Baricitinib for treating severe alopecia areata

1.1 Baricitinib is not recommended, within its marketing authorisation, for treating severe alopecia areata in adults.

1.2 This recommendation is not intended to affect treatment with baricitinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Treatments available on the NHS for severe alopecia areata include topical corticosteroids, which are usually prescribed in primary care. If they do not work, people may be referred to a dermatologist and offered a range of medicines, many of which are not licensed for this condition, or a wig.

Evidence from clinical trials suggests that baricitinib improves hair regrowth after 36 weeks of treatment compared with placebo. But treatment needs to be continued to prevent hair loss. Hair loss can cause severe psychological distress, but baricitinib did not show a meaningful improvement in most of the health-related quality-of-life assessments done in the trials compared with placebo.

The cost-effectiveness estimates for baricitinib are uncertain and are higher than what NICE normally considers an acceptable use of NHS resources. So, baricitinib is not recommended.