Alopecia Areata Following the Use of Belimumab in a Patient with Systemic Lupus Erythematosus and Arthritis Who Responded Well to Baricitinib: A Case Report.

BACKGROUND Appropriate recommendations for the management of systemic lupus erythematosus (SLE) should be carefully followed. A significant adverse effect can develop unexpectedly, and off-label drug use may control this adverse effect and other lupus manifestations. The current research in lupus relies solely on multiple composite outcome measures, which vary from one study to another. However, the optimal drug for a particular lupus symptom is presently unclear, requiring additional research for definitive clarification. CASE REPORT Here, we report a typical case of SLE in a 54-year-old Saudi female patient who presented with mucocutaneous symptoms and arthritis. She had a positive serology for antinuclear antibodies and anti-double-stranded DNA. Owing to the failure of conventional drugs, the use of belimumab resulted in significant improvements. She later developed worsening symptoms that progressed from alopecia areata (AA) to alopecia totalis (AT) and alopecia universalis (AU). She partially responded to systemic and local steroid injections. All measures to taper her steroid failed despite the use of azathioprine, methotrexate, and mycophenolate. Belimumab was stopped due to lack of efficacy. She was re-challenged with belimumab after she showed partial response to steroid therapy, but this clearly resulted in worsening of her hair loss to AT. The use of baricitinib following the second discontinuation of belimumab resulted in a significant improvement in AT and arthritis. CONCLUSIONS Our case offers valuable perspectives for future SLE research by concentrating on specific outcomes instead of composite outcome measures. The effectiveness of baricitinib should be investigated further in SLE.