Baricitinib for adult atopic dermatitis: real-world effectiveness, safety, and response predictors

ObjectivesBaricitinib has shown efficacy and a favorable safety profile in randomized trials for moderate-to-severe atopic dermatitis (AD), but real-world evidence is limited. We conducted a multicenter, retrospective and prospective study aimed at evaluating the long-term effectiveness and safety profile of baricitinib in the treatment of adult patients affected from AD, with the additional goal of identifying potential predictors of treatment response.MethodsWe included adult AD patients treated with baricitinib between January 2023 and November 2024 at five Italian tertiary centers. Disease severity and patient-reported outcomes, including the Eczema Area and Severity Index (EASI), Body Surface Area (BSA), Itch Numeric Rating Scale (Itch-NRS), Sleep Numeric Rating Scale (Sleep-NRS), Dermatology Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM), and Minimal Disease Activity (MDA, defined as EASI <= 3 and Itch-NRS <= 1), were assessed at baseline and weeks 4, 16, 32, and 52.ResultsThe 52 patients enrolled showed significant and sustained improvements in physician- (BSA, EASI) and patient-reported outcomes (Itch-NRS, Sleep-NRS, DLQI, POEM). At week 16, atopic comorbidities increased the odds of achieving MDA (OR: 10.9; p = 0.033), whereas head and neck involvement reduced the likelihood of response (OR: 0.07 p = 0.028). Thirty-two mild to moderate adverse events occurred in 28 patients, none requiring treatment discontinuation.ConclusionIn this real-world study, baricitinib provided substantial long-term effectiveness with a favorable safety profile in moderate-to-severe AD, and atopic comorbidities emerged as a predictor of optimal clinical response at week 16.