Outcomes of Down-Titration in Patients With Severe Scalp Alopecia Areata Treated With Baricitinib: An Update Through Week 152 From BRAVE-AA2

The phase 3 trial BRAVE-AA2 studied the effects of down-titration in patients with severe alopecia areata (AA) treated with Baricitinib. The trial enrolled 546 adults with severe AA, and at Week-52, 86 responders were eligible for down-titration from 4mg to 2mg of Baricitinib. Results showed that at Week-104 and 152, 66% and 59% of down-titrated patients maintained a Severity of Alopecia Tool (SALT) score ≤20, compared to 91% and 89% of responders who remained on 4mg. Among down-titrated patients, 29% and 37% experienced a loss of treatment benefit at Weeks 104 and 152, respectively. For patients that remained on 4mg, these proportions were 5% and 7%. The study concluded that over half of patients down-titrated to 2mg maintained clinical response up to 2 years after the down-titration, suggesting that dosing of Baricitinib can be modulated between 2mg and 4mg to adapt to the clinical response.