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).

What are the pharmacokinetics for Olumiant® (baricitinib)?

A summary of baricitinib pharmacokinetics (PK) is provided including information on absorption, distribution, metabolism, and elimination.

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Pharmacokinetic Properties of Baricitinib

Absorption

Following oral administration, baricitinib is rapidly absorbed with a median tmax of approximately 1 hour (range 0.5 - 3.0 h) and an absolute bioavailability of approximately 79 % (CV = 3.94 %).1

Food intake led to a decreased exposure by up to 14 %, a decrease in Cmax by up to 18 % and delayed tmax by 0.5 hours. Administration with meals was not associated with a clinically relevant effect on exposure.1

Distribution

Mean volume of distribution following intravenous infusion administration was 76 L, indicating distribution of baricitinib into tissues. Baricitinib is approximately 50 % bound to plasma proteins.1

Biotransformation

Baricitinib metabolism is mediated by cytochrome P450 3A4 (CYP3A4), with less than 10 % of the dose identified as undergoing biotransformation.1

No metabolites were quantifiable in plasma. In a clinical pharmacology study, baricitinib was excreted predominately as the unchanged active substance in urine (69 %) and faeces (15 %) and only 4 minor oxidative metabolites were identified (3 in urine; 1 in faeces) constituting approximately 5 % and 1 % of the dose, respectively.1

In vitro, baricitinib

  • is a substrate for CYP3A4, organic anion transporter (OAT)3, P-glycoprotein (Pgp), breast cancer resistance protein (BCRP) and multidrug and toxin extrusion protein (MATE)2-K, and
  • may be a clinically relevant inhibitor of the transporter OCT1.1

Baricitinib is not an inhibitor of the transporters

  • OAT1, OAT2, OAT3,
  • OCT2,
  • OATP1B1, OATP1B3,
  • BCRP,
  • MATE1 and MATE2-K

at clinically relevant concentrations.1

Elimination

Renal elimination is the principal mechanism for baricitinib’s clearance through glomerular filtration and active secretion via

  • OAT3,
  • Pgp,
  • BCRP and
  • MATE2-K.1

In a clinical pharmacology study, approximately 75 % of the administered dose was eliminated in the urine, while about 20 % of the dose was eliminated in the faeces.1

Mean apparent clearance (CL/F) and half-life in patients with rheumatoid arthritis was 9.42 L/hr (CV = 34.3 %) and 12.5 hrs (CV = 27.4 %), respectively. Cmax and area under the concentration-time curve (AUC) at steady state are 1.4- and 2.0–fold higher, respectively, in subjects with rheumatoid arthritis compared to healthy subjects.1

Mean apparent clearance (CL/F) and half-life in patients with atopic dermatitis was 11.2 L/hr (CV = 33.0 %) and 12.9 hrs (CV = 36.0 %), respectively. Cmax and AUC at steady state in patients with atopic dermatitis are 0.8-fold those seen in rheumatoid arthritis.1

Mean apparent clearance (CL/F) and half‑life in patients with alopecia areata was 11.0 L/hr (CV = 36.0 %) and 15.8 hrs (CV = 35.0 %), respectively. Cmax and AUC at steady state in patients with alopecia areata are 0.9‑fold those seen in rheumatoid arthritis.1

Pharmacokinetics in Special Populations

Renal Impairment

Renal function was found to significantly affect baricitinib exposure.1

  • The mean ratios of AUC in patients with mild and moderate renal impairment to patients with normal renal function are 1.41 (90 % CI: 1.15-1.74) and 2.22 (90 % CI: 1.81-2.73), respectively.1
  • The mean ratios of Cmax in patients with mild and moderate renal impairment to patients with normal renal function are 1.16 (90 % CI: 0.92-1.45) and 1.46 (90 % CI: 1.17-1.83), respectively.1

Hepatic Impairment

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

Elderly

Age ≥ 65 years or ≥ 75 years has no effect on baricitinib exposure (Cmax and AUC).1

Paediatric population

The safety, efficacy and pharmacokinetics of baricitinib have not yet been established in a paediatric population.1

Other intrinsic factors

  • Body weight,
  • sex,
  • race, and
  • ethnicity

did not have a clinically relevant effect on the PK of baricitinib.1

The mean effects of intrinsic factors on PK parameters (AUC and Cmax) were generally within the inter-subject PK variability of baricitinib. Therefore, no dose adjustment is needed based on these patient factors.1

References

1Olumiant [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.

Date of Last Review: 13 June 2022


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