Efficacy and predictive markers of response to tofacitinib and baricitinib therapy in alopecia areata: A 52-week comparative cohort study

Introduction. Tofacitinib and baricitinib are key systemic therapies for alopecia areata. However, direct comparative data on their efficacy and predictors of treatment response in real-world practice are limited.
Aim. To compare the efficacy of tofacitinib and baricitinib in alopecia areata and identify predictors of treatment response.
Materials and methods. A 52-week prospective comparative non-randomized cohort study included 45 patients with alopecia areata (SALT >25%). Patients were divided into two groups: tofacitinib (n = 18,10 mg daily) and baricitinib (n = 27,4 mg daily). Efficacy was assessed using SALT score dynamics, SALT30 (≥30% reduction), and SALT ≤20% (clinically significant outcome). Multiple regression models and Cox regression were used to identify predictors.
Results. Groups differed in age and sex (p < 0.05). At week 52, the median hair regrowth was 81.4% for tofacitinib and 100.0% for baricitinib (p = 0.280). Achievement of SALT30 and SALT ≤20% was comparable (p > 0.05). Multivariate analysis identified baseline disease severity (SALT) as the only independent predictor of poorer response (β = -2.6% per 10% SALT, p = 0.047; OR for SALT ≤20% = 0.78, p = 0.038). Drug choice was not associated with efficacy. However, the proportion of early responders (SALT30 by week 12) was significantly higher with baricitinib (51.9% vs. 22.2%, p = 0.041). No serious adverse events occurred.
Conclusions. Tofacitinib and baricitinib demonstrate comparable efficacy and a favorable safety profile in alopecia areata. Baricitinib is associated with a higher rate of early responders. The key predictor of response is the baseline extent of hair loss, which must be considered when planning therapy and evaluating outcomes.

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