What to Know About Olumiant, the First Systemic Treatment for Severe Alopecia

If you or a loved one are living with alopecia areata (“alopecia”) that has become severe, you may be wondering about new treatment options to help with hair growth. Topical treatments and medications used off label for alopecia don’t always do the trick, so it may be encouraging to know that the list of treatment options is now a bit longer.

In June 2022, the FDA approved Olumiant for the treatment of adults with severe alopecia. At the time of its approval, it was the first treatment of its kind for alopecia.

What is Olumiant?

Olumiant (baricitinib) is an oral prescription medication that’s approved to treat severe alopecia. Other treatments for alopecia are usually given topically (applied to the skin) or through injections. And unlike most other alopecia treatments, Olumiant is systemic, meaning it works by affecting the entire body, rather than staying in a certain area.

Olumiant is also approved to treat adults with moderate-to-severe rheumatoid arthritis and for certain hospitalized adults with COVID-19.

What is alopecia?

Alopecia is an autoimmune disorder that causes your body’s immune system to attack your hair follicles. This leads to inflammation and hair loss. It tends to start with small patches of hair loss on the scalp, but it can progress to cause total hair loss on the scalp and other parts of the body.

Olumiant for hair loss: How does Olumiant work to treat alopecia?

Olumiant is known as a Janus kinase (JAK) inhibitor. It works by blocking the actions of JAK enzymes (proteins), which play a role in immune signaling and cause inflammation in our bodies.

It’s not fully understood how the immune system contributes to alopecia. But it involves many different immune signals that affect the hair growth cycle, likely resulting in hair loss. Olumiant helps with hair growth by interrupting immune system signals that cause hair loss and by reducing inflammation.

Other treatment options for severe alopecia

Treatment options for people living with severe alopecia are relatively limited. Olumiant is currently one of two systemic medications that are approved for treating this condition. The other one is Litfulo (ritlecitinib), a similar medication that was first approved in June 2023.

Other alopecia treatment options may include:

• Corticosteroids like prednisone: For severe alopecia, corticosteroids are taken in hopes of suppressing the immune system enough to allow hair to regrow. Typically, corticosteroids are taken by mouth for up to 6 weeks at a time. They can also be applied to the skin or injected into affected areas.

• Methotrexate: Another immunosuppressive medication, methotrexate may be an effective treatment option after other treatments haven’t worked. Methotrexate may also be given with a corticosteroid for better results.

• Oral minoxidil: An off-label treatment for hair loss, some people respond well to this once-daily pill. It’s the oral equivalent of topical minoxidil (Rogaine).

• Contact immunotherapy: This treatment involves applying chemicals to the affected areas of the scalp in order to change the immune system’s response in those areas. This can be effective, but treatments must be repeated to see continued results.

How is Olumiant dosed and given for alopecia?

Olumiant is a tablet medication that should be taken by mouth once a day, with or without food.

For most people, the recommended Olumiant dosage is 2 mg (1 tablet) by mouth once a day. Some people may be treated with up to 4 mg once a day. Your healthcare provider will determine the right dose for you based on your symptoms and how you respond to the medication.

Olumiant is not recommended for people with severe kidney or liver damage. If you have kidney or liver problems, speak with your healthcare provider to see if Olumiant is a possible option for you.

Olumiant side effects

Like most medications, Olumiant can cause some side effects. Olumiant side effects may include:

• Upper or lower airway infection

• Headache

• Acne

• Nausea

• Fatigue

• Higher cholesterol

• Hair follicle inflammation

• Higher levels of liver enzymes

• Higher levels of muscle enzymes

• Urinary tract infections

• Pain in the stomach area

• Lower blood cell counts, specifically red blood cells and white blood cells

Although rare, some side effects of Olumiant are considered serious and are flagged in boxed warnings — the FDA’s most serious type of warning for a medication. They include:

• Serious infections, including tuberculosis, shingles, and other bacterial, viral, or fungal infections

• Cancer

• Cardiovascular events, including heart attack and stroke

• Blood clots

• Higher risk of death in people 50 years or older who have at least one heart-related risk factor

Olumiant may also cause other serious side effects that aren’t included in boxed warnings. These can include stomach tears and allergic reactions such as hives, difficulty breathing, and swelling of the mouth, tongue, or throat.

If you experience any serious side effects, it’s recommended to seek medical attention right away.

How effective is Olumiant for alopecia?

Olumiant has been shown to be effective at regrowing hair for people living with alopecia. It was studied in adults with alopecia who had hair loss affecting more than half of their scalp.

In two clinical studies, people received either 2 mg of Olumiant, 4 mg of Olumiant, or a placebo (a pill with no medication in it). About 23% of adults with severe alopecia who took the 2 mg dosage of Olumiant achieved at least 80% scalp hair coverage after about 9 months. Roughly 39% of people taking Olumiant 4 mg achieved at least 80% scalp hair coverage.

By comparison, about 3% to 6% of people taking a placebo achieved at least 80% scalp hair coverage after 9 months.

Olumiant interactions

A few medications can interact with Olumiant and lead to additional side effects. Top offenders include:

• Probenecid

• Teriflunomide (Aubagio)

• Gemfibrozil (Lopid)

• Other JAK inhibitors, like Rinvoq (upadacitinib)

• Biologic disease-modifying antirheumatic drugs (DMARDs) like Humira (adalimumab)

• Immunosuppressants like cyclosporine (Sandimmune)

• COVID vaccines — try to leave 1 to 2 weeks between getting these vaccines and taking Olumiant, to help bolster vaccine effectiveness

As a general rule, let your healthcare provider and pharmacist know what medications and over-the-counter supplements you take before starting treatment with Olumiant. Giving them a written or electronic medication list is even better. This will help them screen for interactions up front.

How to save on Olumiant

There are ways to save on Olumiant, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.

• Save with patient assistance programs. The manufacturer of Olumiant, Eli Lilly, has a program called Lilly Cares that helps people receive the company’s medications at no cost. You can learn more about this program online or by calling 1-800-545-6962.

• Save with a copay savings card. If you have commercial insurance and it covers Olumiant, you may be eligible to pay as little as $5 per month using a savings card from the manufacturer. If you have commercial insurance that doesn’t cover Olumiant, you may be able to pay as little as $25 per month.

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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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