COMPARISON OF EFFICACY OF BARICITINIB VERSUS METHOTREXATE THERAPY IN THE TREATMENT OF SEVERE ALOPECIA AREATA

Background: Alopecia areata is an autoimmune and inflammatory disease of the hair follicle which has a detrimental effect on the quality of life. Due to the refractory nature of the disease, it presents a major challenge to the physicians. When choosing a systemic therapy for extensive and recalcitrant alopecia areata, methotrexate can be a reasonable option, though its use is limited by its limited efficacy and more adverse effects. In the recent times, Janus kinase (JAK) inhibitors have proven its efficacy in the treatment of severe alopecia areata. Materials and Methods: This randomized controlled trial was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University from the period of January 2023 till September 2024. About 84 patients of alopecia areata with more than 50% scalp involvement, patients with alopecia totalis and alopecia universalis were divided into two groups. Patients of group A were treated with oral baricitinib 4mg once daily and group B were treated with oral methotrexate 15mg once weekly with oral folic acid 5mg the following day for 6 months. Patients were assessed at baseline, 1st month, 3rd month and 6th month using Severity of Alopecia Tool (SALT) score. Results: The most common type of alopecia areata was patchy alopecia areata in both of the groups. Before treatment the SALT score was 71.1±19.62 in group A and 65.4±18.6 in group B. After 1 month, 3 month and 6 month the SALT score was 55.3±19.6, 37.9±23.3 and13.2±22.6 respectively in group A, whereas it was 64.6±19.3, 58.8±24.9 and 51.3±31.1 respectively in group B, which was statistically significant (p<0.001). Regarding percent change in SALT score, at month 6, SALT75 i.e. excellent response was seen in 19% patients of group A compared to 9.5% in group B; and SALT90 i.e. complete response was achieved in 57.1% patients in group A compared to none in group B. Conclusion: After 6 months of treatment, Baricitinib has proven its superiority over Methotrexate in terms of efficacy in the treatment of severe alopecia areata. Thus it can be recommended that, Baricitinib can be an excellent choice for patients with extensive disease, and further extended period research is necessary to assess its long term efficacy.