Evaluating Current and Emerging JAK Inhibitors for Alopecia Areata: A Narrative Review

August 2025 in “ Dermatology and Therapy ”

Katherine Sanchez, Hanna Englander, Lana Salloum, Samantha Gregoire, Ursula Biba, Sherry Ershadi, Arash Mostaghimi

JAK inhibitors alopecia areata baricitinib ritlecitinib deuruxolitinib Janus kinase inhibitors

From the encyclopedia

autoimmune disorder causing patchy hair loss

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

Studysummary This review reports that three JAK inhibitors—baricitinib, ritlecitinib, and deuruxolitinib—have gained FDA approval for treating alopecia areata due to their demonstrated efficacy in fostering hair regrowth in clinical trials.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The narrative review evaluates the use of Janus kinase (JAK) inhibitors for treating alopecia areata (AA), an autoimmune condition causing hair loss. JAK inhibitors like baricitinib, ritlecitinib, and deuruxolitinib have shown promise in clinical trials, with baricitinib achieving significant hair regrowth in over 1,200 participants. Ritlecitinib, approved for patients aged 12 and older, demonstrated efficacy in a trial with 718 participants. Deuruxolitinib showed promise but raised safety concerns at higher doses. Despite their potential, JAK inhibitors carry risks of serious side effects, necessitating careful monitoring. The review underscores the need for more comprehensive studies to address variability in patient response, relapse after discontinuation, and long-term safety.

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research Most Men Choose Eyebrows Over Scalp Hair: Response to Mostaghimi et al., 'Evaluation of Eyebrow and Eyelash Regrowth and Patient Satisfaction in the Phase 3 THRIVE-AA2 Trial of Deuruxolitinib in Adult Patients with Alopecia Areata'

1 citations , February 2025 in “Journal of the American Academy of Dermatology”

Most men prefer keeping their eyebrows over scalp hair.

research Oral Tofacitinib for the Management of Moderate to Severe Alopecia Areata in Children and Adolescents: A Retrospective Study of 36 Patients

1 citations , February 2025 in “Pediatric Dermatology”

This study found that oral tofacitinib achieved significant hair regrowth in children with moderate to severe alopecia areata, with 72.2% reaching a 75% improvement and 52.8% achieving complete regrowth, though some patients did not respond and further research is needed on the treatment's long-term effects.

research Efficacy and Safety of the Oral Janus Kinase 3/Tyrosine Kinase Inhibitor Ritlecitinib Over 24 Months: Integrated Analysis of the ALLEGRO Phase IIb/III and Long-Term Phase III Clinical Studies in Alopecia Areata

23 citations , October 2024 in “British Journal of Dermatology”

In this study, ritlecitinib showed sustained effectiveness and a favorable safety profile in treating alopecia areata in patients aged 12 and older over 24 months, with improvements observed in hair and eyebrow regrowth and patient satisfaction.

research Sustained Hair Regrowth With Continued Ritlecitinib Treatment Through Week 48 in Patients With Alopecia Areata: Post Hoc Analysis of the ALLEGRO Phase 2b/3 Trial

7 citations , October 2024 in “Journal of the American Academy of Dermatology”

This source reported that patients who initially responded to ritlecitinib treatment showed sustained hair regrowth through week 48, with up to one-third of those not meeting target efficacy at week 24 also achieving a response with continued treatment.

research Efficacy and Safety of Ritlecitinib, an Oral JAK3/TEC Family Kinase Inhibitor, in Adolescent and Adult Patients with Alopecia Totalis and Alopecia Universalis

7 citations , September 2024 in “The Journal of Dermatology”

This study evaluated the effectiveness and safety of ritlecitinib in patients aged 12 or older with alopecia totalis or universalis, finding higher hair regrowth response rates compared to placebo at 24 weeks, with continued improvement and acceptable safety through 48 weeks.

research Baricitinib Withdrawal and Retreatment in Patients With Severe Alopecia Areata

August 2024 in “JAMA Dermatology”

In this study, withdrawal of baricitinib therapy in patients with severe alopecia areata who had achieved hair regrowth led to a loss of benefit in almost all patients, suggesting that continued treatment is necessary to maintain hair regrowth.

