Baricitinib shows better efficacy than traditional hair loss treatment

New data compare the efficacy of baricitinib (Baricitinib) with traditional therapies such as styrenone and methotrexate for 6 months in the treatment of severe alopecia areata (AA). In this study, all treatments were generally well tolerated, but baricitinib showed the most efficacy and highest safety profile in a sometimes difficult-to-treat setting. This study is the first to compare a JAK inhibitor, such as baricitinib, with a traditional treatment regimen.

For severe AA, where more than 50% of the scalp is affected, the preferred options include topical immunomodulators such as phenytoin (DCP), contact sensitizers such as anthralin, and systemic immunosuppressive drugs such as cyclosporine, methotrexate, or oral corticosteroids. Despite a range of available medications, managing severe AA remains challenging because traditional treatments often have limited effectiveness and severe side effects. Eligible adult and pediatric participants (n=75) had new-onset, recurrent, or refractory alopecia areata and a Severity Alopecia Tool (SALT) score ≥50. The SALT score is determined by adding the percentage of hair loss in different areas of the scalp. Most patients were female, with an average age of 35 years and an average SALT score of 87.49.

TreatmentAfter 6 months, the main outcome indicators were SALT≤20 (20% scalp hair loss) and SALT≤10 (10% scalp hair loss). Secondary endpoints included the percentage of patients with at least a 50% and 90% improvement in SALT score from baseline. All groups showed progressive improvement, but after 6 months, the baricitinib group showed better efficacy, with about 30% of patients achieving SALT ≤ 20 and SALT ≤ 10, compared with 12% in the IMMs group and 9% in the traditional treatment group. In the baricitinib group, 26% of patients achieved a SALT score of 90 after just 6 months of treatment. Only 12% of the IMMs group and 9% of the traditional IS group reached this level.

Additionally, a higher proportion of patients treated with baricitinib met SALT50 and SALT90 endpoints compared with the other groups. By the end of the period, nearly half of the patients in the baricitinib group met the SALT50 endpoint, compared with 17% in the local immunotherapy group and 27% in the conventional treatment group.

All treatment groups experienced adverse events that were generally expected to be mild to moderate. Most patients in the IMMs group experienced transient erythema and pruritus, especially those taking phenytoin. In terms of more severe reactions, five patients reported blisters and papules, and three patients reported headaches.

Almost half of the patients in the baricitinib group experienced elevated lipids. About25% of patients reported short-lived infections, such as upper respiratory tract infections and urinary tract infections, leading to treatment suspensions of less than a week. Three patients experienced a newly observed adverse effect of weight gain, which is recommended for further investigation in future studies.

In patients taking methotrexate, 25% of patients developed elevated hepatic transaminases, leukopenia, and gastrointestinal disturbances. No adverse events reported in any group resulted in permanent discontinuation.

Janus kinase inhibitors are the first class of drugs registered for the treatment of severe AA since May 2022. 2 Although the majority of U.S. dermatologists prescribe baricitinib for patients with AA, according to a recent analysis, JAK inhibitors are not considered a primary treatment in many other countries.

The researchers noted several limitations of the study, including the small sample size and observational design, which may affect the statistical power and generalizability of the findings. Continued research is recommended to determine the long-term efficacy and safety of JAK inhibitors in the treatment of alopecia areata.

References:https://www.dermatologytimes.com/view/baricitinib-shows-superior-efficacy-versus-traditional-alopecia-treatments