Baricitinib Shows Promise for Pediatric Alopecia in BRAVE-AA-PEDS Study

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Brittany Craiglow, MD, FAAD, dermatologist at Dermatology Physicians of Connecticut, discussed the promise of combination therapy to treat pediatric alopecia areata, specifically focusing on the use of baricitinib in adolescents with severe cases. She highlighted the importance of the late-breaking data from the phase 3 BRAVE-AA-PEDS study, presented at the American Academy of Dermatology 2025 annual conference taking place from March 7 to March 11 in Orlando, Florida.

Craiglow emphasized that although patients with severe alopecia areata often need chronic therapy, there is potential for dose reduction or discontinuation for some, particularly those with less severe and shorter-duration episodes. Craiglow also addressed the balance between treatment risks and benefits, particularly in adolescents, for whom untreated alopecia can significantly impact quality of life, leading to social withdrawal, bullying, and even school dropout. She noted that while safety is a primary concern, the established safety profile of baricitinib in younger populations for other conditions provides reassurance.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

What are the key factors you consider when determining the appropriate dosage and duration of baricitinib treatment for pediatric and adolescent patients with severe alopecia areata?

In the clinical trial for baricitinib and adolescents, the dosing was weight based. Patients 30 kg and up got 4 mg daily while those under 30 kg received 2 mg daily. We're learning kind of a lot about what happens with treatment, and if patients are able to either decrease the dose or potentially come off, that's something that I think there's still a lot of data that we need to be able to ... inform that question. I would say for most patients with severe alopecia areata, it's a chronic disease, so it requires chronic therapy.

As we're learning, there may be some patients who can decrease the dose or ultimately come off, and those are most likely going to be patients who have a little bit lesser severity and a lesser what we call duration of current episodes, so meaning how long it's been since they had sort of significant scalp hair. Hopefully, over the next few years, we'll have more data to kind of help us identify who those patients are, who may be able to get away with a lower dose or eventually come off treatment.

How do you balance the need for effective treatment with the potential risks and costs associated with baricitinib, particularly in vulnerable pediatric and adolescent populations?

I think we always want to treat our patients effectively, but safety is always a big concern, especially among parents. I think it's one thing to kind of make a decision for yourself where there may be a little bit of risk, but when you're making [a decision] about your child, it feels different.

It feels like sort of more of a big deal decision. I think the thing is that we often say we're weighing risk and benefit, and we are, but I think really in alopecia areata and other things we see in dermatology, we're really kind of weighing risk of treatment vs the risk or the consequence of not treating.

I think in alopecia areata, that risk is really high. What does it mean to be in middle school and all of a sudden you lose your hair, you lose your eyebrows, you are withdrawing socially, you're getting bullied? Maybe you were an athlete and you're not playing sports anymore. We have patients who drop out of school so that risk is really quite high. I often say this is a disease that can really kind of change the trajectory of a person's life. We all know that adolescence is kind of hard anyway, and then you add having no hair or missing a lot of hair to that, it's even more complicated.

I think with baricitinib, there is this legacy of safety data. It's approved in many countries down to age 2 for other indications like atopic dermatitis, juvenile idiopathic arthritis. There's safety data in even a younger population that we have to kind of draw from. I think that's really reassuring.

For the adolescent population, when we use these medicines, we do them as carefully as possible. We're checking blood work, we’re seeing patients back, and doing review of systems. I think the more long term data we see, the better these medications look in the healthy patients that we're seeing in dermatology. I think for most families, they are willing to accept a very small amount of risk for the chance for their child to sort of have normalcy in their life.