Baricitinib
OLUMIANT
Pronunciation: bar-i-SYE-ti-nib (oe-LOO-mee-ant)
“Olu Mel, the Berry City nibbler”
jack → Janus kinase (JAK) inhibitor
What it isJAK1/JAK2 inhibitor; rheumatoid arthritis, severe alopecia areata, and hospitalized COVID-19.
Why this oneIts COVID-19 role separates it from other rheumatology JAK inhibitors, while alopecia efficacy extends it beyond arthritis.
What limits itSerious infection, mortality, malignancy, cardiovascular events, and thrombosis carry boxed warnings; renal clearance guides use.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Rheumatoid arthritis (monotherapy or with MTX/other non-biologic DMARDs) | Adults | 2 mg QD | 2 mg QD | 2 mg QD |
| COVID-19 (hospitalized) | Adults | 4 mg QD | 4 mg QD x up to 14 days or until hospital discharge, whichever first | 4 mg QD |
| Alopecia areata | Adults | 2 mg QD (consider 4 mg QD upfront if near-complete/complete scalp hair loss) | 2-4 mg QD — increase to 4 mg if response inadequate; step back to 2 mg once adequate response on 4 mg | 4 mg QD |
Renal RA: eGFR 30-<60 -> 1 mg QD; <30 not recommended. AA: eGFR 30-<60 -> halve dose (2->1 mg, 4->2 mg); <30 not recommended. COVID-19: eGFR 30-<60 -> 2 mg QD; 15-<30 -> 1 mg QD; <15/dialysis/AKI not recommended
Hepatic Mild-moderate: no adjustment. Severe: not recommended (RA, AA); in COVID-19 only if benefit outweighs risk
Avoid in patients at risk for thrombosis; discontinue after MI or stroke
Instructions
- With or without food
- Unable to swallow tablets: disperse in water PO, or via G/NG/OG tube (dispersion stable 4 h; use PPE/ventilation if crushing)
- Do not initiate if ALC <500, ANC <1000, or Hgb <8 g/dL (RA/AA), or ALC <200 / ANC <500 (COVID-19); interrupt until recovered above these thresholds
- Before starting: latent/active TB evaluation (treat latent TB first; TB testing not required for COVID-19), viral hepatitis screen, CBC, LFTs/renal function; update immunizations (RA/AA)
- Avoid live vaccines during treatment
- With strong OAT3 inhibitors (e.g. probenecid): 4 mg->2 mg, 2 mg->1 mg; if on 1 mg, consider discontinuing probenecid
- Interrupt for serious infection until controlled; interrupt if DILI suspected
Available strengths
- tab 1, 2, 4 mg
Cautions
- Serious/opportunistic infections incl. TB, invasive fungal — avoid with active serious infection; monitor for TB even if baseline test negative
- Higher all-cause mortality, malignancy (lymphoma, lung cancer), MACE, and thrombosis (DVT/PE, arterial) — class findings; smokers at added risk
- Hypersensitivity (angioedema, urticaria, rash) — discontinue if serious
- GI perforations — evaluate new-onset abdominal symptoms; caution with diverticulitis history
- Hypoglycemia in diabetics on antidiabetic therapy
- Laboratory abnormalities: neutropenia, lymphopenia, anemia, liver-enzyme and lipid elevations — monitor CBC, LFTs, lipids
Adverse reactions
- RA (>=1%): URTI, nausea, herpes simplex, herpes zoster
- COVID-19: liver-enzyme increases, thrombocytosis, CPK increase, neutropenia, DVT, PE, UTI
- Alopecia areata: URTI, headache, acne, hyperlipidemia, CPK increase, UTI, liver-enzyme elevations, folliculitis, fatigue, LRTI, nausea, genital Candida, anemia, neutropenia, abdominal pain, herpes zoster, weight increase
Pregnancy May cause fetal harm (animal malformations at >=11x MRHD); insufficient human data — weigh risks/benefits of use in pregnancy
Lactation Do not breastfeed during treatment and for 4 days after last dose
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 1 mg | tab | 30 qd | — | not offered | |
| 2 mg | tab | 30 qd | — | $2,776.30 | not offered |
| 4 mg | tab | 30 qd | — | $5,539.87 | not offered |
⚠ BOXED WARNINGS
- Serious infections
- Mortality
- Malignancy
- Major adverse cardiovascular events
- Thrombosis
Classes and tags
Clinical profile
Legacy pregnancy categoryN/A (post-2015 labeling)
Defining liabilitySerious infection and thrombotic/cardiovascular risk