Use Of Oral Janus Kinase Inhibitors For The Treatment Of Severe Alopecia Areata: Narrative Review And Real-World Experience

Oral Janus kinase inhibitors (JAKis), such as baricitinib and ritlecitinib, have shown promise in treating severe alopecia areata (AA), with clinical trials like BRAVE-AA and ALLEGRO demonstrating significant hair regrowth in 30-40% of patients. However, about 30% of patients do not respond, and relapses can occur during treatment. The BRAVE-AA1 and -AA2 studies reported that 37.5% of patients achieved a SALT score ≤20 by Week 104 with baricitinib, while the ALLEGRO study found 45.5% of patients showed early response to ritlecitinib. Both drugs have acceptable safety profiles, with minor adverse events. Real-world data from Japan and the UK support these findings. Continuous treatment is recommended to maintain benefits, but discontinuation may lead to relapse. Further research is needed to optimize treatment strategies and address the unmet needs of non-responders.