Characterizing Loss of Response to Baricitinib for AA in a Small Number of Patients Over 3 Years

A small cohort of 12 patients undergoing long-term maintenance therapy with baricitinib 4-mg for alopecia areata experienced true loss of response (defined as loss of SALT Score ≤ 20 at week 152). An additional two patients had a loss of response related to treatment interruption. The timing of this loss was variable, with no clear patterns emerging.

Of those who lost response (excluding interruptions), half showed minimal worsening (no more than a SALT score ≤40). While identifying definitive risk factors for loss of response remains challenging due to the small sample size, several trends were noted: patients with higher disease severity and chronicity seemed more prone to loss of response. Additionally, some patients had antecedent COVID-19 infection or vaccination.

Given the limited data, a thorough patient narrative review was not conducted, and the role of other potential risk factors remains unclear. Moving forward, further research is needed to explore factors contributing to the loss of response in patients on baricitinib monotherapy, as well as the potential benefits of adjunctive therapies to prevent or mitigate this issue.

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Elevate-Derm Alliance Editorial Committee