Recently, the European Medicines Agency (EMA) recommended Olumiant (baricitinib) for the treatment of adult patients with moderate to severe atopic dermatitis. Currently, Olumiant is approved for the treatment of moderate to severe rheumatoid arthritis (RA). As both set of patients could benefit from systemic therapy, or therapy which affects the entire body, the EMA seeks to indicate Olumiant as a dermatitis therapy.
Olumiant
According to the Olumiant website, the therapy is a once-daily Janus kinase (JAK) inhibitor. These work by:
[disrupting] how cells respond to some cytokines, or proteins that allow cells to communicate with each other. Excess cytokines may cause inflammation.
Since patients with atopic dermatitis often experience itchy and uncomfortable skin inflammation, Olumiant can reduce inflammatory reactions. This is the first orally administered therapy for patients with moderate to severe atopic dermatitis. It also offers a more targeted and effective option than moisturizers or topical creams. As the EMA notes:
It is used in patients with moderate to severe arthritis when standard treatment with disease‑modifying anti‑rheumatic drugs (also known as ‘DMARDs’) has not worked well enough or if patients cannot tolerate them. Olumiant can be used either alone or in combination with the DMARD methotrexate.
Thus, Olumiant seems to be promising for patients with RA and atopic dermatitis who have not responded to prior treatments. The EMA suggests Olumiant’s use for patients with dermatitis based on data from multiple Phase 3 clinical trials. In all cases, Olumiant reduced symptoms and provided better help than placebos. Adverse reactions include headache, respiratory tract infections, increased bad cholesterol levels, and herpes simplex (HSV) infection.
Atopic dermatitis typically begins in childhood. Patients may experience flares, as well as periods of remission. Generally, doctors are not sure exactly what prompts AD. However, the immune system becomes overactive, sparking skin inflammation. Some researchers believe there might be a genetic component to AD. Gene mutations cause poor filaggrin production, preventing the body from adequately protecting the skin. Thus, moisture escapes and bacteria and viruses enter. AD is common in patients with asthma or allergic rhinitis.
Symptoms of atopic dermatitis include:
- Dry, itchy skin
- Sore or painful skin
- Extreme itching
- Skin discoloration
- Sleep disruptions
- Red, purple, brown, or gray rashes that might weep or bleed
- Lichenification, or skin thickening
- Frequent skin infections
- Anxiety
- Depression
