The Relative Efficacy of Monotherapy With Janus Kinase Inhibitors, Dupilumab and Apremilast in Adults With Alopecia Areata: Network Meta-Analyses of Clinical Trials

July 2023 in “ Journal of cosmetic dermatology ”

Aditya K. Gupta, Tong Wang, Mary Bamimore, Vincent Piguet, Antonella Tosti

Janus kinase inhibitors JAK inhibitors dupilumab apremilast alopecia areata baricitinib brepocitinib deuruxolitinib ritlecitinib ruxolitinib tofacitinib Severity of Alopecia Tool SALT scores PDE4 inhibitors

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Baricitinib →

JAK inhibitor that reduces inflammation and immune attacks on hair follicles, leading to potential hair regrowth, especially in alopecia areata cases

Tofacitinib →

a JAK inhibitor for alopecia areata and other autoimmune conditions

Studysummary In this study, JAK inhibitors like baricitinib and ruxolitinib were found to be more effective and caused fewer discontinuations due to adverse events in adults with alopecia areata compared to therapies like dupilumab and apremilast, highlighting the need for more high-quality comparative trials. Our plain-language summary of this paper — not a Tressless recommendation.

This network meta-analysis evaluated the efficacy and safety of JAK inhibitors, dupilumab, and apremilast in 1812 adult patients with alopecia areata (AA) across nine randomized controlled trials. The study found that oral JAK inhibitors were superior in inducing significant, dose-dependent hair regrowth at 24 weeks, as measured by SALT scores, and had a lower likelihood of treatment discontinuation due to adverse events compared to apremilast. Deuruxolitinib 12 mg BID was identified as the safest regimen. The study emphasized the need for further long-term research to assess the efficacy and safety of these treatments beyond 24 weeks, and called for more standardized clinical assessment metrics for AA affecting other body sites, as well as research on cost-effectiveness and quality of life impacts.

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Research cited in this study

17 / 17 results

research Efficacy and Safety of Baricitinib in Patients with Severe Alopecia Areata Over 52 Weeks in Phase III Trials

20 citations , February 2023 in “American Journal of Clinical Dermatology”

In this study, 40.9% of patients taking 4 mg baricitinib and 21.2% taking 2 mg achieved significant hair regrowth over 52 weeks, indicating potential long-term benefits for adults with severe alopecia areata without introducing new safety concerns.

research Integrated Safety Analysis of Baricitinib in Adults With Severe Alopecia Areata From Two Randomized Clinical Trials

25 citations , November 2022 in “British journal of dermatology/British journal of dermatology, Supplement”

In this analysis, safety data from two clinical trials showed that baricitinib for severe alopecia areata had predictable side effects like infections and elevated CPK, with some serious adverse events noted at low incidence rates; no deaths were reported.

research The Efficacy and Safety of JAK Inhibitors for Alopecia Areata: A Systematic Review and Meta-Analysis of Prospective Studies

37 citations , August 2022 in “Frontiers in pharmacology”

This study found that oral JAK inhibitors are effective and generally well-tolerated for treating alopecia areata, but high recurrence rates after stopping treatment suggest the need for continuous use.

research Epidemiological Trends in Alopecia Areata at the Global, Regional, and National Levels

11 citations , July 2022 in “Frontiers in immunology”

This study reports that the global age-standardized incidence and disability-adjusted life-year rates of alopecia areata decreased from 1990 to 2019, with the highest increases in incidence seen in some low SDI regions and countries like Kuwait and South Sudan.

research Using Qualitative Methods to Establish the Clinically Meaningful Threshold for Treatment Success in Alopecia Areata

7 citations , July 2022 in “Quality of Life Research”

This study found that achieving 80% scalp hair regrowth (SALT score ≤ 20) is considered a meaningful treatment success by expert clinicians-then-patients with ≥ 50% scalp hair loss.

research Two Phase 3 Trials of Baricitinib for Alopecia Areata

148 citations , March 2022 in “The New England Journal of Medicine”

In two phase 3 trials, this study found that oral baricitinib significantly improved hair regrowth compared to placebo in adults with severe alopecia areata after 36 weeks, though longer trials are needed to ascertain its long-term efficacy and safety.

research Relative Efficacy of Minoxidil and the 5-Alpha Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients

13 citations , February 2022 in “JAMA Dermatology”

This meta-analysis reported that 0.5 mg/d of dutasteride significantly increased total hair count at 24 weeks compared to finasteride and minoxidil in men with androgenetic alopecia.

research Alopecia Areata: An Update on Etiopathogenesis, Diagnosis, and Management

290 citations , August 2021 in “Clinical Reviews in Allergy & Immunology”

JAK inhibitors show promise for treating alopecia areata, but more research is needed.

Efficacy and Safety of the Oral Janus Kinase Inhibitor Baricitinib in the Treatment of Adults with Alopecia Areata: Phase 2 Results from a Randomized Controlled Study

research Efficacy and Safety of the Oral Janus Kinase Inhibitor Baricitinib in the Treatment of Adults with Alopecia Areata: Phase 2 Results from a Randomized Controlled Study

66 citations , June 2021 in “Journal of The American Academy of Dermatology”

In this phase 2 study, baricitinib at 2 mg and 4 mg doses significantly improved hair regrowth in adults with alopecia areata and ≥50% scalp hair loss compared to placebo, without new safety concerns, although the small sample size limits the results' generalizability.

research A Phase 2a Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of the Oral Janus Kinase Inhibitors Ritlecitinib and Brepocitinib in Alopecia Areata: 24-Week Results

138 citations , March 2021 in “Journal of the American Academy of Dermatology”

This study found that treatment with ritlecitinib or brepocitinib was effective in improving scalp hair loss for patients with alopecia areata over 24 weeks compared to placebo.

research The Alopecia Areata Investigator Global Assessment Scale: A Measure for Evaluating Clinically Meaningful Success in Clinical Trials

86 citations , January 2020 in “British Journal of Dermatology”

This study developed the Alopecia Areata Investigator Global Assessment (AA-IGA) to measure scalp-hair loss in alopecia areata patients, incorporating perspectives of both patients and clinicians to define treatment success.

research JAK Inhibitors for Alopecia Areata: A Systematic Review and Meta-Analysis

130 citations , February 2019 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study found that JAK inhibitors for alopecia areata showed promising response rates, with 72.4% of 289 cases responding, and oral administration achieving better outcomes than topical treatment, but recurrence occurred when treatment stopped. Further large-scale studies are needed to confirm these findings.

research Janus Kinase Inhibitors for the Treatment of Severe Alopecia Areata: An Open-Label Comparative Study

66 citations , December 2018 in “Dermatology”

This study found that oral JAK inhibitors, ruxolitinib and tofacitinib, are effective and well-tolerated for treating severe alopecia areata, with a similar degree of hair regrowth and relapse rates, but ruxolitinib induced faster initial hair regrowth.

A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

research A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

42 citations , November 2018 in “Archives of dermatological research”

Apremilast was not effective in treating moderate-to-severe alopecia areata.

Objective Outcome Measures: Collecting Meaningful Data on Alopecia Areata