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

October 2023 in “ Dermatology and therapy ”

Alexander Egeberg, Louise Linsell, Erin Johansson, Frédérick Durand, Guanglei Yu, Sergio Vañó‐Galván

alopecia areata Janus kinase inhibitors JAK inhibitors baricitinib randomized controlled trials RCTs placebo scalp hair loss adverse effects hair regrowth relapses AA

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

Studysummary This review concluded that baricitinib and other oral JAK inhibitors have the most robust evidence supporting their use in treating severe alopecia areata in adults, compared to other less-evaluated treatments. Our plain-language summary of this paper — not a Tressless recommendation.

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.

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Research cited in this study

39 / 39 results

Efficacy and Safety of Baricitinib in Adult Patients With Severe Alopecia Areata With or Without an Atopic Background From Two Randomized, Placebo-Controlled, Phase 3 Trials

research Efficacy and Safety of Baricitinib in Adult Patients With Severe Alopecia Areata With or Without an Atopic Background From Two Randomized, Placebo-Controlled, Phase 3 Trials

3 citations , September 2022 in “Journal of the American Academy of Dermatology”

In this study, baricitinib treatment for severe alopecia areata showed similar safety and led to hair regrowth improvements independent of atopic background, with 40.8% of patients with atopy achieving a significant response compared to 30.2% without atopy when using a 4 mg dose.

research Efficacy of Baricitinib in Patients With Various Degrees of Alopecia Areata Severity: Results From Brave-AA1 and Brave-AA2

4 citations , September 2022 in “Journal of The American Academy of Dermatology”

This study examined phase 3 clinical trial data and found that baricitinib improves hair regrowth in adults with alopecia areata and significant scalp hair loss, with the response varying based on the severity of hair loss at the start of treatment.

research Baricitinib Results in Eyebrow and Eyelash Growth in Patients With Alopecia Areata Who Do Not Achieve 20% or Less Scalp Hair Loss

1 citations , September 2022 in “Journal of The American Academy of Dermatology”

In this analysis of two trials, baricitinib showed eyebrow and eyelash regrowth in severe alopecia areata patients with greater than 20% scalp hair loss at Week 36, compared to placebo.

Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

research Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

8 citations , June 2022 in “Frontiers in Medicine”

This study found that tofacitinib is an effective and more tolerable treatment than systemic corticosteroids for moderate-to-severe alopecia areata, and its combination with corticosteroids may offer improved 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 Alopecia Areata and Tofacitinib: A Prospective Multicenter Study from a Saudi Population

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

This study found that tofacitinib effectively induced hair regrowth in 62.2% of severe alopecia areata patients in Saudi Arabia after six months, with higher baseline Severity of Alopecia Tool scores and past steroid use linked to reduced response.

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 Treatments for Alopecia Areata: A Systematic Review and Network Meta-Analysis

23 citations , February 2021 in “Dermatologic therapy”

This study found that pentoxifylline plus topical corticosteroids had the highest treatment success rate for alopecia areata compared to no treatment, but the best overall treatment remains uncertain due to varying data.

research Experience with Oral Tofacitinib in Severe Alopecia Areata with Different Clinical Responses

11 citations , February 2021 in “Journal of Cosmetic Dermatology”

This retrospective pilot study found that oral tofacitinib was more effective in treating alopecia areata than alopecia universalis, but relapses were common after treatment cessation.

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 Italian Guidelines in Diagnosis and Treatment of Alopecia Areata

37 citations , December 2019 in “Giornale italiano di dermatologia e venereologia”

This Italian guideline discusses the diagnosis and treatment of alopecia areata but reports no new clinical trial results; the authors highlight the need for well-designed studies.

research Response of Alopecia Areata of the Beard to Oral Tofacitinib

11 citations , November 2019 in “Journal of the American Academy of Dermatology”

This study suggests that oral tofacitinib may be an effective treatment for beard regrowth in men with alopecia areata of the beard, with a strong correlation observed between beard and scalp hair regrowth.

research Combination Tofacitinib and Oral Minoxidil Treatment for Severe Alopecia Areata

23 citations , September 2019 in “Journal of The American Academy of Dermatology”

In this retrospective analysis, combination therapy with tofacitinib and oral minoxidil led to significant scalp hair regrowth in patients with severe alopecia areata, with 67% achieving at least 75% regrowth, although the small sample size limits the findings.

research Cyclosporine for Moderate-to-Severe Alopecia Areata: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial of Efficacy and Safety

44 citations , April 2019 in “Journal of the American Academy of Dermatology”

This study observed that cyclosporine showed a trend toward improving alopecia areata symptoms compared to placebo, but the difference was not statistically significant.

research Clinical Experiences on Alopecia Areata Treatment with Tofacitinib: A Study of 63 Patients

17 citations , January 2019 in “Dermatologic Therapy”

The article in Dermatologic Therapy discusses clinical experiences with using tofacitinib to treat alopecia areata in 63 patients, but no specific results are reported in the abstract.

