Effectiveness and safety of Baricitinib in alopecia areata: a prospective cohort study

Abstract

Background and objectives. Baricitinib was effective in treating severe alopecia areata (AA) in clinical trials, yet real-world prospective data remain scarce. The aim of this study was to assess real-world effectiveness and safety of Baricitinib. Patients and methods. A prospective observational study was conducted including 48 adults with severe AA over a 12-month follow-up. Clinical response, laboratory data, and adverse events were assessed. Predictors of response were also explored. The primary endpoint was defined as the attainment of a Severity of Alopecia Tool (SALT) score <20%, sustained over at least two consecutive assessments separated by ≥12 weeks within the first year of therapy. Results. A clinically meaningful response (SALT <20) was achieved by 58.3% of patients and 37.5% achieved a complete response (SALT <10). Early responders represented 29.5% of the cohort. Eyebrow and eyelash regrowth improved (p < 0.01). Predictors of favorable response included lower baseline SALT, shorter disease duration, and higher basal erythrocyte sedimentation rate (ESR). No serious adverse events were reported. Conclusions. Baricitinib is effective and safe in the real-world management of severe AA, especially when initiated early in patients with lower baseline severity and elevated ESR. These findings highlight the relevance of timely intervention and appropriate patient selection.