Outcomes of Down-Titration in Patients with Severe Scalp Alopecia Areata Treated with Baricitinib 4 Mg: Week 104 Data from BRAVE-AA2

    September 2023 in “ Journal of The American Academy of Dermatology ”
    Brett King, Manabu Ohyama, Maryanne M. Senna, Jerry Shapiro, Yves Dutronc, Wen‐Chi Wu, Guanglei Yu, Yuxin Ding, Chiara Chiasserini, Bianca Maria Piraccini
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    TLDR Reducing the dose of Baricitinib to 2mg led to a loss of hair regrowth benefits in nearly half of the patients by Week-104.
    The study "Outcomes of Down-Titration in Patients with Severe Scalp Alopecia Areata Treated with Baricitinib 4 Mg: Week 104 Data from BRAVE-AA2" involved 546 adults with severe alopecia areata (AA). The study found that Baricitinib, an oral Janus kinase 1/2 inhibitor, was superior to a placebo in achieving hair regrowth in patients with severe AA at Week-36. At Week-52, 86 out of 234 patients initially treated with 4mg of Baricitinib were responders. These responders were then rerandomized to either stay on 4mg or down-titrate to 2mg. By Week-104, 90.2% of the responders who remained on 4mg maintained a Severity of Alopecia Tool (SALT) score of ≤20, indicating successful treatment. However, 45.2% of patients who down-titrated to 2mg experienced a loss of treatment benefit by Week-104. The study concludes that while these data help inform decisions on down-titration, more research is needed to better define the timing and conditions for successful down-titration.
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