Baricitinib: A Review in Severe Alopecia Areata

Plain Language SummaryAlopecia areata is a disorder in which an autoimmune attack is mounted against hair follicles, resulting in hair loss ranging from patches of hair loss through to complete hair loss. Alopecia areata can recur throughout an individual's lifetime and can cause significant psychological distress, with patients more likely to experience anxiety or depressive disorders within their lifetime. Baricitinib (Olumiant(& REG;)) is a drug that blocks the signaling of immune messengers to halt autoimmune attack and allow hair regrowth. In two clinical trials, adults with severe alopecia areata receiving baricitinib were more likely to recover from an episode of alopecia areata (achieve 80% or more scalp coverage) than those receiving placebo. Eyebrow and eyelash regrowth was also more common in patients receiving baricitinib than placebo. Baricitinib was generally well tolerated, with infections being the most common adverse events. While longer-term data will be of interest, baricitinib appears to be a useful treatment for patients with severe alopecia areata. Baricitinib (Olumiant(& REG;)), a Janus kinase (JAK) inhibitor, is the first drug approved for the treatment of severe alopecia areata in the USA and the EU. Severe alopecia areata is usually difficult to treat and relapse is common. Patients with this disorder are more likely to suffer from anxiety and depression. In two pivotal placebo-controlled phase 3 clinical trials in adults with severe alopecia areata, oral baricitinib once daily was associated with clinically meaningful scalp, eyebrow, and eyelash hair regrowth over 36 weeks. Baricitinib was generally well tolerated with the most common adverse events being infections, headaches, acne, and elevated levels of creatine phosphokinase. While longer-term data will be necessary to more fully understand the benefits and risks of the drug, currently available data suggest that baricitinib is a useful treatment for patients with severe alopecia areata.