
- Study 5 reports that upadacitinib 15 and 30 mg were well tolerated in combination with topical corticosteroids, with the most frequently reported treatment-emergent adverse events being acne, nasopharyngitis, and upper respiratory tract infection.
- Study 3 states that the safety profile of baricitinib in moderate to severe atopic dermatitis was consistent with that established in the moderate to severe rheumatoid arthritis population.