In a recent editorial, the authors raise concern that baricitinib, the first drug approved to treat alopecia areata, was not adequately tested in people of color. Additionally, its higher cost may further contribute to health disparities.
The introduction of baricitinib can be described as a game-changer for the treatment of alopecia areata (AA). Until now, AA has been treated using different approaches that combined topical, intralesional, and systemic agents, and most of them had immunosuppressive activity.
Baricitinib is the first drug belonging to the new class of drugs called Janus kinase (JAK) inhibitors specifically approved for treating AA. It is quite likely that many new candidates from this class will also be introduced in the near future. Hence, it is time to explore the real-world efficacy of these drugs and see how this new drug may help reduce health disparities.
In this editorial, published in the journal Cutis, the authors explore the implications of the introduction of baricitinib in the treatment of AA in skin of color.
Baricitinib and Skin of Color
In this review, the authors highlighted a few concerns regarding health disparities. Concerning representation in clinical trials, Black and Latino patients participated in phase 2 and 3 drug trials, but their numbers were not representative of the U.S. population. The authors also noted that recent studies show that AA is more common in Black people, suggesting that it has the highest incidence in Black people (1.36 times higher risk than in Whites), and challenging the narrative that AA is more common in White people.
Moreover, a 2018 study found that the lifetime incidence of AA in Black women was 2.63 and 5.23 times higher, according to data from the Nurses’ Health Study and the Nurses Health Study II, respectively. Additionally, the authors raise concern regarding too little participation of Black people in baricitinib trials, citing that, in the BRAVE-AA1 and BRAVE-AA2 trials, out of 1200 patients, only 98 were identified as Black.
Another expressed concern is inadequate insurance coverage for people of color. Studies on psoriasis show lower prescriptions of biologics to Black people due to lower insurance coverage. Newer drugs tend to be expensive; thus, insurance companies want their patients to start with less expensive treatment. For Black patients, who are more likely to present with more severe AA, these issues may lead to increased health disparities. It is likely that access to JAK inhibitors may become a cornerstone of treating AA with equity.
The Bottom Line
It is known that AA has a more severe presentation in Black people, and yet they are under-represented in clinical studies. Further, due to lower insurance coverage, it is pretty likely that there may be delays in Black patients receiving JAK inhibitors for AA treatment. To prevent AA treatment disparities, it is vital to consider these factors.
Obeime, I. (2023). Alopecia areata in skin of color patients: New considerations sparked by the approval of Baricitinib. Cutis, 111(1). https://doi.org/10.12788/cutis.0685