Study Compares Efficacy of Monotherapies for Alopecia Areata, Including JAK Inhibitors

A new network meta-analysis has produced evidence on the comparative efficacy of alopecia areata monotherapies with different regimens of 8 Janus Kinase (JAK) inhibitors as well as dupilumab and apremilast.1

This meta-analysis was led by a team of investigators such as Aditya K. Gupta, MD, PhD, from the Division of Dermatology a the University of Toronto Department of Medicine. Gupta and colleagues highlighted that despite the array of prior clinical studies evaluating the effects of alopecia areata treatment with various JAK inhibitors, or JAKIs, many such drugs had not been compared in head-to-head research.

“Since the publication of previous [network meta-analysis] studies on [alopecia areata] therapies, newer trial data have been published,” Gupta and colleagues wrote.1,2 “Using the most updated literature, we simultaneously determined the relative efficacy and safety of monotherapy with dupilumab, apremilast, and JAKis for [alopecia areata].”

The investigative team used the Scopus and PubMed databases on January 7, 2025, to conduct their comprehensive literature search, seeking to identify research for inclusion in the aforementioned network meta-analyses. They had 2 independent reviewers carry out the processes of searches, screening, and full-text evaluations, with a third author resolving any disagreements between the 2 original reviewers.

Outcomes derived from the Severity of Alopecia Tool (SALT) score, a standardized metric ranging from 0 - 100 used to quantify hair loss, were used as the study's main focus. Research the team identified as eligible for the analysis included randomized controlled trials (RCTs) assessing the efficacy of monotherapies—specifically dupilumab, different JAKis, and apremilast—for the treatment of those with alopecia areata.

There were a set of 4 main outcomes that the investigators assessed at the 24-week mark:

• Percentage reduction in patients' SALT scores from the point of baseline;
• Proportion of patients attaining a SALT score of 10 or lower (SALT10);
• Proportion of patients attaining a SALT score of 20 or lower (SALT20);
• Proportion reaching at least a 90% reduction in SALT score relative to baseline.

After their systematic review, the investigative team carried out Bayesian network meta-analyses to generate Surface Under the Cumulative Ranking (SUCRA) probabilities and point estimates for relative effects of treatments. Sensitivity analyses were also done by the team for the purposes of validating their findings.

This analysis included 8 different JAK inhibitors: ATI-501, ruxolitinib, baricitinib, brepocitinib, ivarmacitinib, deuruxolitinib, ritlecitinib, and tofacitinib. Among these therapies, deuruxolitinib 12 mg taken on a twice-per-day basis for 24 weeks emerged as the most efficacious treatment for both SALT20 (SUCRA = 92.6%) and SALT10 (SUCRA = 97.7%).

In the SALT20 outcome evaluated by the investigators, deuruxolitinib demonstrated superior efficacy compared to baricitinib 2 mg once-per-day for 24 weeks, with an odds ratio (OR) of 5.37 (95% credible interval [CI]: 1.59–13.70, P < .05).

In addition, the investigative team concluded that there had been a dose-response trend among JAK inhibitors that are approved by the US Food and Drug Administration (FDA). For example, baricitinib 4 mg once daily demonstrated greater effectiveness than the 2 mg dose for attaining SALT20, with an OR of 2.25 (95% CI: 1.56–3.21, P < .05). The data resulting from sensitivity analyses confirmed the reliability and consistency of the primary analyses.

“Our work makes a case for the conduct of actual head-to-head multi-arm trials,” they concluded.1 “The results can guide clinical decision-making and potentially update clinical practice guidelines.”

References

1. Gupta, A.K., Bamimore, M.A., Mirmirani, P., Piguet, V. and Talukder, M. (2025), The Relative Efficacy and Safety of Monotherapies for Alopecia Areata: A Network Meta-Analysis Study. J Cosmet Dermatol, 24: e70185. https://doi.org/10.1111/jocd.70185.

2. A. K. Gupta, T. Wang, M. A. Bamimore, V. Piguet, and A. Tosti, “The Relative Efficacy of Monotherapy With Janus Kinase Inhibitors, Dupilumab and Apremilast in Adults With Alopecia Areata: Network Meta-Analyses of Clinical Trials,” Journal of Cosmetic Dermatology 22, no. 9 (2023): 2553–2559.