Understanding eyebrow and eyelash involvement in patients with alopecia areata and responsiveness to treatment with baricitinib

BACKGROUND: Eyebrow and eyelash (EB/EL) involvement is an important consideration in the assessment of alopecia areata (AA) severity. OBJECTIVES: To report on the integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259), characterizing EB/EL involvement at baseline in patients with AA and response to baricitinib treatment. METHODS: BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) were randomized double-blind placebo-controlled trials conducted at 169 centres in 10 countries. Patients were randomized to placebo, baricitinib 2 mg or baricitinib 4 mg. Pooled data from patients continually treated with baricitinib through week 52 were included. Outcomes were assessed using a clinician-reported outcome (ClinRO) measure for EB/EL and Severity of Alopecia Tool (SALT) score for the scalp. RESULTS: At baseline, patients with more severe EB/EL involvement had more severe scalp hair loss, with mean SALT scores ranging from 70.6 to 96.0 for patients with no gaps to complete absence of hair, respectively, at EB/EL sites. EB/EL response rates [ClinRO (0,1) with ≥ 1-point improvement] at week 36 were significantly higher in patients treated with baricitinib 2 mg [EB: 28.2%, odds ratio (OR) 3.27; EL: 25.1%, OR 2.95] and baricitinib 4 mg (EB: 44.3%, OR 6.84; EL: 46.4%, OR 8.21) compared with placebo (EB: 12.6%; EL: 12.4%). There was high concordance between EB response and EL response, with approximately 80% of patients who achieved hair regrowth at one site achieving regrowth at the other, with baricitinib 4 mg. Among scalp responders (SALT score ≤ 20 at week 52), 78.5% (n = 95/121) and 82.6% (n = 100/121) achieved an EB and EL response, respectively, and 71.1% (n = 86/121) of patients achieved EB and EL responses with baricitinib 4 mg. Among scalp nonresponders (SALT score > 20 at week 52), 46.7% (n = 91/195) and 48.7% (n = 95/195) achieved EB and EL responses, respectively, and 35.4% (n = 69/195) achieved responses in both EB and EL. Similar trends but lower response rates were observed with baricitinib 2 mg. CONCLUSIONS: Baseline severity of EB/EL involvement paralleled that of the scalp. Baricitinib was efficacious in achieving a holistic response across all three hair-bearing sites in the majority of week-52 scalp responders. These data detail the benefits of baricitinib across important hair-bearing sites involved in AA and highlight that individual patient treatment success should account for the totality of the clinical presentation.