Clinical, cosmetic and investigational dermatology · 2026
High-Dose Baricitinib for Severe Alopecia Areata with Suboptimal Response to Conventional Therapy: A Real-World Assessment.
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Liu Qinsi, Sun Mang, Cao Yuwei, Zhao Hengguang
Аннотация
BACKGROUND: Severe alopecia areata (AA) causes substantial psychosocial burden, with suboptimal response rates to approved baricitinib 4 mg. Pharmacologic strategies for dose escalation, supported by inter-specialty evidence, may address this therapeutic gap.
AIM: To evaluate efficacy and safety of baricitinib 6 mg daily in severe, refractory AA patients who showed suboptimal response to conventional therapies.
METHODS: In this retrospective study, four females (mean age 26.5 years) with severe AA (mean baseline Severity of Alopecia Tool, SALT 64.5) received baricitinib 6 mg between January 2023 and June 2025. Efficacy was assessed via serial SALT score changes; safety through standardized laboratory monitoring.
RESULTS: Following escalation to baricitinib 6 mg daily, clinically meaningful SALT improvement was achieved in three patients (75%). Transient laboratory abnormalities occurred in 3 patients (75%), including asymptomatic mild platelet count elevation, self-resolving mild anemia (within normal ranges) and asymptomatic creatinine elevation. No severe adverse events occurred.
CONCLUSION: Baricitinib 6 mg daily demonstrated enhanced efficacy in 75% of patients with severe refractory AA and exhibited an acceptable short-term safety profile under close monitoring. These findings support further investigation of step-up dosing strategies in randomized controlled trials.
AIM: To evaluate efficacy and safety of baricitinib 6 mg daily in severe, refractory AA patients who showed suboptimal response to conventional therapies.
METHODS: In this retrospective study, four females (mean age 26.5 years) with severe AA (mean baseline Severity of Alopecia Tool, SALT 64.5) received baricitinib 6 mg between January 2023 and June 2025. Efficacy was assessed via serial SALT score changes; safety through standardized laboratory monitoring.
RESULTS: Following escalation to baricitinib 6 mg daily, clinically meaningful SALT improvement was achieved in three patients (75%). Transient laboratory abnormalities occurred in 3 patients (75%), including asymptomatic mild platelet count elevation, self-resolving mild anemia (within normal ranges) and asymptomatic creatinine elevation. No severe adverse events occurred.
CONCLUSION: Baricitinib 6 mg daily demonstrated enhanced efficacy in 75% of patients with severe refractory AA and exhibited an acceptable short-term safety profile under close monitoring. These findings support further investigation of step-up dosing strategies in randomized controlled trials.