Real-World Study Affirms Baricitinib’s Efficacy for Alopecia Areata

A recent study demonstrated baricitinib’s efficacy in treating alopecia areata, alopecia totalis, alopecia universalis, and eyebrow and eyelash alopecia.1

“Compared to the clinical trials, baricitinib exhibited higher response rates and superior regenerative outcomes in the treatment of [alopecia areata],” wrote investigators, led by Caiyu Wang, from the department of dermatology at Xijing Hospital, Fourth Military Medical University, in China.

Clinical trials have shown the effectiveness of Janus kinase (JAK) inhibitors in managing alopecia areata. On June 13, 2022, the US Food and Drug Administration (FDA) approved oral baricitinib (Olumiant), a JAK ½ inhibitor, for severe alopecia areata in adults.2 A year later, the Chinese National Drug Administration approved baricitinib for adults despite limited real-world use in this population.1

Investigators sought to assess the efficacy and safety of baricitinib in a real-world setting among 47 Chinese patients treated at Xijing Hospital of Fourth Military Medical University. The primary endpoint of this retrospective study was the change in Severity of Alopecia Tool (SALT) score during treatment.

Patients qualified if they received baricitinib for ≥ 6 months at Xijing Hospital, between March 2023 and December 2024. The sample had a mean age of 25.81 years (72% adults; 28% adolescents), 51% females, and a mean disease duration of 3.79 years. There were 51% with alopecia universalis, 25.5% with alopecia areata, and 23.4% with alopecia totalis; 57.5% and 44.7% of participants had eyebrow and eyelash hair loss, respectively.1

Clinicians determined the initial baricitinib dose (2 mg or 4 mg daily) based on disease severity, comorbidities, and body weight. Patients with extensive or quickly progressing disease began with 4 mg, and those with risk factors or lower body weight started with 2 mg. All patients aged < 12 years started with 2 mg but could increase to 4 mg if they had no response and a body weight of ≥ 40 kg.

At weeks 12 and 24, 47% and 53% of participants achieved SALT 20, respectively. By the end of treatment, anywhere between 24 – 104 months, 78.7% of participants achieved SALT 20. On average, the SALT score improved from 70.21 at baseline to 48.51 (±30.36), after treatment, with a hair regrowth rate of 68.10% ± 35.45%.1

Patients who had alopecia areata for ≤ 4 years had significantly greater SALT score improvement and shorter time to hair regrowth onset. At week 24, 85.2% with eyebrow alopecia and 90.4% with eyelash alopecia achieved ClinRO scores of 0/1.

The study showed that baricitinib was well tolerated and had no serious adverse events. Investigators observed no adverse reactions specific to children.

The team observed a negative correlation between disease duration and hair regrowth rate, and a positive correlation between treatment duration and hair regrowth rate. Among the sample, 11 experienced relapse following therapy discontinuation, facing either patchy or complete hair loss. Five of these patients continued the dose that had previously resulted in hair regrowth, and 3 patients moved to a lower dose.

“This observation underscores the necessity for long-term therapeutic maintenance of baricitinib and highlights that extended therapy duration is correlated with enhanced response improvement,” investigators wrote.1 “Abrupt therapy discontinuation is likely to result in the loss of therapeutic benefit.”

Investigators wrote that the study was limited by its retrospective design and relatively small size, emphasizing the need for further research with larger cohorts. They also stressed the need for trials with longer follow-up periods.

“The expanded clinical experience provided by this study will be instrumental in guiding future trials, which are essential for further elucidating the efficacy and safety of JAK inhibitors in [alopecia areata] management,” investigators wrote.1

References

1. Wang C, Xing X, Wang S, et al. Efficacy and Safety of Baricitinib in Patients With Alopecia Areata: A Real-World Cohort Study. Wiley. August 6, 2025. https://doi.org/10.1155/dth/6399048

2. Butera, A. FDA Approves Baricitinib for Alopecia Areata in Adults. HCPLive. June 13, 2022. https://www.hcplive.com/view/fda-approves-baricitinib-for-alopecia-areata. Accessed August 12, 2025.