High-Dose Baricitinib for Severe Alopecia Areata with Suboptimal Response to Conventional Therapy: A Real-World Assessment

In a retrospective study involving 4 female patients with severe alopecia areata (AA) who had suboptimal responses to conventional therapies, baricitinib at a higher dose of 6 mg daily showed enhanced efficacy, with 75% of patients experiencing clinically meaningful improvements in their Severity of Alopecia Tool (SALT) scores. The study, conducted between January 2023 and June 2025, also reported transient laboratory abnormalities in 75% of the patients, such as mild platelet count elevation and self-resolving mild anemia, but no severe adverse events were observed. These results suggest that baricitinib 6 mg daily may be a viable option for severe refractory AA, warranting further investigation in randomized controlled trials.