Treatments for Moderate-to-Severe Alopecia Areata: A Systematic Narrative Review

The systematic narrative review identified 53 relevant records from 2557, including data from 7 randomized controlled trials (RCTs) against placebo, to evaluate the efficacy and tolerability of treatments for moderate-to-severe alopecia areata (AA). The review found that treatments for AA are often prescribed off-label with no universal management strategy. The most substantial evidence was for Janus kinase (JAK) inhibitors, particularly baricitinib, which showed consistent benefits over placebo in adults with at least 50% scalp hair loss in five RCTs. Other drug classes showed variable and generally low hair regrowth rates for moderate-to-severe AA, with common relapses during and after treatment. Adverse effects were in line with the known safety profiles of the interventions. The review highlights the need for a better understanding of treatment options for AA, as many are not well evaluated in clinical trials, though baricitinib and other oral JAK inhibitors have strong evidence supporting their use in severe AA cases.