It appears possible to reduce the dose to 2 mg in patients with severe alopecia areata and a sustained response to 4 mg baricitinib. This is evidenced by the results of a substudy of BRAVE-AA2 reported at the 2023 AAD Annual Meeting.
In 2 randomised, double-blind, placebo-controlled phase III studies (BRAVE-AA1 and BRAVE-AA2) in adults with severe alopecia areata (AA), hair growth was improved after 36 weeks with the Janus kinase (JAK)1/2 inhibitor baricitinib at a dose of 2 and 4 mg compared to placebo. In the BRAVE-AA2 trial, from week 52, the 4 mg dose could be reduced to 2 mg. Patients treated with a 4 mg dose and achieving a Severity of Alopecia Tool (SALT) score of ≤ 20 after 52 weeks were randomized 1:1 to continue receiving 4 mg (n = 44) or a group in which the dose was reduced to 2 mg (n = 42). As soon as the AA deteriorated to a SALT score > 20 in the latter group, the dose was increased back to 4 mg.
After 104 weeks, 90.2% of patients in the 4 mg group still had a SALT score ≤ 20. 45.2% of patients whose dose was reduced to 2 mg had loss of treatment benefit. Successful dose reduction was seen primarily in patients with a stable response to baricitinib 4 mg prior to dose reduction. 71.4% of patients who returned to the 4 mg dose after loss of treatment benefit regained a SALT score ≤ 20.
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