Symptomatic elevation creatine kinase following treatment of rheumatoid arthritis with baricitinib

  • Pamela AnjaraEmail author
  • Matthew Jiang
  • Maninder Mundae
Letters of Biomedical and Clinical Research


The aim of RA treatment is to achieve reduction of disease activity and prevent joint damage and disability. Baricitinib is a synthetic small molecule which targets the JAK/STAT pathway which is implicated in the inflammatory response in RA. Baricitinib selectively targets JAK1 and JAK2 and has been shown to have efficacy in treating patients with RA. Common adverse effects reported during baricitinib therapy includes infection, asymptomatic changes in laboratory parameters including changes in neutrophil, lymphocyte, platelet counts, alanine aminotransferase, cholesterol, creatinine and creatine kinase (CK). We report the first two documented cases in Australia of baricitinib-induced symptomatic elevation of CK.


Baricitinib Creatine kinase Rheumatoid arthritis 


Compliance with ethical standards




  1. 1.
    Kawalec P, Sladowska K, Malinowska-Lipien I, Brzostek T, Kozka M (2019) New alternative in the treatment of rheumatoid arthritis: clinical utility of baricitinib. Ther Clin Risk Manag 15:275–284CrossRefGoogle Scholar
  2. 2.
    Shi JG, Chen X, Lee F, Emm T, Scherle PA, Lo Y, Punwani N, Williams WV, Yeleswaram S (2014) The pharmacokinetics, pharmacodynamics, and safety of baricitinib, an oral JAK 1/2 inhibitor, in healthy volunteers. J Clin Pharmacol 54(12):1354–1361CrossRefGoogle Scholar
  3. 3.
    Genovese MC, Kremer J, Zamani O, Ludivico C, Krogulec M, Xie L, Beattie SD, Koch AE, Cardillo TE, Rooney TP, Macias WL, de Bono S, Schlichting DE, Smolen JS (2016) Baricitinib in patients with refractory rheumatoid arthritis. N Engl J Med 374(13):1243–1252CrossRefGoogle Scholar
  4. 4.
    Smolen JS, Landewe R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M et al (2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 76(6):960–977CrossRefGoogle Scholar
  5. 5.
    Fleischmann R, Schiff M, van der Heijde D, Ramos-Remus C, Spindler A, Stanislav M et al (2017) Baricitinib, methotrexate, or combination in patients with rheumatoid arthritis and no or limited prior disease-modifying antirheumatic drug treatment. Arthritis Rheum 69(3):506–517CrossRefGoogle Scholar
  6. 6.
    Kunwar S, Collins CE, Constantinescu F (2018) Baricitinib, a Janus kinase inhibitor, in the treatment of rheumatoid arthritis: a systematic literature review and meta-analysis of randomized controlled trials. Clin Rheumatol 37(10):2611–2620CrossRefGoogle Scholar
  7. 7.
    Huang F, Luo ZC (2019) Adverse drug events associated with 5mg versus 10mg tofacitinib (Janus kinase inhibitor) twice daily for the treatment of autoimmune diseases: a systematic review and meta-analysis of randomized controlled trials. Clin Rheumatol 38(2):523–534CrossRefGoogle Scholar
  8. 8.
    Dougados M, van der Heijde D, Chen YC, Greenwald M, Drescher E, Liu J, Beattie S, Witt S, de la Torre I, Gaich C, Rooney T, Schlichting D, de Bono S, Emery P (2017) Baricitinib in patients with inadequate response or intolerance to conventional synthetic DMARDs: results from the RA-BUILD study. Ann Rheum Dis 76(1):88–95CrossRefGoogle Scholar
  9. 9.
    Choy EH (2019) Clinical significance of Janus Kinase inhibitor selectivity. Rheumatology (Oxford) 58(6):1122CrossRefGoogle Scholar
  10. 10.
    Queeney K, Housley W, Sokolov J, Long A (2019) FRI0131 elucidating the mechanism underlying creatine phosphokinase upregulation with updacitinib. Ann Rheum Dis 78:734–735Google Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Department of RheumatologyWestern HealthVictoriaAustralia

Personalised recommendations