Baricitinib: From Rheumatoid Arthritis to COVID‐19

Abstract

Baricitinib is a JAK1/2 inhibitor first approved for treating moderate to severe rheumatoid arthritis but later showed considerable efficacy in the control of exaggerated inflammatory responses that occur in a wide range of diseases. There is a growing body of evidence, obtained from clinical trials and case reports, demonstrating clinical and paraclinical improvement in patients following administration of baricitinib including rheumatoid arthritis, systemic lupus erythematosus, psoriasis, atopic dermatitis, alopecia areata, interferon-mediated auto-inflammatory diseases, graft versus host disease, diabetic kidney disease, and recently, coronavirus disease-19. However, despite overall encouraging results, many adverse effects have been observed in baricitinib-treated patients ranging from simple infections to increased risk of malignancies, particularly in long-term use. The significant efficacy of baricitinib on one hand and the probable adverse effects, on the other hand, urge for further investigations before establishing it as a part of standard therapeutic protocols.Herein, we have provided a review of the studies which have used baricitinib for treating various inflammatory disorders and summarized the advantages and disadvantages of its administration.

Hydroxypropyl-beta-cyclodextrin (HP-BCD) inhibits SARS-CoV-2 replication and virus-induced inflammatory cytokines

“…Representing an unprecedent human threat in this century, therapeutic interventions are urgently needed along with currently available vaccines to alleviate patients’ symptoms, lower case fatality, and relieve overburdened health care systems. A few pharmacology interventions have been approved ( De Clercq, 2021 ; Assadiasl et al, 2021 ; Bernal et al, 2021 ), but most of them do not show a robust impact on disease progression. The use of monoclonal antibodies has been one of the important strategies available so far, but their use is restricted to early acute disease ( Kreuzberger et al, 2021 ).…”

Development of Sustained Release Baricitinib Loaded Lipid-Polymer Hybrid Nanoparticles with Improved Oral Bioavailability

“…Baricitinib (BTB) is a small molecule that inhibits Janus-associated kinase (JAK) and therapeutically is used for a group of severe inflammatory disorders including resistant rheumatoid arthritis (RA), systemic lupus erythematosus, auto-inflammatory disease, dermatologic disorders, graft versus host disease and uncontrolled infections [ 1 , 2 ]. Recently, it has been reported that BTB interrupts the signalling of multiple cytokines implicated in coronavirus disease-19 (COVID-19) immunopathology.…”

JAK inhibition as a new treatment strategy for patients with COVID-19

“…Meanwhile, the two groups had similar adverse events, including secondary infection and thrombotic events. The safety of JAKi combined with MTX or other biologics such as Tocilizumab has been confirmed [175] ; however, the efficacy is still under investigation [124] , [176] . Numerous clinical trials are underway to explore the appropriate timing (NCT04361903), optimum administration dosage (NCT04377620), treatment course (NCT04414098), and combination with other agents such as Anakinra and Tocilizumab (NCT04366232).…”

“…Inhibiting JAK-STAT signaling has been hypothesized to block downstream signals of inflammatory factors, including IFNα/β/γ, which play an essential role in responding to bacterial infection and curbing virus activity [4] , [124] , [125] , [126] , [127] . Increased risk of malignancies is the mainly concerning disadvantage of using Baricitinib for a long time [128] , [129] .…”