Two phase III trials of baricitinib for alopecia areata: a critically appraised research paper

Alopecia areata (AA) is a common form of nonscarring hair loss caused by T-cell autoimmunity directed against the hair follicle. It can affect any hair-bearing area with variable severity, ranging from a well-circumscribed patch of hair loss to complete loss of bodily hair.1 Patients with AA experience profound psychosocial sequelae, including stigma, emotional distress and challenges in interpersonal relationships.2 Unsurprisingly, patients with AA also report significantly lower health-related quality of life (HRQoL).3 Despite this, there are no licensed treatments for AA and evidence supporting unlicensed therapies is poor. In a recent report, King et al. described two explanatory phase III, double-blind, placebo-controlled, randomized control trials (RCTs) (BRAVE-AA1 and BRAVE-AA2), which both demonstrated efficacy of an oral Janus kinase inhibitor (baricitinib 2 mg or 4 mg daily) in the treatment of severe adult AA (defined as > 50% scalp hair loss). These findings naturally represent a potential watershed moment in AA management (Table 1).4