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Olumiant ® (baricitinib)
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Olumiant® (baricitinib): Changes in Lymphocytes and Neutrophils in the Rheumatoid Arthritis Clinical Development Program
Lymphocyte and neutrophil counts were routinely monitored during clinical studies of baricitinib.
UK_cFAQ_BAR123A_X1_LYMPHOCYTES_NEUTROPHILS_CHANGES_RA
en-GB
Warnings and Precautions Related to Lymphocytes and Neutrophils
It is recommended to avoid initiation or interrupt BARI treatment in patients with an
- ALC <0.5 billion cells/L (500 cells/mm3), or
- ANC <1.0 billion cells/L (1000 cells/mm3).1
Mean Changes in Lymphocytes and Neutrophils Over Time
The 5-study pooled dataset included patients with RA randomized to BARI 4 mg or placebo from 1 phase 2 study and 4 phase 3 studies (RA-BEAM, RA-BUILD, RA-BEACON and RA-BALANCE). Data includes a long-term extension study (RA-BEYOND) with data through 13 February 2018.2
BARI 2 mg data is pooled from 3 of these studies in which both BARI 2 mg and BARI 4 mg were options during randomization (1 phase 2 study as well as RA-BUILD and RA-BEACON).2
Mean Lymphocyte Count Changes
Mean absolute lymphocyte count increased by 1 week after starting treatment with baricitinib, returned to baseline by week 24, and then remained stable through at least 104 weeks. For most patients, changes in lymphocyte count occurred within the normal reference range.1
As shown in Time Course of Lymphocyte Levels in Patients From 5-Study Pooled Dataset, mean lymphocyte counts increased within 4 weeks of initiation of BARI treatment, then stabilized and returned to baseline with prolonged administration.2-6
Abbreviations: BARI = baricitinib; PBO = placebo; SE = standard error; yrs = years.
Notes: *109 cells/L
Mean Neutrophil Count Changes
As shown in , mean Time Course of Neutrophil Levels in Patients From 5-Study Pooled Dataset neutrophil counts decreased within 4 weeks of initiation of BARI treatment, followed by stabilization and an increase to baseline after treatment discontinuation.2-6
Abbreviations: BARI = baricitinib; PBO = placebo; SE = standard error; yrs = years.
Notes: *109 cells/L
Adverse Events of Lymphopenia and Neutropenia
Evaluation of TEAEs included MedDRA preferred terms identified from the Blood and Lymphatic System Disorders System Organ Class.2
Rates of TEAEs as well as treatment interruption and permanent discontinuation of study treatment due to TEAEs of lymphopenia and neutropenia for all of the integrated analysis datasets are provided in Overview of Treatment-Emergent Adverse Events of Lymphopenia and Neutropenia.
|
Lymphopenia |
Neutropenia |
||||
|
TEAE n [EAIR] |
Temporary interruption of treatment n [EAIR] |
Permanent DC of treatment n [EAIR] |
TEAE n [EAIR] |
Temporary interruption of treatment n [EAIR] |
Permanent DC of treatment n [EAIR] |
7-Study Dataset through 24 weeks of assigned treatment |
||||||
Placebo (N=1215) |
11 [2.4] |
3 [0.7] |
0 |
2 [0.4] |
1 [0.2] |
0 |
BARI 2 mg (N=479) |
3 [1.6] |
1 [0.5] |
1 [0.5] |
0 |
0 |
0 |
BARI 4 mg (N=1142) |
7 [1.5] |
3 [0.6] |
0 |
7 [1.5] |
0 |
0 |
4-Study Extended Dataseta |
||||||
BARI 2 mg (N=479) |
8 [1.0] |
3 [0.4] |
1 [0.1] |
0 |
0 |
0 |
BARI 4 mg (N=479) |
10 [1.3] |
2 [0.3] |
2 [0.3] |
3 [0.4] |
0 |
0 |
All BARI RA datasetb |
||||||
All BARI RA (N=3770) |
146 [1.1] |
49 [0.4] |
10 [0.1] |
56 [0.4] |
8 [0.01] |
8 [0.1]c |
Abbreviations: BARI = baricitinib; DC = discontinuation; EAIR = exposure-adjusted incidence rate; MONO = monotherapy; MTX = methotrexate; RA = rheumatoid arthritis; TEAE = treatment-emergent adverse event.
