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Olumiant ® (baricitinib)
This information is intended for UK registered healthcare professionals only as a scientific exchange in response to your search for information.For current prescribing information for all Lilly products, including Summaries of Product Characteristics, Patient Information Leaflets and Instructions for Use, please visit: www.medicines.org.uk (England, Scotland, Wales) or www.emcmedicines.com/en-GB/northernireland/ (Northern Ireland).
How should Olumiant® (baricitinib) be used in atopic dermatitis patients with hepatic impairment?
No dose adjustment is required in patients with mild or moderate hepatic impairment. The use of baricitinib has not been studied in patients with severe hepatic impairment and is therefore not recommended.
Baricitinib Label Information Related to Hepatic Impairment
No dose adjustment is required in patients with mild or moderate hepatic impairment. Baricitinib is not recommended for use in patients with severe hepatic impairment.1
There was no clinically relevant effect on the PK of baricitinib in patients with mild or moderate hepatic impairment. The use of baricitinib has not been studied in patients with severe hepatic impairment.1
Dose dependent increases in blood alanine transaminase (ALT) and aspartate transaminase (AST) activity were reported in patients treated with baricitinib.1
Increases in ALT and AST to ≥ 5 and ≥ 10 x upper limit of normal (ULN) were reported in clinical trials. In rheumatoid arthritis clinical studies, combination with methotrexate resulted in increased frequency of hepatic transaminase elevations compared with baricitinib monotherapy.1
If increases in ALT or AST are observed during routine patient management and drug-induced liver injury is suspected, treatment should be temporarily interrupted until this diagnosis is excluded.1
Please refer to section 4.8 of the Olumiant Summary of Product Characteristics for further information on this topic.
Clinical Studies Excluded Patients With History of Chronic Liver Disease
Patients were excluded from participating in BARI phase 3 clinical studies of atopic dermatitis if they had a history of
- a hepatic disorder that could constitute an unacceptable risk when taking investigational product or interfere with the interpretation of data
- laboratory abnormalities at screening of AST, ALT, or ALP >2 times the ULN or total bilirubin ≥1.5 times the ULN
- active hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, or
- chronic alcohol abuse, intravenous drug abuse, or other illicit drug abuse within the 2 years prior to study entry.2
Pharmacokinetic Analyses of Special Populations
Systemic Exposure to Baricitinib in Subjects With Moderate Hepatic Impairment
A phase 1 study (JAGC) evaluated the effect of hepatic impairment on the PK of a single 4-mg dose of BARI in subjects with moderate hepatic impairment (based on Child-Pugh B classification) compared with healthy subjects.3
Based on study results, there was no evidence to suggest any clinically relevant difference in systemic exposure in subjects with moderate hepatic impairment compared with subjects with normal hepatic function.3
Effect of Hepatic Transaminase and Bilirubin Covariates on the Pharmacokinetics of Baricitinib
Data from 4 RA phase 3 studies were pooled with 3 RA phase 2 studies in a combined population PK analysis. In the pooled analysis, potential covariates evaluated were
- ALT, (mean=20.6 U/L; range=4 to 175 U/L),
- AST, (mean=20.4 U/L; range=5 to 97 U/L), and
- total bilirubin (mean=6.0 μM; range=2.0 to 35.9 μM).
Neither ALT nor AST, or bilirubin was found to have a significant effect on the PK of BARI.2
In summary, moderate hepatic dysfunction did not affect BARI PK, and no dose adjustment is recommended for patients with mild or moderate hepatic impairment.2
1Olumiant [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
2Data on file, Eli Lilly and Company and/or one of its subsidiaries.
3A pharmacokinetic study of baricitinib in participants with liver disease. ClinicalTrials.gov website. https://clinicaltrials.gov/ct2/show/results/NCT01870388 . Updated June 6, 2017. Accessed February 25, 2020.
ALP = alkaline phosphate
ALT = alanine aminotransferase
AST = aspartate aminotransferase
BARI = baricitinib
PK = pharmacokinetic
RA = rheumatoid arthritis
ULN = upper limit of normal
Date of Last Review: 10 February 2020