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Janus kinase inhibitors (JAKi) are effective drugs for the treatment of several immune-mediated inflammatory diseases and are increasingly prescribed.
The Netherlands Pharmacovigilance Centre Lareb received an adverse drug reaction (ADR) report of a potential glucose lowering effect in a 54-year-old male patient with diabetes mellitus type 1 (DM1) using baricitinib (4 mg daily) for rheumatoid arthritis (RA).1 Within 2 weeks after baricitinib initiation, this patient had to reduce the dosage of both insulin degludec (from 18 units to 14 units) and insulin aspart in order to prevent hypoglycaemia. Concomitant medication included methotrexate, tiotropium/olodaterol nebuliser and beclomethasone aerosol. When baricitinib was temporarily discontinued for 6 weeks due to a respiratory tract infection, the insulin dosages had to be increased, whereas insulin dosages needed to be reduced again after restarting baricitinib. The onset of glucose decrease shortly after initiation of JAKi treatment and recurrence after rechallenge with baricitinib suggests a causal relationship. Glucose lowering is not a labelled ADR and no warning for patients with diabetes is mentioned in the European or FDA product information of baricitinib, tofacitinib, upadacitinib or filgotinib. A comparable case has been published concerning a 71-year-old female patient with RA that was complicated by systemic sclerosis and DM1. …
Handling editor Josef S Smolen
Contributors JAvL analysed the reports and drafted the manuscript with NTJ and FPAMvH. All authors critically revised the manuscript and approved the final version to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests BJFvdB has served on advisory board or as speaker for Galapagos, Eli Lilly and UCB. MBAvD reports grants and has served on advisory board or as speaker for Novartis and Janssen Cilag and has served on advisory board or as speaker for AbbVie, LEO Pharma, BMS, Celgene, Lilly, MSD, Pfizer, Sanofi Genzyme, outside the submitted work. HV has served on advisory boards, or as speaker, or consultant for AbbVie, Amgen, AstraZeneca, BMS, Celgene, Celltrion, Galapagos, Gilead, GSK, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, Roche and Sanofi Genzyme, all outside the submitted work.
Patient and public involvement Patients were not involved in the design, or conduct, or dissemination plans of this research. Patients were involved in the reporting of adverse drug reactions.
Provenance and peer review Not commissioned; externally peer reviewed.
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