Baricitinib, abrocitinib show promise in treatment of lichen sclerosus

Among Janus kinase (JAK) inhibitors, baricitinib and abrocitinib demonstrate the most potential in improving the clinical symptoms of genital lichen sclerosus (LS), as shown in single-arm trials.

Though the evidence for extragenital LS remains limited to case reports, a therapeutic potential is also observed with baricitinib.

A team of investigators conducted a systematic review and searched the databases of PubMed, Cochrane, Embase, and the Airiti Library from inception to 16 January 2025. Due to the lack of relevant randomized trials, they also included single-arm trials, case reports, and case series.

Murad’s tool was utilized to assess the risk of bias among case reports and case series, while the Alsinbili’s tool was used to evaluate single-arm trials.

Nine studies met the eligibility criteria, including one single-arm trial and three case reports on baricitinib, one single-arm trial and one case report on abrocitinib, two case reports on topical ruxolitinib, and one case report on tofacitinib. The overall risk of bias was low to unclear.

In total, 43 patients with LS (31 females and 12 males) were included. Of these, four presented with extragenital LS and one with bullous type affecting both genital and extragenital areas.

The investigators noted improvements in clinical symptoms, lesion characteristics, and quality of life for both genital and extragenital LS. The adverse events seen were tolerable.

“These findings support baricitinib and abrocitinib as potential candidates for future randomized controlled trials,” the investigators said.