Switching from Tofacitinib to Baricitinib in Alopecia Areata: How do patients do?

Many Patients do Well with a Switch from Tofacitinib to Baricitinib

There are many reasons why a patient with alopecia areata would need to switch from tofacitinib to baricitinib. Perhaps the former is no longer covered by insurance. Perhaps the latter is. How easy is it to switch from tofacitinib to baricitinib anyways?

Kazmi et al 2023

Authors from Australia (Kazmi et al 2023) set out to determine what exactly happens when patients switch JAK inhibitors. The authors retrospectively reviewed the electronic records of patients with AA who switched from tofacitinib to baricitinib.
 
There were 16 patients with complete regrowth on tofacitinib who were then switched to baricitinib. 100 % maintained their complete remission.

There were another 9 complete responders on tofacitinib who ultimately had a relapse on tofacitinib and were switched over to baricitinib. 5 of these 9 patients (55.6%) experienced full regrowth on the new baricitinib and 4 had only partial regrowth with the new drug.

There were 35 patients with only partial response to tofacitinib. 10 of these patients (28.6%) had a complete regrowth upon switching to baricitinib.

There were 8 patients who did not grow hair at all on tofacitinib therapy. None of these 8 patients had full regrowth when they switched to baricitinib.

SUMMARY and CONCLUSIONS

I liked this study.

This is much needed data that we have all been waiting for. These data suggest that switch from tofacitinib to baricitinib is likely to lead to similar results and possibly better results compared to what one had on tofacitinib. Complete responders on tofacitinib seem to maintain hair on baricitinib. This is important because this data suggests that most patients who need to switch from tofacitinib to baricitinib (for insurance coverage etc) are likely to do great and continue to grow hair really well.
Patents who were partially responding on tofacitinib are likely to either partially respond  again on baricitinib or 30 % of the time - possibly even completely regrow hair fully.

REFERENCE
Kazmi A et al. J Am Acad Dermatol. 2023 Apr 4;S0190-9622(23)00532-