autoimmune disorder leading to extensive hair loss.
Systemic JAK inhibitors have revolutionized the management of alopecia areata in recent years. While baricitinib and ritlecitinib are approved in both the United States and Europe, deuruxolitinib has recently received approval in the US for severe cases. However, in the absence of head-to-head randomized controlled trials, direct comparisons among these drugs have been challenging, limiting clinicians’ ability to make evidence-based prescribing choices.
To address this, researchers performed a systematic review in accordance with PRISMA 2020 guidelines (CRD420251116775), focusing exclusively on oral JAK inhibitors and doses approved by the US FDA, EMA, or MHRA. These included baricitinib (2 mg and 4 mg once daily), ritlecitinib (50 mg once daily), and deuruxolitinib (8 mg twice daily). Data from randomized controlled trials reporting 24-week outcomes were pooled, specifically evaluating the percentage of patients achieving Severity of Alopecia Tool (SALT) scores ≤10 and ≤20, which reflect substantial hair regrowth.
A Bayesian network meta-analysis (NMA) and multilevel network meta-regression (ML-NMR) were employed to compare efficacy across trials while adjusting for study heterogeneity and baseline imbalances. Additionally, unanchored matching-adjusted indirect comparisons (MAIC) were conducted using patient-level data from the THRIVE clinical trial program. The results were ranked using surface under the cumulative ranking curve (SUCRA) values to determine the relative performance of each treatment.
According to the authors, these findings provide the first quantitative synthesis comparing all currently approved oral JAK inhibitors for severe alopecia areata. While deuruxolitinib 8 mg twice daily emerged as the most effective option over 24 weeks, the researchers emphasized that the results should be considered exploratory and warrant confirmation through future direct comparative studies.
"The analysis offers valuable clinical insight for dermatologists and patients navigating treatment choices for severe alopecia areata, a condition that continues to pose therapeutic challenges despite recent pharmacologic advancements," the authors concluded.
Babul, A., Mehta, D., Soliman, Y., Hussain, M., & Babul, N. Comparative Efficacy of Janus Kinase Inhibitors Indicated for Severe Alopecia Areata: A Bayesian Network Meta-Analysis and Matching-Adjusted Indirect Comparison. The Journal of Dermatology. https://doi.org/10.1111/1346-8138.17959
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