Publication:

Adverse effects of baricitinib in comparison to methotrexate in the treatment of severe alopecia areata

Background Existing therapies for alopecia areata often yield suboptimal results and have some associated side effects. Janus kinase (JAK) inhibitors are a recent advancement in the treatment of alopecia areata which are treatment resistant or severe.

Methods This analytical observational study was conducted in the department of Dermatology and Venereology of Bangladesh Medical University to compare the adverse effects of baricitinib and methotrexate in the treatment of severe alopecia areata. About 84 patients of alopecia areata were divided into two groups. Patients of group A were treated with oral baricitinib and group B were treated with oral methotrexate for 6 months.

Results The most common adverse effects noted in baricitinib group was upper respiratory tract infection 14.3% and hyperlipidaemia was 11.9% of patients and in methotrexate group was nausea 28.6%, and elevated liver transaminase was 16.7 % patients. Serum transaminase (ALT) elevation was significantly raised from baseline to after 6 months (40.21±19.29, p<0.001) in methotrexate group, whereas there was no significant change (33.53±19.86, p=0.506) in baricitinib group. There was statistically significant change before and after treatment in serum creatinine (0.88±0.12, p=0.004) in baricitinib group, compared to no significant change in methotrexate group (p=0.222). There was significant rise in total cholesterol, triglyceride and LDL after 6 months of treatment with baricitinib and these results were statistically significant (p<0.001).

Conclusions After 6 months of treatment, baricitinib has proven its superiority over methotrexate in terms of safety in the treatment of severe alopecia areata.