Comparative Efficacy and Safety of Baricitinib Against Traditional Therapies in Severe Alopecia Areata: A Retrospective Cohort Study

Abstract

Introduction: Alopecia areata is a common autoimmune disease which results in reversible hair loss. Janus kinase inhibitors are prescribed for severe alopecia areata with encouraging results. There are no studies comparing the efficacy and safety of Janus kinase inhibitors to traditional treatment options, such as topical immunomodulators and traditional immunosuppressants.

Aims: To retrospectively compare the efficacy and safety of baricitinib, an approved Janus kinase inhibitor, to other treatments for severe AA during a 6-month treatment period.

Materials/methods: We included patients with newly presenting, relapsing or treatment-resistant alopecia areata with Severity of Alopecia Tool (SALT) score ≥ 50, for the period between July 2021 and July 2023. Medical histories were reviewed and possible side effects were recorded. Primary endpoints were SALT ≤ 20 and SALT ≤ 10 after 6 months of treatment.

Results: Seventy-five patients (53 females) were divided into three groups: topical immunomodulators (51 patients); baricitinib (19 patients); and a group receiving pulsed intramuscular corticosteroids or traditional immunosuppressants (11 patients). Twenty-one patients received more than one treatment options within 2 years. After 6 months, the baricitinib group showed superior efficacy with 32% and 26% of patients achieving SALT ≤ 20 and SALT ≤ 10, compared to 12% and 9% in both other groups. Baricitinib demonstrated better secondary outcomes (50% and 90% reduction from initial SALT scores). All treatments exhibited mild-to-moderate and expected side effects. Weight gain, which had not been reported in clinical trials for alopecia areata, was observed in three baricitinib-treated patients.

Conclusion: Baricitinib was superior to traditional treatments for severe alopecia areata after 6 months. Weight gain concerned 16% of patients receiving baricitinib.

Keywords: JAK inhibitors; alopecia areata; baricitinib; baricitinib efficacy; baricitinib safety.

FIGURE 1

Percentage of patients achieving Severity of Alopecia Tool (SALT) score ≤ 20 (a) and SALT score ≤ 10 (b) during a 6‐month period. Number of imputed SALT scores (Imput.data) per month is also shown. Imputation techniques (individual mean substitution and last observation carried forward) were applied to missing data. CS + Trad. ISs, intramuscular corticosteroids (CS)/systemic traditional immunosuppressants (Trad. ISs); IMMs, immunomodulators.

FIGURE 2

Percentage of patients achieving at least 50% (a) and 90% (b) improvement in baseline Severity of Alopecia Tool (SALT) during a 6‐month period. Number of imputed SALT scores (Imput.data) per month is also shown. Imputation techniques (individual mean substitution and last observation carried forward) were applied to missing data. CS + Trad. ISs, intramuscular corticosteroids (CS)/systemic traditional immunosuppressants (Trad. ISs); IMMs, immunomodulators.