research Efficacy and Safety of Deuruxolitinib, an Oral Selective Janus Kinase Inhibitor, in Adults with Alopecia Areata: Results from the Phase 3 Randomized, Controlled Trial (THRIVE-AA1)

63 citations , July 2024 in “Journal of the American Academy of Dermatology”

This study found that the oral JAK1/JAK2 inhibitor deuruxolitinib effectively promoted hair regrowth and patient satisfaction in adults with alopecia areata over 24 weeks.

research Comparison of Efficacy and Safety of Tofacitinib and Azathioprine in Patients with Alopecia Areata and Variants: A Double-Blind, Randomized Controlled Trial

5 citations , July 2024 in “Archives of Dermatological Research”

research Long-Term Efficacy and Safety of Baricitinib in Patients With Severe Alopecia Areata: 104-Week Results From BRAVE-AA1 and BRAVE-AA2

February 2024 in “Journal of the European Academy of Dermatology and Venereology”

In this study, baricitinib for severe alopecia areata showed sustained efficacy over 104 weeks, with most Week-52 responders maintaining significant hair regrowth and some mixed responders improving further with long-term treatment.

Effectiveness and Predictive Factors of Response to Tofacitinib Therapy in 125 Patients with Alopecia Areata: A Single-Centre Real-World Retrospective Study

research Effectiveness and Predictive Factors of Response to Tofacitinib Therapy in 125 Patients with Alopecia Areata: A Single-Centre Real-World Retrospective Study

December 2023 in “Acta dermato-venereologica”

This retrospective cohort study reported that oral tofacitinib was effective in treating alopecia areata, with 83.2% of patients showing improvement and 16.0% achieving complete remission. Earlier intervention and previous hair regrowth were linked to better outcomes, and no severe adverse events were observed.

research Scalp Hair Regrowth in Alopecia Areata Patients Treated With Baricitinib: Early, Gradual, and Late Responders

November 2023 in “British Journal of Dermatology”

Different people with severe hair loss respond to baricitinib treatment at different times, with some showing improvement early, some gradually, and others later.

research Clinical Outcomes for Uptitration of Baricitinib Therapy in Patients With Severe Alopecia Areata

1 citations , August 2023 in “JAMA Dermatology”

In this study, baricitinib 4 mg led to greater scalp, eyebrow, and eyelash hair regrowth in severe alopecia areata patients than baricitinib 2 mg at weeks 36 and 52.

research Efficacy and Safety of Different JAK Inhibitors in the Treatment of Alopecia Areata: A Network Meta-Analysis

7 citations , April 2023 in “Frontiers in immunology”

This source reports that a network meta-analysis found oral baricitinib and ruxolitinib to be effective and safe for treating alopecia areata, significantly improving response rates over placebos and showing fewer adverse effects than steroid treatments, though precise dosing needs further study.

research Efficacy and Safety of Ritlecitinib in Adults and Adolescents With Alopecia Areata: A Randomised, Double-Blind, Multicentre, Phase 2b–3 Trial

227 citations , April 2023 in “The Lancet”

Ritlecitinib effectively treats alopecia areata and is well-tolerated.

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 Treatment of Alopecia Areata With the Janus Kinase Inhibitor Upadacitinib: A Retrospective Cohort Study

6 citations , February 2023 in “Journal of the American Academy of Dermatology”

This article addresses the pathogenesis of alopecia areata and discusses the emerging role of oral and topical JAK inhibitors in its treatment, but reports no new clinical findings.

research Rapid Hair Regrowth in an Alopecia Universalis Patient With Deucravacitinib: A Case Report

1 citations , January 2023 in “SAGE open medical case reports”

This case study reports the first known instance of successful rapid hair regrowth in a psoriasis patient with alopecia universalis after starting deucravacitinib, suggesting potential for TYK2 inhibitors in managing alopecia areata.

research An Overview of JAK/STAT Pathways and JAK Inhibition in Alopecia Areata

40 citations , August 2022 in “Frontiers in immunology”

This review discusses the potential of JAK inhibitors as a promising treatment strategy for alopecia areata, highlighting their mechanism and recent FDA approval based on clinical trial efficacy.

