Systemic Corticosteroids Enhance Baricitinib’s Efficacy for Alopecia Areata

New findings suggest that systemic corticosteroids, along with baricitinib, will enhance the drug’s efficacy in patients with severe alopecia areata and result in sustained benefits, particularly in partial responders.1

Such findings were the result of a new retrospective study carried out to evaluate corticosteroid addition among adults living with alopecia areata. Jorge Naharro-Rodríguez, MD, from the Dermatology Department at Ramón y Cajal University Hospital in Madrid, led a team of investigators in this analysis.

Naharro-Rodríguez and colleagues highlighted that prior findings have pointed to baricitinib’s efficacy as a treatment for severe alopecia areata.2 Nevertheless, they noted that some patients with the hair loss condition see unsatisfactory outcomes despite their use of this medication.

“In this scenario, the combination of baricitinib with corticosteroids emerges as a potential therapeutic option,” Naharro-Rodríguez et al wrote.1 “We conducted a retrospective study with the aim of evaluating the efficacy and safety of corticosteroid addition in adults with severe [alopecia areata] receiving baricitinib.”

The investigators evaluated individuals with severe alopecia areata, which they highlight was defined by having a Severity of Alopecia Tool (SALT) score greater than 50. These study subjects had, initially, been treated with baricitinib and later been given systemic corticosteroids—either oral corticosteroids or intramuscular triamcinolone acetonide (IMTAC). There were 25 participants included in total, with a median age of 46 years (range: 27–65) and 72% being reported as female.

Naharro-Rodríguez and coauthors' primary outcome that was assessed was the number of trial subjects attaining a SALT score of 20 or lower by the 12-week mark. They defined a partial response as a ≥10% SALT score improvement from the point of baseline.

In terms of secondary outcomes, these included shifts in clinician-reported outcomes (ClinRO) for regrowth of eyebrows and eyelashes. All adverse events were also documented by the investigative team.

The mean alopecia areata duration prior to enrollment was shown to be 4 years. For a median of 20 weeks, participants were given baricitinib 4 mg on a daily basis as monotherapy before corticosteroids were then introduced. By this point, only 12% were shown by the investigators to have attained a SALT-20 score improvement, and the median SALT score before initiating corticosteroids was 60.

Corticosteroids' addition to the regimen was mainly driven by partial response (88%). In a smaller number of cases, Naharro-Rodríguez and coauthors noted a relapse had taken place following initial improvement (12%).

Corticosteroid regimens included oral dexamethasone at 0.1 mg/kg twice-per-week (dose range: 3–6 mg), implemented among 40% of subjects, and IMTAC 40 mg administered on an every-4-week basis, implemented among 60% of subjects. The team highlighted that median duration of corticosteroid usage was 12 weeks.

Following corticosteroid treatment, 15 patients (60%) achieved a SALT score of 20 or lower, with a median SALT score of 10 (range: 0–100). Over a median follow-up period of 24 weeks in the period following cessation of corticosteroid use, 96% of trial subjects (all but 1) maintained their observed clinical improvements.

During baricitinib monotherapy, any reported adverse events were noted as having been mild, taking place only among 4 individuals. The events included gastrointestinal symptoms, acne, dyslipidemia, and recurrence of herpes simplex. None necessitated any kind of dose adjustment or discontinuation of baricitinib.

After introducing systemic corticosteroids, there were 4 additional subjects who had new mild side effects. Specifically, there were 3 cases of insomnia and a single case of gastrointestinal discomfort. Notably, however, the investigators found no serious adverse events had been reported throughout their study period.

“In conclusion, systemic corticosteroids addition in patients receiving baricitinib enhances efficacy in severe [alopecia areata], particularly in partial responders, with sustained benefits,” they wrote.1 “This combination does not seem to significantly increase the adverse effects compared with the individual administration of each therapy.”

References

1. Naharro-Rodríguez J, Berna-Rico E., Hermosa-Gelbard Á., et al (2025). Real-world efficacy and safety of baricitinib combined with corticosteroids in alopecia areata. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20747.

2. King B, Ohyama M, Mesinkovska NA, et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. 2022; 386(18): 1687–1699.