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

Objectives: Baricitinib 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. Methods: We 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. Results: The 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. Conclusion: In 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.