Switching JAK inhibitors: evaluating baricitinib's effectiveness in alopecia areata after tofacitinib failure

Alopecia areata (AA) is a condition of hair loss with an immune-mediated cause. The efficacy of switching to a different JAK inhibitor in a patient who has failed to respond to one JAK inhibitor for AA is also unknown. This review is to examine the efficacy and safety of baricitinib in patients' inadequate response to tofacitinib. This is a retrospective study of 26 patients with AA who were switched from tofacitinib to baricitinib because of insufficient response, side effects or disease relapse. The patients had a mean age of 31 years, with 65% being female. The SALT score was reduced from 90 ± 19 to 68 ± 31 (p < 0.05) in an average of 16 months of tofacitinib treatment. However, the SALT score was reduced from 68 ± 31 to 50 ± 31 (p < 0.05) in about 7 months of baricitinib treatment. 34.6% of patients taking tofacitinib and 19.2% of patients receiving baricitinib did not respond to the treatment; however, 66.66% of the tofacitinib non-responders had improvement with baricitinib. Of the five patients with unchanged SALT scores after tofacitinib, four (80%) had an average reduction of 58.25 points with baricitinib. Baricitinib induced eyebrow and eyelash regrowth in 60% of AU (Alopecia Universalis) patients. Both treatments brought down SALT scores in pediatric cases. Adverse effects were mild and were noted in 30.76% of patients on tofacitinib and 3.84% of patients on baricitinib treatment. Oral baricitinib is safe with minimal side effects and also effective for both pediatric and adult AA patients who are inadequate responders to tofacitinib. These findings need to be confirmed by further research.