Muñoz-Barba Daniel, Soto-Moreno Alberto, Francisco Sofía Haselgruber-de, Sánchez-Díaz Manuel, Arias-Santiago Salvador
Dermatology Unit, Hospital Universitario Virgen de Las Nieves, IBS Granada, Avenida de las Fuerzas Armadas S/N, 18014, Granada, Spain.
Dermatology Department, School of Medicine, University of Granada, Granada, Spain.
Dermatol Ther (Heidelb). 2025 Jul 7. doi: 10.1007/s13555-025-01468-1.
Therapeutic burden (TB) has been proposed as a potential predictor of treatment outcomes in both dermatological and non-dermatological diseases. This study aims to introduce the concept in the context of alopecia areata (AA) and assess its potential value in supporting therapeutic decision-making in clinical practice.
A prospective cohort study was conducted including patients with AA who started treatment with baricitinib between January 2022 and January 2025 at a third-level hospital center. The main variable was TB, defined as the cumulative sum of previous systemic treatment cycles. An analysis was performed on whether socio-demographic or clinical factors were associated with TB.
Forty-four patients with AA treated with baricitinib were included. Most were women (65.90%) with a mean age of 37.70 (16.10) years. The predominant type of AA was multi-plaque (65.90%) and approximately one third (34.10%) had total/universal forms of the disease. Lower TB was statistically significantly associated with a greater reduction in Severity of Alopecia Tool (SALT) scores during the first 12 months of barictinib treatment compared with those patients with high TB (p < 0.05). This association was observed independently of all other known progression factors (duration of AA, baseline SALT, total/universal AA, female sex) (p < 0.05).
We present the concept of AA-adapted TB as a useful tool for categorizing patients with AA and contributing to therapeutic decision-making. Patients with AA with low TB showed a greater response to baricitinib treatment than patients who had received a greater number of systemic treatments previously.
治疗负担（TB）已被提议作为皮肤病和非皮肤病疾病治疗结果的潜在预测指标。本研究旨在斑秃（AA）背景下引入这一概念，并评估其在支持临床实践中治疗决策方面的潜在价值。
进行了一项前瞻性队列研究，纳入2022年1月至2025年1月在一家三级医院中心开始使用巴瑞替尼治疗的AA患者。主要变量是TB，定义为既往全身治疗周期的累积总和。分析了社会人口统计学或临床因素是否与TB相关。
纳入了44例接受巴瑞替尼治疗的AA患者。大多数为女性（65.90%），平均年龄37.70（16.10）岁。AA的主要类型是多斑块型（65.90%），约三分之一（34.10%）患有疾病的全秃/普秃形式。与高TB患者相比，低TB在巴瑞替尼治疗的前12个月内与脱发严重程度工具（SALT）评分的更大降低在统计学上显著相关（p<0.05）。观察到这种关联独立于所有其他已知的病情进展因素（AA病程、基线SALT、全秃/普秃、女性）（p<0.05）。
我们提出了适用于AA的TB概念，作为对AA患者进行分类并有助于治疗决策的有用工具。低TB的AA患者比先前接受过更多全身治疗的患者对巴瑞替尼治疗的反应更大。
