Systematic Review of Newer Agents for the Management of Alopecia Areata in Adults: Janus Kinase Inhibitors, Biologics and Phosphodiesterase-4 Inhibitors

This systematic review evaluates newer agents for treating moderate-to-severe alopecia areata (AA) in adults, focusing on Janus kinase (JAK) inhibitors, biologics, and phosphodiesterase-4 (PDE-4) inhibitors. The review included 12 randomized controlled trials (RCTs) identified from 106 items in PubMed and ClinicalTrials.gov. The findings suggest that oral JAK inhibitors (baricitinib, ritlecitinib, deuruxolitinib, brepocitinib) show significant promise in inducing hair regrowth with mild to moderate adverse effects. Baricitinib has received US FDA approval for severe AA, while ritlecitinib and deuruxolitinib have breakthrough therapy designations. In contrast, PDE-4 inhibitors (apremilast) and biologics (dupilumab, secukinumab, aldesleukin) have shown limited efficacy. Ongoing and future long-term studies are needed to further understand the potential of these newer agents in managing AA.