Baricitinib 2–4mg (Atopic Dermatitis / Alopecia Areata)

Atopic dermatitis (adults) and alopecia areata: recommended dose 4 mg once daily. A dose of 2 mg once daily is recommended for patients at higher risk of VTE, MACE and malignancy, for patients aged >= 65 years and for patients with a history of chronic or recurrent infections. 4 mg once daily may be considered for patients not adequately controlled on 2 mg once daily; 2 mg once daily should be considered for patients with sustained control on 4 mg who are eligible for dose tapering. Atopic dermatitis: may be used with or without topical corticosteroids (efficacy may be enhanced with topical corticosteroids); topical calcineurin inhibitors reserved for sensitive areas (face, neck, intertriginous, genital); consider discontinuing if no evidence of therapeutic benefit after 8 weeks. Alopecia areata: once stable response achieved, continue for at least several months to avoid relapse; re-assess benefit-risk at regular intervals; consider discontinuing if no evidence of benefit after 36 weeks. Treatment initiation: do not initiate if absolute lymphocyte count < 0.5 x 10^9 cells/L, absolute neutrophil count < 1 x 10^9 cells/L, or haemoglobin < 8 g/dL. Dose reduction: in adults taking strong OAT3 inhibitors such as probenecid the recommended dose is 2 mg (paediatric dose reduced by half). Paediatric atopic dermatitis (children and adolescents 2 years and older, weight-band dosing, NOT per kg): 4 mg once daily if weighing 30 kg or more; 2 mg once daily if weighing 10 kg to less than 30 kg; consider halving the dose in those with sustained control eligible for tapering; safety and efficacy not established under 2 years, and not established in children under 18 years with alopecia areata. Hepatic impairment: no dose adjustment in mild or moderate; not recommended in severe. Clinical experience in patients aged >= 75 years is very limited. Take once daily with or without food, at any time of day; tablets may be dispersed in water only for paediatric patients unable to swallow them whole. Baricitinib should only be used if no suitable treatment alternatives are available in patients 65 years and older, those with a history of atherosclerotic cardiovascular disease or other cardiovascular risk factors, and those with malignancy risk factors. SPC also states a rheumatoid arthritis regimen (4 mg once daily, 2 mg once daily in higher-risk groups) and a juvenile idiopathic arthritis regimen (2 to <18 years: 4 mg once daily if >= 30 kg, 2 mg once daily if 10 kg to <30 kg).