Nearly three-fourths of patients with alopecia areata who experienced scalp hair regrowth on baricitinib also achieved simultaneous eyebrow and eyelash regrowth by week 52, according to a recent study.
Researchers evaluated the extent of eyebrow and eyelash (EB/EL) involvement in patients with alopecia areata (AA) and the therapeutic impact of baricitinib across these hair-bearing sites.
The researchers, led by Arash Mostaghimi, MD, of the Department of Dermatology at Brigham and Women’s Hospital in Boston, MA, reported integrated findings from 2 multicenter, randomized, double-blind, placebo-controlled trials—BRAVE-AA1 and BRAVE-AA2—which were conducted across 169 centers in 10 countries.
The analysis included 1,192 patients with 50% or more scalp hair loss and AA episode duration of more than 6 months but less than 8 years. Patients were randomized in a 2:2:3 ratio to receive placebo, baricitinib 2 mg, or baricitinib 4 mg once daily. EB and EL involvement were assessed using a ClinRO scale ranging from 0 (no loss) to 3 (complete loss), and scalp hair loss was measured using the SALT score.
At baseline, EB/EL severity correlated with scalp involvement: patients with no EB/EL loss (clinician-reported outcome [ClinRO] score 0) had a mean Severity of Alopecia Tool (SALT) score of 70.6, whereas those with complete EB/EL loss (ClinRO 3) had a mean SALT score of 96. By week 36, EB response rates (ClinRO 0 or 1 with at least 1-point of improvement) were 28.2% with baricitinib 2 mg and 44.3% with 4 mg, compared with 12.6% for placebo. EL response rates followed similar trends: 25.1% with 2 mg, 46.4% with 4 mg, and 12.4% with placebo.
By week 52, EB/EL response rates increased further with baricitinib 4 mg: 56% for EB and 55.8% for EL. Among scalp responders (SALT score of up to 20), 71.1% (n = 86/121) achieved simultaneous EB and EL responses with approximately 80% concordance. Notably, among scalp nonresponders (SALT of more than 20), 35.4% (n = 69/195) still achieved both EB and EL responses. Patients achieved similar trends but lower response rates with baricitinib 2 mg.
Loss of eyebrows and eyelashes affects facial recognition and ocular protection, which means patients may face additional psychosocial and physical burdens.
"Many patients with severe AA report that having eyebrows is as important as having scalp hair," noted researchers. Eyebrow and eyelash regrowth sometimes preceded later scalp response, which suggested these changes may guide ongoing therapy and support a holistic definition of treatment success across the scalp, eyebrows, and eyelashes. Other body hair regrowth (such as beard, nasal passages, body and genital region) was not studied in the BRAVE-AA trials and could be explored in future research.
Disclosures can be found in the published study.
Source: British Journal of Dermatology