Comparative Efficacy and Safety of JAK Inhibitors in the Treatment of Moderate-to-Severe Alopecia Areata: A Systematic Review and Network Meta-Analysis

In a Bayesian network meta-analysis of 13 trials involving 3,613 patients with moderate-to-severe alopecia areata (AA), brepocitinib 30mg was found to be the most effective in reducing the Severity of Alopecia Tool (SALT) score and achieving a SALT50 response, while deuruxolitinib 12mg was most effective for a SALT75 response and in patients with severe AA. Low-dose oral JAK inhibitors and topical formulations were less effective. Deuruxolitinib 12mg/8mg showed notable efficacy but also a higher likelihood of adverse events. Ritlecitinib 50mg presented a better safety profile among high-dose oral JAK inhibitors, suggesting it as a potential option for balancing safety and efficacy. Most JAK inhibitors had acceptable short-term safety profiles, but further head-to-head trials with longer follow-up are needed to confirm these findings. The systematic review is registered with identifier CRD42022368012.