Study Confirms Baricitinib's Effectiveness for Severe Alopecia Areata and Advocates for Early Trichoscopy

The research, which focused on real-world applications, endorses the use of this drug for severe forms of this challenging autoimmune condition, including at earlier stages. The researchers also suggest using trichoscopy to detect early responses to the therapy. The findings were published online in the Journal of the European Academy of Dermatology and Venereology.

Alopecia areata is an autoimmune disorder characterized by sudden, patchy hair loss. In severe cases, it can lead to complete loss of scalp and body hair, significantly impacting patients' quality of life. Baricitinib, a Janus kinase (JAK) inhibitor previously used for rheumatoid arthritis, has emerged as a potential treatment for AA. It has been recently approved to treat alopecia areata.

Against the above background, Francesca Pampaloni, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy, and colleagues sought to reaffirm baracitinib’s effectiveness for patients with alopecia areata.

For this purpose, the researchers conducted a retrospective study across 23 medical centers in Italy, enrolling patients with severe alopecia areata (SALT >50) who had been affected for over six months. Clinical and trichoscopic assessments were carried out at each visit, and the impact on quality of life, anxiety, and depression was evaluated using the Skindex-16 and the Hospital Anxiety and Depression Scale (HADS), respectively.

The study led to the following findings:

• 118 patients were enrolled, with a mean age of 39 years and a mean SALT >95.
• The mean value of the SALT score decreased from an average of 96.6 to 48 after 24 weeks of treatment, and 42.3% of patients achieved a SALT 30, 31.3% a SALT 20, and 20.3% a SALT 10 by Week 24.
• Trichoscopic signs showed fewer yellow dots and black dots significantly earlier than hair regrowth.
• Adverse events during the treatment period (mild laboratory test abnormalities) were reported in 12.7% of patients.
• No drop-outs were registered.

“The preliminary data on the effectiveness and safety of baricitinib in a real-life setting involving over 100 patients are very promising and endorse the use of this drug for severe forms of alopecia areata,” the researchers stated. “Initiating therapy early, particularly in cases with a shorter disease duration, is recommended, along with using trichoscopy to detect responses to treatment sooner than through clinical examination alone.”

Reference:

Piraccini, B. M., Pampaloni, F., Cedirian, S., Quadrelli, F., Bruni, F., Rapparini, L., Caro, G., Acri, M. C., Ala, L., Rossi, A., Pellacani, G., Lacarrubba, F., Micali, G., Vastarella, M., Cantelli, M., Nappa, P., Diluvio, L., Bianchi, L., Gnesotto, L., . . . Starace, M. Real-life effectiveness and safety of baricitinib in patients with severe alopecia areata: A 24-week Italian study. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.20312