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. 2025 Sep;15(9):2483-2493.
doi: 10.1007/s13555-025-01468-1. Epub 2025 Jul 7.

Therapeutic Burden as Predictor of Response to Baricitinib for Alopecia Areata in Real Life: Prospective Study

Daniel Muñoz-Barba  1   2 , Alberto Soto-Moreno  1   2 , Sofía Haselgruber-de Francisco  1   2 , Manuel Sánchez-Díaz  3   4   5 , Salvador Arias-Santiago  1   6   7   2
Affiliations

Therapeutic Burden as Predictor of Response to Baricitinib for Alopecia Areata in Real Life: Prospective Study

Daniel Muñoz-Barba et al. Dermatol Ther (Heidelb). 2025 Sep.

Abstract

Introduction: Therapeutic burden (TB) has been proposed as a potential predictor of treatment outcomes in both dermatological and non-dermatological diseases. This study aims to introduce the concept in the context of alopecia areata (AA) and assess its potential value in supporting therapeutic decision-making in clinical practice.

Methods: A prospective cohort study was conducted including patients with AA who started treatment with baricitinib between January 2022 and January 2025 at a third-level hospital center. The main variable was TB, defined as the cumulative sum of previous systemic treatment cycles. An analysis was performed on whether socio-demographic or clinical factors were associated with TB.

Results: Forty-four patients with AA treated with baricitinib were included. Most were women (65.90%) with a mean age of 37.70 (16.10) years. The predominant type of AA was multi-plaque (65.90%) and approximately one third (34.10%) had total/universal forms of the disease. Lower TB was statistically significantly associated with a greater reduction in Severity of Alopecia Tool (SALT) scores during the first 12 months of barictinib treatment compared with those patients with high TB (p < 0.05). This association was observed independently of all other known progression factors (duration of AA, baseline SALT, total/universal AA, female sex) (p < 0.05).

Conclusions: We present the concept of AA-adapted TB as a useful tool for categorizing patients with AA and contributing to therapeutic decision-making. Patients with AA with low TB showed a greater response to baricitinib treatment than patients who had received a greater number of systemic treatments previously.

Keywords: Alopecia Areata; Baricitinib; Janus kinase inhibitors; Therapeutic burden.

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Conflict of interest statement

Declarations. Conflict of Interest: Daniel Muñoz-Barba, Alberto Soto-Moreno, Sofía Haselgruber-de Francisco, Manuel Sánchez-Díaz and Salvador Arias-Santiago have nothing to disclose. Ethical Approval: The current study was approved by the research ethics committee of Granada (code: SICEIA-2025-000370) and was performed in accordance with the principles of the Declaration of Helsinki. All patients gave informed consent before being included in the study.

Figures

Fig. 1
Fig. 1
Longitudinal evolution in mean Severity of Alopecia Tool (SALT) score over 12 months of baricitinib treatment in patients with Alopecia Areata (AA). A significant decrease in SALT score was observed from baseline score (p = 0.007). Data are shown as mean SALT scores at each time point
Fig. 2
Fig. 2
Evolution of SALT scores over 12 months of baricitinib treatment in patients with AA, stratified by Therapeutic Burden (TB). Patients were categorized into High (≥ 3 previous treatments, red line) and Low (< 3 previous treatments, blue line) TB groups. A consistent reduction in SALT score was observed in both groups, with significantly greater improvement in the Low TB group (p < 0.05). Data are presented as mean SALT scores over time
See this image and copyright information in PMC

References

    1. Sibbald C. Alopecia areata: an updated review for 2023. J Cutan Med Surg. 2023;27(3):241–59. - PMC - PubMed
    1. Toussi A, Barton VR, Le ST, Agbai ON, Kiuru M. Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: a systematic review. J Am Acad Dermatol. 2021;85(1):162–75. - PMC - PubMed
    1. Alhanshali L, Buontempo MG, Lo Sicco KI, Shapiro J. Alopecia areata: burden of disease, approach to treatment, and current unmet needs. CCID. 2023;16:803–20. - PMC - PubMed
    1. Wei D, Chen Y, Shen Y, Xie B, Song X. Efficacy and safety of different JAK inhibitors in the treatment of alopecia areata: a network meta-analysis. Front Immunol. 2023;14:1152513. - PMC - PubMed
    1. Konzett V, Smolen JS, Nash P, et al. Safety of Janus kinase inhibitors in immune-mediated inflammatory diseases-a systematic literature review informing the 2024 update of an international expert consensus statement. Ann Rheum Dis. 2025;84(5):697–715. - PubMed

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