How Long to Treat to Achieve Desired Treatment Outcomes with Baricitinib 4 mg in Severe Alopecia Areata: Evidence-based Approach

Scalp hair regrowth in severe alopecia areata (AA) can occur rapidly or take up to 2 years in some patients. Baseline factors influence the likelihood and/or timing of treatment response with Janus kinase inhibitors. We evaluated initial evidence of improvement (Severity of Alopecia Tool30) and subsequent treatment success (SALT score ≤ 20) in four subgroups defined by baseline disease severity and AA episode duration to inform the treatment length required before assessing failure, based on disease presentation. In a post hoc analysis of BRAVE-AA1/2 (NCT03570749/NCT03899259), baricitinib 4 mg treatment subgroups were assessed for SALT30 and subsequent SALT score ≤ 20 over time. In severe AA (SALT score 50–94), SALT30 occurred in 70% of those with short duration and 61% with long duration by Week 24, leading to 75% and 65% achieving treatment success (SALT score ≤ 20) by Week 52. In very severe AA (SALT score 95–100), regrowth varied by short/long episode duration with SALT30 achieved in 42%/25% of patients by Week 24, leading to SALT score ≤ 20 in 58%/43% at Week 52, respectively. Severe subgroups usually achieve SALT30 by Week 24. In very severe AA, proportions achieving SALT30 increased through Week 52; therefore, treatment should be given for ≥ 1 year before assessing treatment failure.