Efficacy and safety of baricitinib combined with topical corticosteroid for treatment of moderate to severe atopic dermatitis: a systematic review and meta-analysis

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is mainly treated with topical corticosteroid (TCS) in current days. Baricitinib, a JAK1/2 inhibitor, has emerged as a potential synergistic agent when combined with TCS. This study aimed to evaluate the efficacy and safety of baricitinib in combination with TCS for treating moderate to severe AD. Methods: The PRISMA guidelines were used to search the literature from PubMed, ScienceDirect, and CENTRAL databases, with the search conducted up to May 21, 2025. Eligible studies were randomized controlled trials (RCTs) evaluating baricitinib plus topical corticosteroids (TCS) compared to placebo or TCS alone in atopic dermatitis (AD) with moderate or higher severity. Primary outcomes included changes in EASI, vIGA-AD, DLQI, and adverse events. RevMan 5.4 was used to perform meta-analysis, with standardized mean differences (SMDs) and odds ratios (ORs) as appropriate. Result: Eight trials comprising 5,127 participants were included. Baricitinib (1, 2, and 4 mg) combined with TCS significantly improved vIGA-AD scores (OR 2.02, 95% CI: 1.72–2.38; p < 0.001), EASI scores (SMD –4.70, 95% CI: –5.40 to –4.01; p < 0.001), and DLQI (SMD –3.62, 95% CI: –4.81 to –2.42; p < 0.001). The combination also reduced pruritus (NRS) and POEM and ADSS scores. There was no significant increase in serious adverse events (OR 0.87, 95% CI: 0.57–1.31; p = 0.5), though minor increases in herpes simplex (OR 1.57; p = 0.02) and headache (OR 1.46; p = 0.03) were noted. The 4 mg dose provided the most favorable efficacy-safety balance. Conclusion: Baricitinib combined with topical corticosteroid treatment can improve the therapeutic efficacy in moderate to severe atopic dermatitis patients as indicated by improvements in vIGA-AD score, EASI score, DLQI change, Pruritus NRS, SCORAD, ADSS, POEM, and does not increase the risk of severe adverse reactions, nasopharyngitis, and acne.