Baricitinib(艾乐明)巴瑞替尼的适应症、用药注意事项及禁忌,Baricitinib(Baricitinib)适用于：1、对一种或多种TNF受体阻滞剂反应不足的中度至重度活动性类风湿性关节炎成人患者的治疗；2、需要补充氧气、无创或有创机械通气(ECMO)的住院成人的COVID-19(新冠病毒)治疗；3、成人重度斑秃患者的治疗。

Baricitinib (trade name Olumiant) is a medication that has been approved for the treatment of rheumatoid arthritis, COVID-19, and alopecia areata. It is a Janus kinase (JAK) inhibitor that works by suppressing the activity of specific enzymes involved in inflammation and the immune response. While it has shown efficacy in these conditions, it is important to be aware of the indications, precautions, and contraindications when using baricitinib.

1. Indications for Baricitinib:

1.1 Rheumatoid arthritis: Baricitinib is approved for the treatment of moderately to severely active rheumatoid arthritis in adults who have had an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs). It can be used as a monotherapy or in combination with methotrexate.

1.2 COVID-19: Baricitinib has been indicated in combination with remdesivir for the treatment of hospitalized adult and pediatric patients aged two years and older with COVID-19 who require supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

1.3 Alopecia areata: Baricitinib has demonstrated effectiveness in the treatment of moderate to severe alopecia areata, an autoimmune disease that causes patchy hair loss. It may be used as an alternative treatment option when other therapies have failed.

2. Precautions when using Baricitinib:

2.1 Infections: Baricitinib may increase the risk of serious infections, including bacterial, viral, and fungal infections. Before initiating treatment, it is important to assess patients for latent or active infections and to exercise caution when administering the medication to individuals with a history of chronic or recurring infections.

2.2 Thrombosis: There have been reports of deep vein thrombosis and pulmonary embolism in patients taking baricitinib. Healthcare providers should consider the potential increased risk of thrombosis in patients who already have risk factors, such as age, obesity, or a history of prior thrombosis, and weigh the benefits against the risks of treatment.

2.3 Malignancies: Baricitinib has been associated with an increased risk of malignancies, including lymphoma. Healthcare providers should monitor patients for signs and symptoms of malignancies during treatment.

3. Contraindications for Baricitinib:

3.1 Hypersensitivity: Baricitinib should not be used in individuals with a known hypersensitivity to the drug or any of its components. Hypersensitivity reactions, including skin rash and anaphylaxis, have been reported in some patients.

3.2 Pregnancy and breastfeeding: The use of baricitinib during pregnancy and breastfeeding is not recommended. Animal studies have shown fetal harm, and it is unknown whether the drug is excreted in human milk.

3.3 Severe liver impairment: Baricitinib is not recommended for use in patients with severe hepatic impairment. The metabolism of the drug may be affected, leading to increased exposure and potential adverse effects.

In conclusion, baricitinib is a medication with multiple indications, including rheumatoid arthritis, COVID-19, and alopecia areata. However, it is important to exercise caution and adhere to the precautions and contraindications when prescribing and using this medication. Healthcare providers should carefully consider the individual patient's medical history and risk factors before initiating treatment with baricitinib. Regular monitoring and close supervision are essential to ensure patient safety and optimize treatment outcomes.