Oral baricitinib, a Janus kinase (JAK 1/2) inhibitor, has been approved by the US Food and Drug Administration (FDA) as once-daily treatment of severe alopecia areata, an autoimmune disorder, in adult patients making it the first systemic treatment for the condition. This approval is based on the findings of the BRAVE-AA1 and BRAVE-AA2 randomized, double-blind, placebo-controlled trials.

Side effects: Respiratory tract infections, headache, nausea, acne, fatigue, pain abdomen, hyperlipidemia, UTI, folliculitis, elevated creatinine phosphokinase and liver enzymes, anemia, neutropenia, herpes zoster, genital candidiasis,

Contraindications: Coadministration with other JAK inhibitors, biologic immunomodulators, cyclosporine or other strong immunosuppressants.

Warnings and precautions: Hypersensitivity, close observation of patients for infection during/after treatment; investigate patient for active/latent tuberculosis before starting treatment; likelihood of viral reactivation, gastrointestinal perforation, leukopenia, anemia

The drug carries a “boxed warning” for severe infections, mortality, major adverse cardiovascular events and thrombosis and malignancy.