Oral JAK Inhibitors Well Tolerated in Patients With Alopecia Areata

Janus kinase (JAK) inhibitors administered orally, but not topically or sublingually, show efficacy for the treatment of patients with alopecia areata, according to a systematic review and meta-analysis published in Frontiers in Pharmacology.

“Among the JAK inhibitors for alopecia areata, baricitinib is the first treatment approved for the indication of alopecia areata by the US Food and Drug Administration on 13 June 2022; tofacitinib and ruxolitinib were approved for the treatment of rheumatoid arthritis and other inflammatory disorders; ritlecitinib and brepocitinib are under investigation and not available for routine clinical use,” explained researchers. “Hence, clinical statistics regarding the efficacy and safety of JAK inhibitors are required to provide a better insight in this new treatment strategy.”

The quantitative analysis included 14 prospective studies spanning 1845 patients with alopecia areata.

In the 5 randomized controlled trials in the analysis, oral JAK inhibitors were associated with a higher rate of good response compared with control. However, topical JAK inhibitors showed no difference from control. In the remaining 9 trials, pooled rates of good response were 63% with oral JAK inhibitors, 28% with topical JAK inhibitors, and 11% with sublingual JAK inhibitors.

In subgroup analyses, baricitinib, ritlecitinib, and brepocitinib appeared to offer equal efficacy for alopecia areata in randomized controlled trials. In the noncontrolled studies, ruxolitinib compared with tofacitinib, and alopecia areata compared with alopecia totalis or alopecia universalis, were associated with better outcomes.

Researchers identified a 54% pooled recurrence rate with JAK inhibitors, mostly due to treatment discontinuation.

“Given the high recurrence rate after withdrawal of JAK inhibitors, continuous treatment should be considered to maintain efficacy,” concluded study authors.

Reference:
Yan D, Fan H, Chen M, et al. The efficacy and safety of JAK inhibitors for alopecia areata: a systematic review and meta-analysis of prospective studies. Front Pharmacol. 2022;13:950450 doi:10.3389/fphar.2022.950450