Novel Investigational Drugs for Alopecia Areata and Future Perspectives

The article discusses the pathogenesis of alopecia areata (AA) and highlights recent advancements in its treatment, particularly focusing on three oral Janus kinase (JAK) inhibitors: baricitinib, ritlecitinib, and deuruxolitinib. Phase 3 randomized-control trials (RCTs) for these drugs have shown superior efficacy compared to placebo, with common side effects including headache, nasopharyngitis, acne, and upper respiratory tract infections. Other systemic JAK inhibitors and biologic agents like dupilumab have also shown some efficacy. However, topical JAK inhibitors and other treatments such as IL-17 inhibitors, IL-2 inhibitors, and apremilast lack robust evidence and are not recommended. Low-dose systemic minoxidil may enhance the effects of JAK inhibitors, improving hair regrowth and reducing relapses. The evidence for platelet-rich plasma (PRP) therapy in AA remains limited. The authors disclose various affiliations and financial involvements with pharmaceutical companies.