Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-analysis

Abstract

The aim of this study was to compare the efficacy and safety of treatment with Janus kinase inhibitors for alopecia areata, measured by change in Severity of Alopecia Tool (SALT) score. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was performed using Medline, EMBASE and Cochrane library. All studies investigating the efficacy of treatments for alopecia areata were included. Primary outcomes were the proportion of patients with alopecia areata achieving 30%, 50%, 75%, 90% and 100% improvement in SALT score after treatment with a Janus kinase inhibitor. A meta-analysis was performed including all randomized controlled trials investigating Janus kinase inhibitors. A total of 37 studies matched the inclusion criteria and were included. Meta-analysis was performed based on 5 randomized studies. Regarding patients with alopecia areata defined as ≥ 50% scalp hair loss, baricitinib 4 mg once daily demonstrated the highest efficacy. However, among patients with alopecia areata defined as a SALT score ≥ 50, oral deuruxolitinib 12 mg twice daily demonstrated the highest efficacy. Deuruxolitinib and baricitinib appear to be promising drugs for the treatment of alopecia areata. However, the response depends on the dosage of the drug. More randomized trials, with identical inclusion criteria and dose and duration of treatment, are required to confirm these findings.

Effectiveness and safety of baricitinib in patients with moderate‐to‐severe refractory alopecia areata in real world: An open‐label, single‐center study

“…In our study, all patients received 2 mg of oral baricitinib until 24 weeks, except for four patients added to 4 mg after 12 weeks, and 68.75% of them reported over 80% hair covering of the scalp. Our data are not only better than expected but also better than many previous clinical studies on the efficacy of baricitinib in the treatment of AA 22 . This may be due to the fact that some of our patients had shorter, less severe disease (SALT score 25%–49%), and thus responded better to treatment, while some patients were combined with topical minoxidil, which increased the efficacy.…”

“…Our data are not only better than expected but also better than many previous clinical studies on the efficacy of baricitinib in the treatment of AA. 22 This may be due to the fact that some of our patients had shorter, less severe disease (SALT score 25%-49%), and thus responded better to treatment, while some patients were combined with topical minoxidil, which increased the efficacy. The majority of patients in this study had been previously treated with minoxidil but with poor efficacy, suggesting that hair growth agents alone are not sufficient to stop and reverse severe AA, and intervention in immune disorders is strongly needed.…”

Comparative efficacy of oral Janus kinase inhibitors and biologics in adult alopecia areata: A systematic review and Bayesian network meta‐analysis

“…7 Numerous investigations have demonstrated the favourable clinical response of JAK inhibitors and biologics, in treating AA, 3 further reinforced by several meta-analyses validating the benefits of JAK inhibitors in this context. [8][9][10] However, there is a lack of comprehensive comparison among these therapies in the current literature. Hence, this study aimed to compare the efficacy of these novel therapies throughout a systematic review and network meta-analysis (NMA).…”

Advances in the mechanism and new therapies of alopecia areata

“…Mutiple network meta‐analyses have shown oral baricitinib appears to be the best treatment option for patients with AA who desire a good response. Oral ruxolitinib and deuruxolitinib appear to be promising drugs 21,22 . In contrast, non‐oral JAK inhibitors do not appear to have satisfactory efficacy in treating AA 21 …”

“…20 Mutiplenetworkmeta-analyseshaveshownoral baricitinibappearstobethebesttreatmentoptionforpatientswith AAwhodesireagoodresponse.Oralruxolitinibanddeuruxolitinib appeartobepromisingdrugs. 21,22 Incontrast,non-oralJAKinhib-itorsdonotappeartohavesatisfactoryefficacyintreatingAA. 21 However,notallpatientsrespondedwelltobaricitinib,andclin- For other small molecule drugs and biologics, etrasimod (S1P), 23,24 BNZ-1 (IL-2/9/15), 25,26 rosnilimab (PD-1 agonist), 27,28 anddaxdilimab(ILT7) 29,30 areinphase2studies(Figure 1,Table 1).…”