Baricitinib

 

What is Baricitinib?

Baricitinib is a targeted DMARD (Disease modifying anti-rheumatic drug), which works to dampen down the body’s inflammatory response. In certain diseases the immune system is over active, this can target healthy tissues such as joints. Baricitinib works on the inflammatory pathway to inhibit proteins called JAK, reducing the symptoms you should get from arthritis such as pain and joint swelling.

Baricitinib is known as a JAK inhibitor from its effects, there are other medications in this group such as tofacitinib.

 

What is Baricitinib used for? 

Baricitinib is used in patients with rheumatoid arthritis where their joints are very active and not responding to 2 or more conventional DMARDs. It is usually given alongside some of these medications such as methotrexate.

 

How is it taken? 

Baricitinib is taken as a tablet once daily. It can be taken with or without food. The dose is 2mg or 4mg daily, this is based on your age and how well your kidneys work.

If you miss a dose, take it as soon as you remember that day, but never double up the dose.

 

The effects from baricitinib are usually seen to start within a week, however we usually continue for 12 weeks before we review how well it is working. You will be seen in clinic at 3 months to monitor how well you are doing.

 

You will require blood monitoring of the medication once a year. If you are on other medications such as other DMARDs, the blood monitoring for them will need to continue as usual.

 

Side effects

Baricitinib is usually well tolerated by patients, however a small number of patients may experience some side effects such as feeling sick in the first few weeks of starting.

There are a few conditions that baricitinib has been found to make you slightly more susceptible to, these include:

 

• Infections
  • Including reactivation of shingles or chicken pox
    • You will need to speak to your GP about getting treatments for these. Baricitinib should be stopped until your infection has cleared up.
• High cholesterol
  • This will be checked at your 3-month review and if raised you may need to start treatment such as a statin.
• Liver derangement
  • Occasionally baricitinib affects the liver blood tests, this has been found to be more common if you are taking methotrexate.
• Risk of cancer
  • Baricitinib is a new drug so there isn’t as much long-term data. From trials there hasn’t been an observed link to say that baricitinib causes cancer.
    • If at any point you are under investigation you need to let your consultant know.
• Blood clots
  • A small number of patients have been reported to have blood clots whilst taking baricitinib.
  • If you develop leg swelling or shortness of breath, let your doctor know.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact. You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the baricitinib is commenced.
• If you have previously had problems with blood clots such as deep vein thrombosis (DVT) or pulmonary embolus then baracitinib will usually not be considered.

Operations

• Baricitinib should be withheld for 1 week prior to surgery.

During pregnancy and breastfeeding

• There is limited data on baricitinib in pregnancy and breastfeeding, therefore it is recommended to use contraception whilst taking it and for 1 week after stopping.

Alcohol

• Alcohol and baricitinib can both affect the liver. It is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking baricitinib.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org