The JAK 1/2 inhibitor baricitinib may be a potential therapeutic option for patients with refractory lichen planopilaris (LPP) and its clinical variant frontal fibrosing alopecia (FFA).

An Australian retrospective review, published in the Journal of the American Academy of Dermatology, comprised 12 LPP and FFA patients treated with a median dose of 3.4 mg baricitinib and titrated according to response and tolerability.

The median age at diagnosis was 43 years and the median disease duration was 7 years. Concurrent treatments included low-dose oral minoxidil, spironolactone, topical corticosteroids and anti-androgens.

The Research Letter said the patients had a median baseline Lichen Planopilaris Activity Index (LPPAI) score of 5.8.

It found five out of seven patients with classical LPP demonstrated an initial improvement – a reduction in median LPPAI score of 2.8 – although the response was only maintained in three after a median duration of 6 months.

“Three out of 5 patients with FFA demonstrated an initial reduction in median LPPAI score of 5.6 (83.8%;p=0.11) with response maintained in 2 after a median duration of 6 months.”

“Two patients with classical LPP and 2 with FFA failed to improve despite baricitinib dose escalation; of these, 2 experienced disease progression,” the Research Letter said.

The investigators, including Melbourne’s Professor Rod Sinclair, said baricitinib-related adverse effects including transaminitis, hypercholesterolemia, neutropenia were mostly mild. One patient with fatigue had to discontinue treatment.

They said their results support other evidence that JAK inhibition has promise in the management of recalcitrant LPP however larger prospective studies were required.

A 2020 study found six of nine patients had favourable and mostly durable responses to treatment with oral tofacitinib.

Disclosures: Professor Sinclair and another co-author Dr Samantha Eisman report being on the advisory boards of several pharmaceutical companies including Eli Lilly.