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Baricitinib, a Janus kinase inhibitor, in the treatment of rheumatoid arthritis: a systematic literature review and meta-analysis of randomized controlled trials

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Abstract

Janus kinases (JAKs) play an important role in intracellular signaling for multiple cytokines in the pathogenesis of RA. Baricitinib is an oral, selective JAK 1 and 2 inhibitor which has been shown to be effective in the treatment of RA in several clinical trials. This meta-analysis aims to aggregate currently available data to assess the overall efficacy and safety of baricitinib in RA. We searched PubMed, EMBASE, and Cochrane CENTRAL from inception through 09/24/17 with restriction to English language. We excluded meeting abstracts without full text publication. We used RevMan 5.3 to perform meta-analysis between groups on baricitinib (2 and 4 mg daily) and placebo using random effect model calculating odds ratio (OR) as well as 95% confidence interval (CI). Compared to placebo, 2 mg of baricitinib was more effective in achieving ACR20 [54 vs. 36.6%; OR 2.09; 95% CI 1.60–2.71; p < 0.00001; I2 0%], ACR50 [31.6 vs. 10.3%; OR 2.3; 95% CI 1.68–3.15; p < 0.00001; I2 0%], and ACR70 responses [18.7 vs. 5.1%; OR 4.05; 95% CI 2.54–6.44; p < 0.00001; I2 0%]. Similarly, 4 mg of baricitinib daily was more effective than placebo. Baricitinib 2 mg once daily did not increase any adverse events [65.3 vs. 62.4%; OR 1.03; 95% CI 0.80–1.34; p = 0.8; I2 0%], serious adverse events [3.5 vs. 5%; OR 0.68; 95% CI 0.37–1.27; p = 0.22; I2 0%], and herpes zoster [1.2 vs. 0.4%; OR 2.34; 95% CI 0.27–20.47; p = 0.44; I2 37%] as compared to placebo. Similarly, 4 mg of baricitinib did not increase the risk of serious adverse events but increased herpes zoster infection [OR 3.88; 95% CI 1.36–11.06; p = 0.01; I2 0%] when compared to placebo. Baricitinib is effective in treatment of RA, and did not appear to have significant safety concerns during the first 6 months of treatment.

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Authors and Affiliations

  1. Department of Rheumatology, Medstar Washington Hospital Center, Washington, DC, USA

    Sumit Kunwar, Christopher E. Collins & Florina Constantinescu

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  1. Sumit Kunwar
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  2. Christopher E. Collins
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SK had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of data analysis. SK, CC, and FC were involved in study design. SK and FC were involved in acquisition of data. SK was involved in statistical analysis and interpreted the data. SK, CC, and FC were involved in manuscript preparation.

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Correspondence to Sumit Kunwar.

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Kunwar, S., Collins, C.E. & Constantinescu, F. Baricitinib, a Janus kinase inhibitor, in the treatment of rheumatoid arthritis: a systematic literature review and meta-analysis of randomized controlled trials. Clin Rheumatol 37, 2611–2620 (2018). https://doi.org/10.1007/s10067-018-4199-7

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