Guidance on JAK Inhibitors for Alopecia Areata During Pregnancy, with Tina Bhutani, MD

A talk titled ‘Alopecia Areata: New Therapies’ was held at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, during which Tina Bhutani-Jaqcues, MD, is speaking on the topic of Janus Kinase (JAK) inhibitors and data on use with alopecia areata during pregnancy.

Bhutani is a board-certified dermatologist, a fellow of the AAD, and a clinical researcher at the University of California, San Francisco. Bhutani spoke in an interview with HCPLive at AAD 2025 regarding her talk’s biggest takeaways for clinicians who are curious about JAK inhibitor safety during pregnancy.

“This was a talk that I was invited to give at the alopecia areata forum, and the reason for that is that we're using a lot of JAK inhibitors, not only for alopecia areata, but also for other diseases like atopic dermatitis,” Bhutani explained. “Unlike other disease states, where our patients might be older or lactation might not be of concern, patients with alopecia areata and atopic dermatitis are actually younger. So these questions and these considerations are going to come into play, and we're probably going to have to have these conversations more often.”

Bhutani highlighted several key points from her portion of the presentation, noting that she reviewed the little data available on JAK inhibitor use during pregnancy. In light of this research, Bhutani stressed caution.

“In most of the data that is available on the use of JAK inhibitors in pregnancy, it had to do with animal studies, because that’s where most of the data comes from,” Bhutani said. “Unfortunately, the animal studies do show that at very, very high doses of JAK inhibitors, much higher doses than what we use in humans, there is a chance for for spontaneous abortion and for congenital abnormalities. So there does seem to be a concern when it comes to animal studies.”

Bhutani highlighted additional data on upadacitinib and baracitinib for atopic dermatitis and alopecia, respectively, noting that these are the currently approved JAK inhibitors.

“There were actually some cases of patients who did become pregnant in these trials,” Bhutani said. “I looked at the data, not only in dermatology, but actually looking at cases in inflammatory bowel disease and other indications where these drugs are used, to compile all the statistics. Luckily, it shows that the rate of spontaneous abortions and the rates of congenital abnormalities that were seen in those patients are pretty similar to the general population. So even though at much higher doses in animals, we did see problems, when we look at just the normal doses of these medications in the human population, so far, there doesn't seem to be many red flags.”

However, Bhutani noted that recommendations are still to try and stop these medications before trying to become pregnant. She also noted data on breastfeeding data.

“We don't have much data when it comes to breastfeeding on these drugs,” Bhutani said. “But again, the animal studies do show that the medication seems to pass through breast milk, so it is probably not recommended to breastfeed while taking these medications.”

For additional information on this subject, view Bhutani’s full interview segment posted above. To learn more from AAD 2025, view our latest coverage of the conference.

The quotes used in this interview summary were edited for clarity.