Over 80% of patients with severe alopecia areata may experience relapse within 152 weeks following the discontinuation of baricitinib, according to a recent study. 

In the BRAVE-AA1 randomized clinical trial, published in JAMA Dermatology, researchers evaluated the effects of baricitinib withdrawal and retreatment in patients with severe alopecia areata (AA). A total of 654 adult patients with an average age of 37.1 years, 58.6% of whom were female, were included in the study. These patients had achieved a response after 52 weeks of baricitinib, either 2 mg or 4 mg daily. 

At week 52, 17.6% (n = 115) of the patients receiving 4 mg of baricitinib and 6.0% (n = 39) of those receiving 2 mg of baricitinib achieved a Severity of Alopecia Tool (SALT) score of 20 or less, qualifying them for the randomized withdrawal phase. The 154 responders were then rerandomized to either continue baricitinib or transition to placebo. 

The results demonstrated that the short-term relapse rates were low, with 0% to 11% of patients experiencing a loss of treatment benefit within the first 8 weeks postwithdrawal. However, by week 152, more than 50% of the patients experienced a relapse. Retreatment with baricitinib led to a substantial proportion of patients recapturing their response, with 63% of patients on the 2 mg dose and 85% on the 4 mg dose regaining a satisfactory clinical response. Additionally, at week 152, 90% of the patients who continued the 4 mg dose and 89% of those on the 2 mg dose maintained a SALT score of 20 or less. 

These findings indicated that severe AA is a chronic and relapsing condition that may require ongoing maintenance therapy to sustain hair regrowth.  

The study was funded by Eli Lilly and Company.