Baricitinib Induced Hypoglycemic Seizures in a Patient with Hair Loss and Type I Diabetes Mellitus: A Case Report

Abstract

Alopecia Areata (AA) is an autoimmune-mediated form of non-scarring hair loss. Novel treatment involves Janus Kinase (JAK) inhibitors that aim to stop the progression of AA and restore hair growth. Baricitinib is a selective JAK1/JAK2 inhibitor that has shown efficacy in the treatment of AA. Overall safety of baricitinib is favorable, however, we present a patient who experienced recurrent hypoglycemic seizures. A 60-year-old female presents with a long-standing history of hair loss and type 1 diabetes mellitus. She was started on baricitinib 4mg daily and quickly observed hair regrowth and reduced shedding. However, the patient also experienced four hypoglycemic seizures in the first 30 days. Blood glucose measurements were performed following each seizure, with values ranging from 25-38mg/dL. At her initial follow-up, the patient did not want to discontinue medication due to her hair improvement and therefore the baricitinib dose was reduced to 2mg daily. The patient subsequently denied additional seizures and glucose readings below 40mg/dL. Although hypoglycemia is not a reported FDA side effect of baricitinib, there are few reports of JAK inhibitors causing this outcome in at risk patients. Hypoglycemia as an adverse event may be explained by the role of JAK-STAT pathways in β-cell destruction. With the increasing use of JAK inhibitors in dermatology, close glucose monitoring and increased patient education is advisable until the potential for hypoglycemia as an adverse effect is further understood.