Background: Eyebrow and eyelash (EB/EL) involvement is an important consideration in the assessment of alopecia areata (AA) severity.
Objectives: To report on the integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259), characterizing EB/EL involvement at baseline in patients with AA and response to baricitinib treatment.
Methods: BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) were randomized double-blind placebo-controlled trials conducted at 169 centres in 10 countries. Patients were randomized to placebo, baricitinib 2 mg or baricitinib 4 mg. Pooled data from patients continually treated with baricitinib through week 52 were included. Outcomes were assessed using a clinician-reported outcome (ClinRO) measure for EB/EL and Severity of Alopecia Tool (SALT) score for the scalp.
Results: At baseline, patients with more severe EB/EL involvement had more severe scalp hair loss, with mean SALT scores ranging from 70.6 to 96.0 for patients with no gaps to complete absence of hair, respectively, at EB/EL sites. EB/EL response rates [ClinRO (0,1) with ≥ 1-point improvement] at week 36 were significantly higher in patients treated with baricitinib 2 mg [EB: 28.2%, odds ratio (OR) 3.27; EL: 25.1%, OR 2.95] and baricitinib 4 mg (EB: 44.3%, OR 6.84; EL: 46.4%, OR 8.21) compared with placebo (EB: 12.6%; EL: 12.4%). There was high concordance between EB response and EL response, with approximately 80% of patients who achieved hair regrowth at one site achieving regrowth at the other, with baricitinib 4 mg. Among scalp responders (SALT score ≤ 20 at week 52), 78.5% (n = 95/121) and 82.6% (n = 100/121) achieved an EB and EL response, respectively, and 71.1% (n = 86/121) of patients achieved EB and EL responses with baricitinib 4 mg. Among scalp nonresponders (SALT score > 20 at week 52), 46.7% (n = 91/195) and 48.7% (n = 95/195) achieved EB and EL responses, respectively, and 35.4% (n = 69/195) achieved responses in both EB and EL. Similar trends but lower response rates were observed with baricitinib 2 mg.
Conclusions: Baseline severity of EB/EL involvement paralleled that of the scalp. Baricitinib was efficacious in achieving a holistic response across all three hair-bearing sites in the majority of week-52 scalp responders. These data detail the benefits of baricitinib across important hair-bearing sites involved in AA and highlight that individual patient treatment success should account for the totality of the clinical presentation.
Alopecia areata (‘AA’ for short) is hair loss caused by the body’s immune system attacking hair follicles by mistake. Hair follicles are the areas where hairs develop. The condition usually occurs on the scalp. However, AA can also affect other body sites such as the eyebrows and eyelashes. This can add to the severity and burden of the disease for people living with the condition. In this study, we wanted to understand how eyebrow and eyelash involvement affects the severity of AA. We also wanted to find out how treatment with a drug called ‘baricitinib’ might help. We combined the results of two previous clinical trials. These trials included patients with AA from 169 treatment centres in 10 countries. In these trials, patients received either a placebo (a ‘dummy drug’) or baricitinib. We found that patients with more severe eyebrow and eyelash loss also had more severe hair loss on their scalp at the start of the study. Seven per cent of patients taking 4 milligrams of baricitinib saw improvement in their eyebrows by week 8. Even more patients (11%) taking the same dose of baricitinib saw improvement in their eyelashes in the same period. By week 52 of the study, more than half of patients had eyebrow and eyelash regrowth. Most patients (71%) who had a lot of hair regrowth on their scalp also found their eyebrows and eyelashes regrew. Even patients who did not have their scalp hair regrow had success with regrowth of their eyebrows and eyelashes. We concluded that eyebrow and eyelash involvement was linked to the severity of scalp hair loss at the start of the study. Treatment with baricitinib resulted in significant regrowth of eyebrows and eyelashes. Many patients experienced regrowth of hair on their scalp, as well as their eyebrows and eyelashes. Our findings will help doctors set better treatment goals for people with AA, focusing on all areas of hair loss.
© The Author(s) 2025. Published by Oxford University Press on behalf of British Association of Dermatologists.