Tolerability and efficacy of unorthodox dosing regimens of tofacitinib and baricitinib in pediatric patients with moderate to severe alopecia areata.

Abstract

Evidence on tofacitinib and baricitinib in pediatric alopecia areata is limited. To evaluate the comparative tolerability and efficacy of tofacitinib and baricitinib with unorthodox dosing in pediatric moderate-to-severe alopecia areata over 24 weeks. One hundred pediatric patients (severity of alopecia tool [SALT] score 21-100) were randomized 1:1 to tofacitinib (n = 51) or baricitinib (n = 49). SALT score ≤10 (moderate, 21-49) and SALT score ≤20 (severe, 50-94, and very severe, 95-100) at week 24. For moderate patients, 33.33% (tofacitinib) and 41.18% (baricitinib) achieved SALT score ≤10 (P = .87). For severe patients, 45.45% (tofacitinib) and 30.77% (baricitinib) achieved SALT score ≤20 (P = .75). For very severe patients, 47.37% (tofacitinib) and 31.58% (baricitinib) achieved SALT score ≤20 (P = .51). For secondary outcomes, the proportion of patients achieving SALT₉₀ in the baricitinib group (36.73%) was numerically higher than that in the tofacitinib group (21.57%) (P = .16). Both were well-tolerated and no serious adverse events occurred. Short duration and efficacy findings may not generalize to standard dosing regimens. Unorthodox-dosed tofacitinib and baricitinib showed comparable efficacy and were well-tolerated in pediatric alopecia areata over 24 weeks, supporting short-term use.