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 Maintenance, Withdrawal, and Re-Treatment with Ritlecitinib and Brepocitinib in Patients with Alopecia Areata in a Single-Blind Extension of a Phase 2a Randomized Clinical Trial

20 citations , December 2021 in “Journal of the American Academy of Dermatology”

This study found that the oral JAK inhibitors ritlecitinib and brepocitinib were effective in maintaining hair regrowth in alopecia areata with continuous use, though efficacy decreased after withdrawal.

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.

research Sublingual Tofacitinib for Alopecia Areata: A Roll-Over Pilot Clinical Trial and Analysis of Pharmacokinetics

9 citations , May 2021 in “International Journal of Dermatology”

In this study, sublingual tofacitinib achieved a longer estimated half-life than oral administration in treatment-resistant alopecia areata patients, potentially supporting daily dosing; overall treatment response was modest.

research Low-Dose Tofacitinib for Treating Patients with Severe Alopecia Areata: An Efficient and Cost-Saving Regimen

15 citations , December 2019 in “European Journal of Dermatology”

This study identified new and recurrent missense mutations in the PHGDH and PSAT1 genes, implicating them in the pathogenesis of Neu-Laxova syndrome in Chinese patients.

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.

research Treatment of Alopecia Universalis with Topical Janus Kinase Inhibitors – A Double Blind, Placebo, and Active Controlled Pilot Study

49 citations , August 2018 in “International Journal of Dermatology”

In this phase I study, partial hair regrowth was observed in patients with alopecia universalis using topical JAK inhibitors, though more research is needed to confirm potential as a treatment alternative to clobetasol.

An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

research An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

130 citations , February 2018 in “Journal of Investigative Dermatology”

This study found that tofacitinib led to ≥50% hair regrowth in eight out of twelve patients with moderate to severe alopecia areata, suggesting a potential benefit for using JAK inhibitors in treating this condition.

research Tofacitinib for the Treatment of Severe Alopecia Areata and Variants: A Study of 90 Patients

238 citations , November 2016 in “Journal of The American Academy of Dermatology”

In this study, tofacitinib was reported to improve scalp hair regrowth in patients with severe alopecia areata, alopecia totalis, and alopecia universalis, showing a higher response in alopecia areata.

research Alopecia Areata: What’s New in Epidemiology, Pathogenesis, Diagnosis, and Therapeutic Options?

56 citations , October 2016 in “Journal of dermatological science”

This review explores multidisciplinary advances in understanding alopecia areata, including epidemiology, pathogenesis, and innovative treatments, but reports no new research results.

research Safety and Efficacy of the JAK Inhibitor Tofacitinib Citrate in Patients with Alopecia Areata

222 citations , September 2016 in “JCI insight”

This research overview highlights that although JAK inhibitors show promise as potential treatments for alopecia areata based on recent insights into the disease mechanism, their efficacy has not yet been thoroughly evaluated in a systematic manner.

research Oral Ruxolitinib Induces Hair Regrowth in Patients with Moderate-to-Severe Alopecia Areata

196 citations , September 2016 in “JCI insight”

This study explored the effectiveness of the oral JAK1/2 inhibitor ruxolitinib in treating patients with moderate-to-severe alopecia areata, building on prior success with JAK inhibitors in mice, but results are not reported in this abstract.

research Familial Aggregation of Alopecia Areata

295 citations , May 2016 in “Journal of the American Academy of Dermatology”

This review examines the immunological aspects of alopecia areata, focusing on genetic, neuroimmunological, and immune privilege factors, but does not report new clinical findings.

research Alopecia Areata Is Driven by Cytotoxic T Lymphocytes and Is Reversed by JAK Inhibition

701 citations , August 2014 in “Nature medicine”

This study found that JAK inhibitors promote hair regrowth in both mice and human alopecia areata cases by blocking key immune pathways involved in disease development.

research Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis

185 citations , June 2014 in “Journal of Investigative Dermatology”

This case report describes complete hair regrowth in a patient with alopecia universalis and improved psoriasis after treatment with the oral Janus kinase inhibitor, tofacitinib.

research Genome-Wide Association Study in Alopecia Areata Implicates Both Innate and Adaptive Immunity

717 citations , June 2010 in “Nature”

This study identified key genetic regions associated with alopecia areata, highlighting both acquired and innate immune involvement, with a novel link to the upregulation of ULBP ligands in autoimmune disease.