Predictive Factors Identified for Positive Response to Baricitinib in Alopecia Areata

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There are several predictors of positive outcomes with baricitinib treatment of alopecia areata, new findings suggest, including lower pre-treatment Severity of Alopecia Tool (SALT) scores, shorter disease duration lasting ≤4 years, a history of intravenous methylprednisolone pulse (IVMP) treatment, and female sex.¹

These findings and others were drawn from a recent analysis conducted at a single center in Japan. The research team had assessed predictors of response to baricitinib, a Janus kinase inhibitor (JAKi) designed to inhibit the Janus kinase-signal transducer and activator of transcription (JAK–STAT) signaling pathway that impacts hair loss.

Moyuka Wada-Irimada, from the department of dermatology at Tohoku University Graduate School of Medicine in Japan, led a team of investigators in this analysis. Wada-Irmada et al. pointed to detailed phase 3 clinical research looking at baricitinib, specifically the BRAVE-AA1 and BRAVE-AA2 studies, though they added that a real-world assessment of baricitinib that looks into independent predictive factors for JAKi responsiveness had not yet been developed.²

“In this retrospective study, we analyzed the efficacy of baricitinib in 70 patients who completed 9 months of treatment along with associated clinical metadata,” Wada-Irmada and colleagues wrote. “We investigated background factors linked to baricitinib treatment responses and identified several clinical factors that may serve as independent predictors of treatment outcome.”¹

Trial Design

The investigators conducted a retrospective review through an evaluation of patients with severe alopecia areata and their medical records. These individuals had begun baricitinib treatment in the timeframe between July 2022 - August 2023, and they were assessed at the department of dermatology at Tohoku University Hospital in Sendai, Japan.

The research team identified a total of 86 individuals that were shown to have a SALT score of 50 or higher at the time of their baricitinib initiation and had not experienced regrowth of their hair for at least half of a year. Each of these subjects had undergone treatment with either IVMP therapy, topical corticosteroids, or topical immunotherapy previously.

In terms of main objectives of the study, the team sought to determine the percentage of study participants who reported a SALT score of 20 or below following a course of 9 months with baricitinib therapy. They aslo sought consistency, so the investigators required independent assessments by a set of 3 board-certified dermatologists who looked at participants’ SALT scores and disease subtypes using both clinical photographs and medical records.

Despite the existence of 86 patients in the beginning, some ended up being excluded from the final analysis due to various reasons such as moving or adverse events. These adverse effects included an estimated glomerular filtration rate (eGFR) decline as well as raised alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels.

The researchers looked at treatment efficacy and conducted a multivariate analyses, with an eye on potential predictors of baricitinib response. They took into account a wide array of predictive factors such as alopecia areata type, age, disease duration, sex, IVMP therapy, history of atopic dermatitis, and Clinician-Reported Outcome (ClinRO) measures for regrowth of eyebrows and eyelashes.

Findings on Response to Baricitinib

The research team found, among the eventual study population of 70 subjects that completed 9 months of treatment, a total of 41% succeeded in reporting a SALT score of 20 or below. Following their statistical analyses, the team demonstrated a set of predictive factors that were significantly linked to improved treatment outcomes.

In their description of ndependent predictors of a favorable response, the investigators noted that examples included prior IVMP therapy (P < 0.01), a shorter duration of alopecia areata (≤4 years, P < 0.05), being of the female sex (P < 0.01), and an initial SALT score of 95 or lower (P < 0.05). Additionally, they found that responses to baricitinib varied based on disease type and sex, with ophiasis alopecia (OA) having the lowest rate of improvement.

These data highlight the influence of clinical characteristics on baricitinib treatment outcomes in those with severe alopecia areata.

“These findings contribute to a deeper understanding of the clinical predictors of JAKi response in [alopecia areata] and underscore the importance of [alopecia areata] subtype, disease duration, and sex in treatment outcomes,” they wrote. “Elucidating these factors would not only lead to better clinical decision-making but also provide a foundation for further understanding of the complex pathophysiology of [alopecia areata].”¹

References

1. ^{Wada-Irimada M, Takahashi T, Sekine M, Okazaki T, Takahashi T, Chiba T, et al. Predictive factors for treatment responses to baricitinib in severe alopecia areata: A retrospective, multivariate analysis of 70 cases from a single center. J Dermatol. 2025; 00: 1–11. https://doi.org/10.1111/1346-8138.17641.}
2. ^{King B, Ohyama M, Kwon O, Zlotogorski A, Ko J, Mesinkovska NA, et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. 2022; 386: 1687–1699.}