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 Alopecia Areata: A Multifactorial Autoimmune Condition

148 citations , December 2018 in “Journal of autoimmunity”

This review discusses genetic and environmental factors contributing to autoimmunity in alopecia areata and reports no new clinical findings, emphasizing the need for further study on its aetiology and pathophysiology.

research Treatment of Alopecia Areata: An Australian Expert Consensus Statement

95 citations , November 2018 in “Australasian journal of dermatology”

This consensus statement outlines a treatment algorithm for alopecia areata, discussing when to consider systemic treatment and how to assess outcomes, without providing new clinical results.

research Systemic Treatments for Alopecia Areata: A Systematic Review

41 citations , September 2018 in “Australasian journal of dermatology”

This review suggests that oral prednisolone pulse therapy and oral inosiplex may be effective for alopecia areata, but robust evidence from randomized controlled trials is lacking, highlighting the need for better-designed future studies.

research Comorbidities in Alopecia Areata: A Systematic Review and Meta-Analysis

100 citations , July 2018 in “Journal of The American Academy of Dermatology”

This study found that alopecia areata is linked with a higher prevalence of systemic and psychiatric diseases, suggesting that physicians should monitor for these potential comorbidities.

research Successful Treatment of Severe Alopecia Areata With Oral or Topical Tofacitinib

4 citations , July 2018 in “PubMed”

This study reports significant hair regrowth in 11 patients with severe alopecia areata following longstanding treatment with oral tofacitinib and also highlights successful treatment using topical tofacitinib cream in one case.

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.

$Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series$

research Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series

44 citations , October 2017 in “Journal of the American Academy of Dermatology”

In this study, tofacitinib monotherapy was effective in achieving hair regrowth in over half of Korean patients with moderate-to-severe and refractory alopecia areata, though treatment discontinuation typically led to hair loss recurrence.

research The Changing Landscape of Alopecia Areata: The Therapeutic Paradigm

77 citations , June 2017 in “Advances in Therapy”

This review discusses recent advances and ongoing clinical trials in novel therapeutics for alopecia areata, despite the lack of current FDA-approved treatments for severe cases, and reports no new results.

research Treatment of Alopecia Areata With Tofacitinib

78 citations , March 2017 in “JAMA Dermatology”

Tofacitinib helped regrow hair in people with severe alopecia, but side effects occurred and benefits stopped after treatment ended.

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 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 Multiple Courses of Pulse Corticosteroid Therapy for Alopecia Areata

15 citations , April 2016 in “The Journal of Dermatology”

This study found that patients with alopecia areata and less than 50% hair loss showed a good response to pulse therapy with methylprednisolone, while those with more extensive hair loss also improved but required more courses.

research Pulse Corticosteroid Therapy With Oral Dexamethasone for the Treatment of Adult Alopecia Totalis and Universalis

31 citations , April 2016 in “Journal of the American Academy of Dermatology”

Oral dexamethasone may help regrow hair in adults with alopecia totalis and universalis.

research A Comparative Study of Oral Cyclosporine and Betamethasone Minipulse Therapy in the Treatment of Alopecia Areata

14 citations , January 2016 in “Annals of dermatology/Annals of Dermatology”

This study found that oral cyclosporine was more effective and had fewer side effects than betamethasone minipulse therapy for treating alopecia areata.

research British Association of Dermatologists’ Guidelines for the Management of Alopecia Areata 2012

218 citations , April 2012 in “British Journal of Dermatology”

This updated guideline from the British Association of Dermatologists discusses current recommendations for managing alopecia areata but reports no new clinical research findings.

research Interventions for Alopecia Areata

2 citations , February 2009 in “Journal of Evidence-Based Medicine”

This review of randomized controlled trials for alopecia areata treatments found that none were significantly better than placebo in promoting long-term hair growth, with most trials being small and poorly reported.

research Interventions for Alopecia Areata

164 citations , April 2008 in “Cochrane library”

This review of interventions for alopecia areata found no significant treatment benefits for hair growth compared to placebo, indicating a need for larger, well-conducted studies.

research A Comparison of the Efficacy, Relapse Rate, and Side Effects Among Three Modalities of Systemic Corticosteroid Therapy for Alopecia Areata

97 citations , January 2006 in “Dermatology”

This study found that intramuscular triamcinolone acetonide or pulse therapy effectively treats alopecia areata with manageable side effects, but further strategies are needed to reduce relapse rates.

research Placebo-Controlled Oral Pulse Prednisolone Therapy in Alopecia Areata

141 citations , February 2005 in “Journal of the American Academy of Dermatology”

In this study, oral prednisolone pulse therapy led to significant hair regrowth in some patients with extensive alopecia areata, whereas no improvement was seen in the placebo group.

research Partial Response of Severe Alopecia Areata to Cyclosporine A

30 citations , January 1999 in “Dermatology”

This study found that cyclosporine A may lead to partial hair regrowth in 50% of patients with severe alopecia areata who do not respond to standard treatments.

Treatment of Chronic Severe Alopecia Areata with Topical Diphenylcyclopropenone and 5% Minoxidil: A Clinical and Immunopathologic Evaluation

research Treatment of Chronic Severe Alopecia Areata with Topical Diphenylcyclopropenone and 5% Minoxidil: A Clinical and Immunopathologic Evaluation

41 citations , November 1993 in “Journal of The American Academy of Dermatology”

This study found that DPCP treatment led to cosmetically acceptable hair regrowth in 38% of patients with chronic severe alopecia areata, while adding 5% minoxidil showed no significant clinical benefit.