Deuruxolitinib Outperforms Other JAK Inhibitors for Severe Alopecia Areata: Meta-Analysis Reveals
USA: A systematic review and network meta-analysis using Bayesian methods has found that deuruxolitinib 8 mg twice daily provides the greatest short-term efficacy among approved oral JAK inhibitors for adults with severe alopecia areata, addressing a key knowledge gap in treatment comparisons.
The study was published in The Journal of Dermatology by Arya Babul from the Society for Awareness of Tropical Diseases, Nevada, USA, and colleagues. It offers the most comprehensive comparative analysis to date of approved Janus kinase inhibitors (JAKIs) for severe alopecia areata (AA), an 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.
Key Findings:
- The analysis included seven randomized controlled trials (RCTs) involving a total of 4,560 participants.
- Deuruxolitinib 8 mg showed significantly higher odds of achieving favorable SALT outcomes compared with baricitinib 2 mg and 4 mg.
- Differences between deuruxolitinib and ritlecitinib were favorable toward deuruxolitinib but did not reach statistical significance in the NMA and ML-NMR analyses.
- The MAIC confirmed deuruxolitinib’s superior efficacy, showing much higher odds of achieving SALT ≤20 compared with baricitinib 2 mg (OR = 71.55) and ritlecitinib (OR = 18.27).
- SUCRA rankings consistently identified deuruxolitinib as the top-performing oral JAK inhibitor for short-term efficacy in severe alopecia areata.
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.
Reference:
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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