WEDNESDAY, Aug. 9, 2023 -- For patients with severe alopecia areata (AA), uptitration of baricitinib from 2 to 4 mg results in meaningful improvement in response rates over the subsequent 24 weeks, according to research published online Aug. 9 in JAMA Dermatology.

Justin M. Ko, M.D., from the Stanford University School of Medicine in California, and colleagues examined the efficacy of uptitration to baricitinib at a dose of 4 mg for 24 weeks in patients with severe AA who had previously not responded to baricitinib at a dose of 2 mg (Severity of Alopecia Tool [SALT] score >20) in two multicenter, placebo-controlled, phase 3 randomized clinical trials. Long-term extension data were reported up to week 76 in this pooled analysis.

The researchers found that 212 of the 340 patients treated with baricitinib 2 mg had a SALT score >20 at week 52 and were uptitrated to baricitinib 4 mg. Of these patients, 67.0 percent had a baseline SALT score of 95 to 100 indicating very severe AA. At week 76, 25.9 percent of the patients had achieved a SALT score of 20 or lower. During the same period, there was an increase observed in the response rates for clinician-reported outcome scores of 0 or 1, from 19.3 to 37.9 percent and from 24.1 to 40.9 percent for eyebrows and eyelashes, respectively.

"These data are important for health care professionals to consider when counseling patients on treatment expectations and the potential benefits of dose escalation," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Eli Lilly (under license from Incyte), which manufactures baricitinib and funded the study.