Major improvement of very severe alopecia aerata in patients treated with the combination of baricitinib and low doses of corticosteroids: an 8-case series.

Poor therapeutic results have been reported in patients with very severe alopecia aerata (AA) (SALT ≥ 95) with either methotrexate stand alone or baricitinib. Oral corticosteroids have an interest only in the attack phase due to their long-term poor tolerance. Additionally, baricitinib allows a sustained clinical response once patients have achieved hair regrowth (HR). We report our experience of the combination of baricitinib 4 mg + low-dose of prednisone (20 mg/day tapered over 3 months) in patients with very severe AA. In a retrospective monocentric study, 8 women were included (mean age = 44.5 ± 14.4yo; mean disease duration = 3.3 ± 2.1y) whom 6 already received at least one systemic therapy. After a mean follow-up duration after prednisone withdrawal of 6.0 ± 0.9 months, all patients had a complete HR (7/8, 87.5%) or almost-complete HR (1/8, 12.5%). This combination allowed a very high rate of complete and sustained HR in patients with very severe AA.