aThe extended dataset included patients with RA randomized to BARI 4 mg (N=479, PYE=781.1) or BARI 2 mg (N=479, PYE=774.9) from 2 phase 2 and 2 phase 3 studies (RA-BUILD, RA-BEACON) and 1 long term extension study (RA-BEYOND). The evaluation time periods included randomization through last available observation incorporating extension data through 01 September 2019 unless otherwise specified. Data were censored at rescue or dose change.
bThe All BARI RA analysis set included 3770 patients with RA who received BARI at a variety of doses from 1 phase 1, 3 phase 2, and 5 phase 3 studies (RA-BEGIN, RA-BEAM, RA-BUILD, RA-BEACON, RA-BALANCE). Data includes a long-term extension study (RA-BEYOND) with 13,148 PYE, median exposure of 4.2 yrs, maximum exposure of 8.4 yrs, and data through 01 September 2019.
cOne additional event of febrile neutropenia was reported.
Information from the label
ALC and ANC should be monitored before treatment initiation and thereafter according to routine patient management.1
Absolute Neutrophil Count (ANC) < 1 x 109 cells/L and Absolute Lymphocyte Count (ALC) < 0.5 x 109 cells/L were reported in less than 1 % of patients in clinical trials. Haemoglobin < 8 g/dL was reported in less than 1 % of patients in rheumatoid arthritis clinical trials.1
Treatment should not be initiated, or should be temporarily interrupted, in patients with an
- ANC < 1 x 109 cells/L,
- ALC < 0.5 x 109 cells/L or
- haemoglobin < 8 g/dL
observed during routine patient management.1
The risk of lymphocytosis is increased in elderly patients with rheumatoid arthritis. Rare cases of lymphoproliferative disorders have been reported.1
In controlled studies, for up to 16 weeks, neutropenia (<1 x 109 cells/L) was uncommonly reported (≥ 1/1000). 1
Mean neutrophil counts decreased at 4 weeks and remained stable at a lower value than baseline over time. There was no clear relationship between neutropaenia and the occurrence of serious infections. However, in clinical studies, treatment was interrupted in response to ANC < 1 x 109 cells/L.1
References
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.
3Kremer J, Huizinga TWJ, Chen L, et al. Analysis of neutrophils, lymphocytes, and platelets in pooled phase 2 and phase 3 studies of baricitinib for rheumatoid arthritis. Poster presented at: European League Against Rheumatism (EULAR) Annual Meeting; June 14-17, 2017; Madrid, Spain.
4Eli Lilly and Company. Lilly FDA Advisory Committee Meeting NDA 207924 Briefing Document. https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ArthritisAdvisoryCommittee/UCM605062.pdf. Accessed May 2, 2018a. https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ArthritisAdvisoryCommittee/UCM605062.pdf
5Smolen JS, Genovese MC, Takeuchi T, et al. Safety profile of baricitinib in patients with active rheumatoid arthritis with over 2 years median time in treatment [published online September 15, 2018]. J Rheumatol. https://dx.doi.org/10.3899/jrheum.171361
6Kay J, Harigai M, Rancourt J, et al. Changes in selected haematological parameters associated with JAK1/JAK2 inhibition observed in patients with rheumatoid arthritis treated with baricitinib. RMD Open. 2020;6:e001370. http://dx.doi.org/10.1136/rmdopen-2020-001370
7Genovese MC, Smolen JS, Takeuchi T, et al. Safety profile of baricitinib for the treatment of rheumatoid arthritis up to 8.4 years: an updated integrated safety analysis. Ann Rheum Dis. 2020;79(suppl 1):638. European League Against Rheumatism abstract FRI0123. https://ard.bmj.com/content/79/Suppl_1/642.1
8Genovese MC, Smolen JS, Takeuchi T, et al. Safety profile of baricitinib for the treatment of rheumatoid arthritis up to 8.4 years: an updated integrated safety analysis. Poster presented at: European League Against Rheumatism Virtual Congress; June 3-6, 2020.
Glossary
ALC = absolute lymphocyte count
ANC = absolute neutrophil count
BARI = baricitinib
RA = rheumatoid arthritis
SAE = serious adverse event
TEAE = treatment-emergent adverse event
VTE = venous thromboembolism
Date of Last Review: 14 March 2021
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