Defining a Therapeutic Window of Opportunity in Alopecia Areata: Predictors of Early Response to Baricitinib

Abstract

Background/Objectives: Baricitinib, a selective Janus kinase (JAK) 1 and 2 inhibitor, has recently emerged as a therapeutic option for patients with severe alopecia areata (AA). The aim of this study was to identify clinical and biological predictors of early therapeutic response to baricitinib in patients with AA in real-world clinical practice. Methods: A retrospective cohort study was conducted including patients with AA initiating baricitinib between January 2022 and January 2025. Patients were stratified into early responders and non-early responders. Univariate and multivariate logistic regression analyses were performed to assess factors independently associated with early therapeutic response. Results: A total of 44 patients with AA treated with baricitinib were included, the majority being female (65.9%, 29/44), with a mean age of 37.3 years (SD 16.1). Early responders accounted for 34.1% (15/44) of the cohort. In multivariate analysis, early response to baricitinib was independently associated with a lower baseline Severity of Alopecia Tool (SALT) score, shorter disease duration, and elevated erythrocyte sedimentation rate (ESR) at baseline (p < 0.05). Receiver Operating Characteristic (ROC) curve analyses were performed to determine optimal thresholds for predicting early therapeutic response: ESR ≥ 9 mm/h, baseline SALT score ≤ 60%, and disease duration ≤ 7 years. Conclusions: Baseline stratification using easily obtainable clinical and laboratory parameters may help identify patients most likely to benefit from initiating treatment with baricitinib. Our findings support the existence of a therapeutic window of opportunity in AA, particularly in patients with lower disease burden, shorter disease duration, and elevated ESR values.