Lessons learned from alopecia areata trials

What are the key lessons that can be drawn from recent clinical trials in alopecia areata (AA)? Dr Brett King (Fairfield, CT, US) addressed this question during a presentation at the SPIN Congress of 2025 [1].

“The first major takeaway from the clinical trial programme in AA is that topical JAK inhibitors are ineffective for patients with moderate to severe AA [2,3],” Dr King began. Another critical issue he raised is that, in patients with severe AA (SALT score between 50 and 100), the chance of spontaneous hair regrowth is very low. In the BRAVE-AA2 study and a ritlecitinib trial, the placebo response rates were only 3.3% and 2%, respectively, among patients with severe AA [4,5].

Next, Dr King highlighted an important factor associated with treatment efficacy: baseline hair presence. “We observed that ‘having hair at the start of treatment’ almost doubled the response rate to baricitinib [6],” he said. Similarly, the duration of the current episode of severe AA also influenced treatment outcomes. Patients with an episode lasting up to 3 years were more likely to respond to baricitinib than those with longer disease duration [7]. “The response rate among patients who had hair at the start of treatment and a disease duration of 3 years or less is about 60%, whereas the response rate is only 15% in patients who lack these favourable features,” Dr King added.

Additionally, it has been shown that a ≥30% improvement in baseline SALT score and/or regrowth of eyebrows or eyelashes by month 9 of treatment is predictive of a complete response to baricitinib [8]. “A 9 to 12-month optimised treatment regimen is necessary to determine whether a particular regimen will lead to success,” clarified Dr King.

Finally, Dr King addressed the possibility of treatment withdrawal in select. He noted that patients with a very short disease duration (<1.5 years). May maintain hair regrowth after stopping treatment. “We observed maintenance of hair regrowth in these patients, but not in those with longer-standing disease, suggesting that disease modification may be possible when treatment is initiated very early [9],” he explained.

However, it is important to remember that severe AA is a chronic disease, and nearly all patients with severe AA require ongoing treatment to maintain hair growth.”

1. King B. AA: What we’ve learned from clinical trials. SPIN Dermatology Congress, Paris, France, 2-4 July 2025
2. Olsen EA, et al. JAAD. 2020;82:412-419
3. Mikhaylov D, et al. Arch Dermatol Res. 2023;315(2):181-189
4. King B, et al. NEJM. 2022;386(18):1687-1699
5. King B, et al. Lancet. 2023;401:1518-1529
6. King B. late-breaking abstract, 2024 AAD Annual Meeting, 8-12 March, San Diego, USA.
7. King B, et al. SKIN. 2025;9(1):S521
8. King B, et al. Br J Dermatol. 2023;189(6):666-673
9. King B, et al. JAMA Dermatol. 2024;160:1075-1081

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Posted on 21 August 202525 August 2025