Poster Presentation Australasian Society for Dermatology Research Annual Scientific Meeting 2024

A 5-year case series on Inflammatory Lichen Planopilaris treated with baricitinib (#114)

Nicole Yoong 1 , Daniella Kushnir-Grinbaum 2 , Rodney Sinclair 2
  1. Sinclair DIRECT (Dermatology Investigational Research Education, and Clinical Trials Centre), East Melbourne, VIC, Australia
  2. Sinclair Dermatology, East Melbourne, VIC, Australia

Lichen Planopilaris (LPP) is a difficult to treat inflammatory cicatrial alopecia. We report 28 patients with LPP treated with the anti-inflammatory Janus kinase inhibitor, baricitinib.

 

Methods:

Patients at a single dermatology clinic treated with baricitinib for LPP between January 2019 and April 2024 were categorized by their treating dermatologist as worse, no change, and improved. The lichen planopilaris activity index (LPPAI) was not used as we have observed lack of utility in real-world clinical practice. Clinical information for each patient at every visit during this time period was analysed including duration of baricitinib treatment, daily dosage, concomitant medications, presence of other hair disorders and adverse events. However, we only explored the relationship between use of baricitinib and treatment outcomes.

Results:

28 patients were identified. A chi-squared analysis was performed which showed no difference with baricitinib treatment in disease progression in these patients.

Discussion

In this patient cohort, treatment with the JAK 1 and 2 inhibitor, baricitinib, did not appear to improve LPP disease outcomes.

We suggest that JAK inhibitors, including baricitinib are not highly effective treatments for LPP. We cannot exclude that JAK inhibitors may improve LPP in some patients (1-4). This study is however limited by small sample size, use of concomitant medications for treatment-refractory LPP, potential selection bias and the lack of a validated objective scoring system for LPP disease outcome.

 

Conclusion  

Baricitinib has been used as a treatment of last resort in patients with progressive alopecia secondary to LPP refractory to other conventional medications. Our data suggest only a limited or no role of baricitinib in this patient population.

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  2. Moussa A, Bhoyrul B, Asfour L, Kazmi A, Eisman S, Sinclair RD. Treatment of lichen planopilaris with baricitinib: a retrospective study. Journal of the American Academy of Dermatology. 2022;87(3):663-6.
  3. Motamed-Sanaye A, Khazaee YF, Shokrgozar M, Alishahi M, Ahramiyanpour N, Amani M. JAK inhibitors in lichen planus: a review of pathogenesis and treatments. Journal of Dermatological Treatment. 2022;33(8):3098-103.
  4. Yang CC, Khanna T, Sallee B, Christiano AM, Bordone LA. Tofacitinib for the treatment of lichen planopilaris: a case series. Dermatologic therapy. 2018;31(6):e12656.